The importance of NEHR integration
Last updated on: 30 Sept 2022
What is National Electronic Health Records (NEHR)
NEHR is a national consolidated view of health records. Jointly contributed by healthcare professionals, patient data in NEHR can help to provide a continuous view of a patient’s health for better diagnostics and treatments.
The National Electronic Health Record (NEHR) was deployed rapidly in both private and public healthcare institutions across Singapore in 2011 to realise the Ministry of Health’s vision for ‘One Patient, One Health Record’. As of January 2021, there are 1,632 participating healthcare institutions in the NEHR. NEHR is operated by Integrated Health Information Systems (IHIS) which is a subsidiary of The Ministry of Health Holdings (MOHH). The NEHR has 4 main aims:
Connecting healthcare professionals to deliver patient-centered care
Achieving better health outcomes
Raising patient safety
Enhancing the patient experience with seamless care
NEHR – One patient, One health record
Improved Coordination & Care
Improved Patient Safety. Better Health Outcomes
Increased Efficiencies
The NEHR ‘C.A.R.E’
Collectively, these 4 aims, dubbed as ‘CARE’, have transformed the patient journey from a fragmented one to a seamless and comprehensive one. Indeed, the NEHR receives and collates data from multiple healthcare providers at various levels (i.e., primary care, specialist care, allied health care, etc.) and displays them to healthcare providers in a systematic and user-friendly manner. The NEHR consists of the following healthcare-related information:
Admissions and Visit History
Hospital Inpatient Discharge Summaries
Laboratory Results
Radiology Results
Medication History
History of Past Procedures/Surgeries
Allergies and Adverse Drug Reactions
Immunization History
During the COVID-19 pandemic, NEHR was enhanced in 2021 to include COVID-19 SWAB tests and vaccination information. Healthcare personals can access NEHR for a patient’s COVID-19 test results and existing medical conditions before vaccination.
Centralized Healthcare Data
Electronic health records (EHRs) and clinic management systems (CMS) consolidate patients’ health history and information to improve coordination of care and enhance patient safety.
NEHR bridges protected health information (PHI) from patients who are managed by institutions from different healthcare groups and provides physicians with a longitudinal view of the patients’ medical history. This enables them to make better informed clinical decisions and improve patient care.
Access to NEHR
For confidentiality and privacy reasons, access to NEHR is only granted to healthcare professionals involved in direct patient care, such as doctors. Every single access is logged and tracked for strict confidentiality and privacy protection.
Any unauthorised access or modification to NEHR data is a chargeable offense under the Computer Misuse Act.
In Singapore, all registered physicians are allowed to access, review, and even upload patient data. All patients in Singapore (citizens and non-citizens alike) who have been managed by an authorised healthcare professional from a NEHR-contributing institution/clinic will have a record in NEHR. In 2018, the Healthcare Services Bill was introduced and mandated all healthcare providers to contribute patient data to the NEHR.
Patients’ NEHR records are confidential, and can only be accessed for the purposes of patient care. NEHR records must not be accessed for other purposes such as insurance or employment.
MOH has implemented safeguards to ensure that NEHR data is not inappropriately accessed; access logs to patients are routinely checked, and regular audits are instituted to prevent illegitimate access. Unauthorised access to NEHR results in significant penalties which are imposed by MOH.
Patients who do not wish to participate in NEHR can opt-out of the service. Physicians should explain the implications and process to patients in detail:
During emergency situations, healthcare providers will not be able to access past healthcare information
Patients who opt out will continue to have their information transmitted to NEHR, but access to this data will be blocked to all healthcare providers
Past information can be unlocked if patients wish to opt back into NEHR at a later time
NEHR security measures
Security was one of the major concerns when doctors submit their patient’s data onto NEHR. Dr. Puthucheary, Senior Minister of State of Singapore, said that ‘Data security remains a key priority for NEHR.
The NEHR is built with stringent access control features and multi-layered security defences to provide resilient, all-rounded cybersecurity measures. These security measures are subjected to regular independent audits, including security penetration tests.
IHiS also works closely with CSA and other government agencies to regularly review and enhance these security measures. These measures are constantly evolved and enhanced.
In order to be vigilant against potential cyber-attacks, clinics are advised to practice good cybersecurity measures.
