Introduction
One of the central pillars of Singapore's Health Information Bill (HIB) is mandatory data sharing. All licensed healthcare providers must contribute specific patient health information to the National Electronic Health Record (NEHR) system.
But what exactly must you share? How should it be formatted? And what happens to data once it's in NEHR?
The Data Sharing Framework
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║ HIB Data Sharing Model ║
╠═════════════════════════════════════════════════════════════════╣
║ ║
║ ┌──────────────┐ ║
║ │ NEHR │ ║
║ │ (Central │ ║
║ │ Repository) │ ║
║ └──────┬───────┘ ║
║ │ ║
║ ┌─────────────┼─────────────┐ ║
║ │ │ │ ║
║ CONTRIBUTE CONTRIBUTE CONTRIBUTE ║
║ │ │ │ ║
║ ▼ ▼ ▼ ║
║ ┌────────┐ ┌────────┐ ┌────────┐ ║
║ │ Public │ │ Private│ │Community│ ║
║ │Hospital│ │ Clinic │ │ Care │ ║
║ └────────┘ └────────┘ └────────┘ ║
║ ║
║ │ │ │ ║
║ └─────────────┼─────────────┘ ║
║ │ ║
║ ACCESS ║
║ (For patient care) ║
║ ║
╚═════════════════════════════════════════════════════════════════╝
Mandatory Data Categories
What MUST Be Shared with NEHR
| Category | Examples | Purpose |
|---|---|---|
| Allergies | Drug allergies, food allergies, environmental allergies | Prevent adverse reactions |
| Vaccinations | COVID-19, flu, childhood immunizations | Track immunization status |
| Diagnoses | ICD-10 coded conditions | Understand patient history |
| Medications | Current prescriptions, dispensed medications | Prevent drug interactions |
| Lab Results | Blood tests, pathology reports | Inform treatment decisions |
| Radiology | X-rays, MRI, CT scan reports/images | Avoid duplicate imaging |
| Discharge Summaries | Hospital discharge notes | Care continuity |
Data Field Specifications
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║ Required Data Fields Per Category ║
╠═════════════════════════════════════════════════════════════════╣
║ ║
║ ALLERGIES ║
║ ───────── ║
║ • Allergen type (drug/food/environmental) ║
║ • Allergen name (standardized) ║
║ • Reaction type (mild/moderate/severe) ║
║ • Reaction description ║
║ • Date recorded ║
║ • Recording provider ║
║ ║
║ MEDICATIONS ║
║ ─────────── ║
║ • Drug name (generic + brand) ║
║ • Dosage ║
║ • Frequency ║
║ • Route of administration ║
║ • Start date ║
║ • Prescribing provider ║
║ • Dispensing location (if applicable) ║
║ ║
║ DIAGNOSES ║
║ ───────── ║
║ • ICD-10 code ║
║ • Diagnosis description ║
║ • Primary/Secondary indicator ║
║ • Date of diagnosis ║
║ • Diagnosing provider ║
║ ║
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Data Standards & Formats
Coding Standards
| Data Type | Standard | Notes |
|---|---|---|
| Diagnoses | ICD-10-CM | Use latest version |
| Procedures | CPT/HCPCS | Standard procedure codes |
| Medications | SNOMED CT | Drug terminology |
| Lab Tests | LOINC | Laboratory observation identifiers |
| Allergies | NEHR Codeset | MOH-specified allergen codes |
Data Quality Requirements
Your data must meet these quality standards:
- • Accuracy - Information matches the source document
- • Completeness - All mandatory fields populated
- • Timeliness - Data submitted within required timeframe
- • Consistency - Standard codes and formats used
- • Validity - Values within acceptable ranges
When Data Must Be Shared
Timing Requirements
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║ Data Contribution Timelines ║
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║ ║
║ DATA TYPE CONTRIBUTION DEADLINE ║
║ ───────── ───────────────────── ║
║ ║
║ Consultation notes Within 3 working days of visit ║
║ Lab results Within 1 working day of availability ║
║ Radiology reports Within 1 working day of finalization ║
║ Discharge summaries Within 3 working days of discharge ║
║ Allergies Immediately upon identification ║
║ Medications (new) At time of prescription/dispensing ║
║ ║
║ Note: "Real-time" contribution is the goal for most systems ║
║ ║
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Data Sharing Permissions
Who Can Access NEHR Data?
