TIDYING UP LOOSE ENDS
Doctors and telemedicine stakeholders assert that the existing gaps in the telemedicine sector can potentially be rectified through either robust government regulations or through the implementation of internal checks and audits.
Dr. Lua, a prominent figure in the healthcare industry, emphasized that it could be advantageous for regulatory authorities to establish a minimum clinical experience requirement for telemedicine providers to enhance the quality of care.
“Experienced clinicians are better equipped to interpret subtle visual cues and provide safe, effective care remotely,” he asserted, highlighting the necessity for seasoned professionals in this rapidly evolving field.
At present, the Ministry of Health (MOH) mandates that doctors complete compulsory telemedicine e-training to be eligible to deliver these services, a requirement that many physicians believe can be fulfilled within just a few days.
Dr. Lua believes this foundational training is a positive step, yet it could be further refined by incorporating regular re-accreditation exercises, ensuring doctors remain up-to-date with appropriate protocols and best practices.
Dr. Tan from DTAP Clinic also proposed implementing restrictions on the number of teleconsultations a patient is permitted to book within a specific timeframe to deter patients from exploiting the system for medical certificates (MCs).
However, during a parliamentary session on Monday (Nov 11), Health Minister Ong Ye Kung expressed that he does not see a pressing need to revisit guidelines specifically concerning telemedicine-related concerns.
The Health Minister asserted that current standards continue to be valid, and enforcement measures have been effective in maintaining the integrity of telemedicine practices.
Mr. Ong acknowledged that there is often a “temptation” for increased audits, enforcement, and regulation; however, he cautioned that such actions might hinder the nation’s ability to fully capitalize on the advancements that new technologies can offer.
He further pointed out that regulatory frameworks “cannot eradicate offences,” indicating the complexity of addressing misuse in telemedicine.
Simultaneously, several telemedicine providers informed CNA TODAY that they have already instituted mechanisms aimed at preventing potential abuse of the system, showcasing a proactive approach to safeguarding telemedicine services.
Telemedicine companies like Doctor Anywhere and Fullerton Health have established rigorous vetting processes for their doctors. These healthcare professionals are required to disclose their telemedicine experience and verify completion of the mandatory MOH telemedicine e-training.
Doctor Anywhere’s Director of Medical Affairs, Andrew Fang, explained that their approved doctors undergo a comprehensive onboarding program that includes obligatory face-to-face training, followed by a probationary period, and regular training sessions designed to reinforce ethical and clinical guidelines.
Senior Medical Director of WhiteCoat Global, Dr. Tan Ming Wei, noted that their platforms incorporate a “tech-driven red flags system,” which alerts doctors to patients who have a history of attempting to obtain MCs within a short time frame, facilitating vigilant oversight.
Ultimately, some healthcare professionals, such as Dr. Jonathan Ti, principal medical advisor for the sexual telehealth platform Quinn, maintain that the responsibility for safeguarding against the misuse of telemedicine rests squarely on healthcare practitioners themselves.
“The greatest safeguard against the shortcomings of teleconsultation services would be having well-trained, ethically sound doctors who can provide reasoned and appropriate assessment and management,” he stated, emphasizing the critical role of practitioner integrity.
While the recent MaNaDr episode may have instilled a sense of uncertainty and public distrust toward some private telemedicine services, Mr. de Silva of DKSH suggested that it’s not entirely negative news.
“Through this incident, the Singapore government has shown that they are playing an active role in mitigating the potential for such incidents to occur in the future,” he remarked, highlighting the government’s proactive stance on public health safety.
THE LIMITLESS FUTURE OF TELEMEDICINE
At present, telemedicine often feels no different from a simple phone call to a friend; however, forthcoming advancements in technology are poised to propel telemedicine far beyond its existing limitations, edging closer to the realm of science fiction.
In October 2023, clinician-scientists from the National University Hospital (NUH) and the Yong Loo Lin School of Medicine at the National University of Singapore (NUS Medicine) conducted an innovative trial, successfully performing a gastrectomy, or stomach surgery, remotely.
While the simulated organ was located in Nagoya, Japan, the surgeons executed the operation from a technologically advanced “surgical cockpit” situated at the Advanced Surgery Training Centre at NUH.
Instead of relying solely on the surgeon’s hands, a sophisticated pair of robotic arms was deployed to carry out the procedure, adeptly handling complex incisions and excisions with precision.
This groundbreaking endeavor was made feasible through a dedicated international fibre-optic network, which effectively transmitted, directed, and replicated the movements of the surgeons stationed in Singapore, showcasing the incredible potential for telemedicine’s future applications.
How can regulatory authorities and telemedicine providers collaborate to enhance the quality of care in digital health services?
**Interview with Dr. Lua: Navigating the Future of Telemedicine**
**Editor:** Thank you for joining us today, Dr. Lua. We appreciate your insights on the current state of telemedicine. To begin, could you elaborate on the key gaps you see within the telemedicine sector?
**Dr. Lua:** Absolutely. One major issue is the varying levels of clinical experience among telemedicine providers. Unlike traditional clinical settings, telemedicine requires practitioners to effectively interpret visual cues without the benefit of in-person examinations. Experienced clinicians have the skills to navigate these challenges, which ultimately contributes to safer and more effective care.
**Editor:** You suggested that regulatory authorities establish minimum clinical experience requirements for telemedicine providers. How would that enhance service quality?
**Dr. Lua:** Setting a minimum experience threshold would ensure that only well-trained, competent clinicians are offering telemedicine services. This can not only elevate the standard of care but also strengthen patient trust in these digital health services.
**Editor:** The Ministry of Health currently mandates e-training for telemedicine providers. What are your thoughts on this training system?
**Dr. Lua:** While the compulsory e-training is a positive initiative, I believe it should evolve. Regular re-accreditation exercises would help keep physicians informed about the latest protocols and best practices, reinforcing quality care in a rapidly changing environment.
**Editor:** Dr. Tan from DTAP Clinic mentioned restricting the number of teleconsultations patients can book to prevent system misuse. What are your views on this suggestion?
**Dr. Lua:** I think it’s an interesting approach and could mitigate potential exploitation, especially in cases where patients seek medical certificates unethically. Striking a balance between accessibility and accountability is crucial.
**Editor:** Health Minister Ong Ye Kung recently stated that current telemedicine guidelines are sufficient. What do you believe could be the implications of this perspective?
**Dr. Lua:** While I respect the Minister’s stance, it can sometimes lead to complacency. Continuous improvement is key in any field, especially one as dynamic as telemedicine. Relying solely on existing regulations might hinder our ability to address emerging challenges effectively.
**Editor:** There is a growing emphasis on internal mechanisms by telemedicine providers to prevent abuse. How can these measures complement regulatory efforts?
**Dr. Lua:** They can work hand-in-hand. Proactive internal policies, like those established by companies such as Doctor Anywhere and Fullerton Health, showcase an industry commitment to maintaining standards. However, robust government oversight remains essential to creating a comprehensive framework that ensures accountability and builds public confidence.
**Editor:** Lastly, you mentioned that the responsibility for safeguarding telemedicine lies with healthcare practitioners. Can you explain why you believe that is fundamental?
**Dr. Lua:** At the end of the day, the integrity and ethical standards of the practitioners will shape the telemedicine experience for patients. Empowering doctors to act responsibly and make sound clinical judgments is vital. When practitioners are well-trained and adhere to high ethical standards, we can uphold the integrity of telemedicine and ensure that it benefits everyone.
**Editor:** Thank you, Dr. Lua, for sharing your valuable insights. It’s clear that the telemedicine sector has the potential for growth and improvement with the right balance of regulations and responsible practice.