It is recommended for clinics to:
Use complex passwords
Two-factor authentication (2FA)
Update security software regularly
Engage with a trustable and reliable clinic system
How to prepare for NEHR contribution
In order to contribute data to NEHR, you’ll need a clinic software that’s NEHR ready and licensed by NEHR. (eg. UNO Clinic Management System)
You will also need to master the clinic system functionality and workflows to effectively and efficiently contribute records.
If your existing clinic system is not NEHR-ready, you will not be able to contribute to NEHR. You might want to consider switching vendors.
NEHR ready clinic
Since contribution to NEHR is done through a NEHR ready clinic system, clinics using a NEHR system are automatically NEHR ready.
As for clinics currently not using any clinic system or the system is not NEHR ready, you will have to switch vendors.
NEHR contribution
Data Contribution to NEHR only focuses on patient’s health record summary. No other information required.
Patient data are transmitted from the healthcare professional’s electronic system, such as a clinic management system (CMS) or Electronic Health Records (EHR).
Depending on the healthcare sector involved, patient data required for contribution will fall into the following category:
Patient demographics
Patient visits
Diagnosis
Discharge Summary
Medications
Laboratory Reports
Radiology Reports
OT Notes / Procedure / Treatments
Immunisation
Allergy
For a typical GP to contribute to NEHR, the data will be:
Patient profile (Mandatory fields Name, Date of Birth, Gender and ID)
Patient visit
Diagnosis
Immunisation
Allergy
Medications
Contribution to the NEHR is not mandatory at the moment, but may subject to further reviews by the MOH.
Benefits of NEHR to private General Practitioners in Singapore
For GP clinics in the private primarycare sector, NEHR can be very beneficial for both the Doctor and patient.
Instant access to patient health records
Better informed diagnosis and prognosis, overall better health outcome
Better patient safety
Enhanced patient experience with more personalised care.
NEHR integration
When doctors select CMS vendors with NEHR integration, please take note of the following:
Compliance with MOH’s security requirements (i.e HIPAA and MTCS)
Provide the necessary support for MOH’s audit
Vendor’s credibility and reputation
Provide dedicated customer/technical support
Familiarity with Singapore’s laws and legislations, the various healthcare practices, and best practices in the industry
Relationship with MOH and IHiS
NEHR and Healthier SG (HSG)
The MOH Healthier SG initiative (HSG) was announced in mid 2022. It will be a major transformation of the Singapore healthcare system toward population health.
Every Singapore resident will be assigned a GP Doctor of their choice to manage their long-term health.
The GP Doctors assigned will have the duties to:
Manage and deliver preventive health to the residents
Develop health plans for lifestyle adjustment, health screening, and vaccinations
Healthier SG is expected to start by mid 2023. HSG enrolment for Singapore residents aged 60 and above will start in the second half of 2023. For ages 40 – 59, enrolment will start in 2024.
Resumption of NEHR contribution for private GPs
Under the Healthier SG initiative, family Doctors, both private and public, will need to work together in their healthcare clusters to coordinate patient care together as a team. Patient data submission and sharing will be critical to keeping Singapore residents healthy.
Hence, private GP clinics and family Doctors will resume NEHR contribution. Private GP Clinics simply have to onboard a NEHR-ready Clinic Management Software to begin NEHR contribution.
The resumption of NEHR contribution will be around the corner.
NEHR opt-out
The NEHR gives all patients privacy and confidentiality for their own data, an opt-out option is given to all patients.
When a patient has opted-out from NEHR, their data will continue to be sent to NEHR, but completely blocked from anyone’s view. Should the patient wish to opt back into NEHR, their data can be restored quickly without any data gap.
In the case where the patient wants further confidentiality and anonymity, they may have the option to not have any data contributed to NEHR. An acknowledgment slip will be signed for them to understand the consequences.
Troubleshooting NEHR
Healthcare providers who are facing problems with access or usability can contact 1800-6644-347 for assistance. Alternatively, you may send an email to nehr.feedback@ihis.com.sg
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source:
www.ihis.com.sg/nehr/about-nehr
Disclaimer:
The information on this page is for general informational purposes only. All information provided by UNO Technologies on this page is to the best of our knowledge. UNO Technologies assumes no responsibility or liability for any errors or omissions in the content of this page.