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║ NEHR Access Framework ║
╠═════════════════════════════════════════════════════════════════╣
║ ║
║ CAN ACCESS FOR: ║
║ ────────────── ║
║ ║
║ ┌─────────────────────────────────────────────────────────┐ ║
║ │ ✓ Direct patient care (treatment, diagnosis) │ ║
║ │ ✓ Care coordination between providers │ ║
║ │ ✓ Emergency situations (even with access restrictions) │ ║
║ └─────────────────────────────────────────────────────────┘ ║
║ ║
║ CANNOT ACCESS FOR: ║
║ ──────────────── ║
║ ║
║ ┌─────────────────────────────────────────────────────────┐ ║
║ │ ✗ Employment decisions │ ║
║ │ ✗ Insurance underwriting │ ║
║ │ ✗ General curiosity (even for family members) │ ║
║ │ ✗ Research (without proper approvals) │ ║
║ │ ✗ Marketing purposes │ ║
║ └─────────────────────────────────────────────────────────┘ ║
║ ║
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Legitimate Purpose Requirement
Every NEHR access must be for a legitimate healthcare purpose. The system logs all access, and inappropriate access can result in:
- •Fines up to S$50,000 (first offense)
- •Fines up to S$100,000 + imprisonment (repeat offense)
- •Professional sanctions
Data That Is NOT Shared
What Stays with Your Clinic
| Data Type | Reason |
|---|---|
| Detailed clinical notes | Beyond NEHR scope |
| Administrative records | Not required for care coordination |
| Billing details | Financial, not clinical |
| Appointment history | Operational data |
| Internal communications | Practice management |
Sensitive Data Handling
Some health information requires special handling:
- •HIV/AIDS status
- •Mental health records
- •Substance abuse treatment
- •Genetic information
- •Sexual health records
These may have additional consent requirements or access restrictions.
The Data Contribution Process
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║ How Data Flows to NEHR ║
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║ ║
║ STEP 1: CAPTURE ║
║ ───────────────── ║
║ Provider enters data in CMS during patient encounter ║
║ │ ║
║ ▼ ║
║ STEP 2: VALIDATE ║
║ ──────────────── ║
║ CMS validates data format and completeness ║
║ │ ║
║ ▼ ║
║ STEP 3: TRANSFORM ║
║ ───────────────── ║
║ CMS maps data to NEHR standards (ICD-10, LOINC, etc.) ║
║ │ ║
║ ▼ ║
║ STEP 4: TRANSMIT ║
║ ───────────────── ║
║ Encrypted transmission to NEHR gateway ║
║ │ ║
║ ▼ ║
║ STEP 5: CONFIRM ║
║ ──────────────── ║
║ NEHR acknowledges receipt, CMS records confirmation ║
║ ║
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Common Data Quality Issues
| Issue | Impact | Prevention |
|---|---|---|
| Missing NRIC/FIN | Cannot link to patient | Mandatory field validation |
| Wrong ICD codes | Incorrect medical history | Code lookup tools, training |
| Duplicate entries | Confusing records | Deduplication processes |
| Outdated allergies | Safety risk | Regular review protocols |
| Incomplete medications | Drug interaction risk | Enforce complete entry |
Handling Data Correction Requests
When errors are identified in NEHR:
- •Document the error - Record what's wrong and why
- •Make the correction - Update in your CMS
- •Sync with NEHR - Correction flows to NEHR
- •Verify update - Confirm correction appears in NEHR
- •Maintain audit trail - Keep record of correction
Important: You cannot delete data from NEHR—only correct it. The original entry and correction are both retained in the audit trail.
Key Takeaways
- •
Contribution is mandatory - All licensed providers must share specified health data.
- •
Quality matters - Poor data quality defeats the purpose of NEHR.
- •
Standards exist - Use ICD-10, LOINC, and other standard codes.
- •
Timeliness is expected - Share data promptly after capture.
- •
Access is audited - Every NEHR access is logged and reviewable.
For detailed data specifications, refer to the NEHR Data Standards Guide