Older GPs Express Concerns Over New Digital Health Record Mandate

In Singapore, a new requirement mandating clinics to contribute patient data to the National Electronic Health Record (NEHR) has raised concerns among older general practitioners (GPs). For over three decades, Dr Edmond Lie has managed his clinic in Clementi using traditional methods—pen, paper, and his own shorthand system. With the impending digital transition, he now faces the challenge of adapting to a new workflow.

The shift to digital records is part of a broader initiative to enhance healthcare coordination and patient safety. While many doctors acknowledge the potential benefits of the NEHR, they express worry about the financial implications and the technical demands associated with compliance. Dr Lie recently invested S$10,000 (approximately US$7,900) in updating his IT system and incurs annual software subscription fees of around S$2,000.

Financial Strain and Increased Workload

Dr Lie has already been dedicating an additional two hours each day, after clinic hours, to enter patient information into his system. He notes the efficiency of his current workflow, saying, “There’s a lot of shorthand that I use in my pen and paper, so it’s very quick.” Yet, he anticipates that joining the NEHR will further increase his workload. Hiring additional staff to manage NEHR submissions could add another S$24,000 annually to his expenses.

“The problem is, my staff are also not computer-savvy because they’ve been with me for so many decades,” Dr Lie explained. This lack of familiarity with digital systems raises concerns that the transition could lead to increased consultation fees, which currently average around S$25.

Other GPs, aged between 61 and 81, share similar worries about the financial burden and the time required to learn new systems. A 69-year-old practitioner from East Coast, who spoke on condition of anonymity, remarked that digital systems may slow down patient consultations, thereby increasing operational costs. “We are fast with paper and pen,” he said, “but with the digital systems taking over, I envisage that this will jack up the price.” His consultation fees range from S$18 to S$30, depending on the complexity of the visit.

Concerns About Compliance Penalties

Beyond the financial aspects, doctors are apprehensive about the stringent penalties for non-compliance. Under the new regulations issued by the Ministry of Health (MOH), healthcare providers must implement measures to protect patient data and report cybersecurity incidents promptly. Violations could lead to fines of up to S$20,000 and imprisonment for up to one year. More severe breaches could result in fines of S$50,000 and even longer prison sentences.

“We are basically a one-man show, not a corporation that has people who know how to do this,” the East Coast GP expressed. He worries that the demands of managing cybersecurity might be overwhelming for those who are not technologically adept.

The MOH has indicated a willingness to assist healthcare providers in navigating these changes, promising to address issues like system incompatibility. However, specifics about funding support and training resources remain under discussion. Some practitioners have already sought assistance in their transitions. Dr Liew Bee Leng, 81, runs a clinic in Marine Parade that has joined the NEHR. She credits her staff for managing most of the IT work, saying, “I still write in paper and pen, then my staff will key in the diagnosis and medicine.”

Out of six doctors surveyed, half are contemplating retirement as they navigate the impending changes. One GP in his late 70s, who still relies on a paper-based system, expressed concern about complying with the new regulations. “I’m supportive of what the government is doing,” he said, “but my clinic is getting old and I’m coming to my 80s.”

Another long-time practitioner, who has operated a neighbourhood clinic for over 40 years, finds the prospect of learning new computer systems daunting. “With the new requirements, I think it would be too much for me,” she admitted, indicating that retirement might be her only option. “I feel a bit sad because I don’t want to retire.”

While Dr Lie is not considering retirement, he emphasizes the need for additional support. He advocates for subsidies, clearer guidance, and manpower assistance to ease the transition for older GPs. Without such measures, he warns that the financial burden of compliance may ultimately impact patients as well.