Introduction
While the Health Information Bill (HIB) mandates data sharing for better care coordination, it also establishes important patient rights. Understanding these rights is crucial for healthcare providers—both to respect patient autonomy and to meet your legal obligations.
The Balance: Sharing vs. Privacy
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║ HIB's Balancing Act ║
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║ ║
║ CARE COORDINATION PATIENT PRIVACY ║
║ ──────────────── ─────────────── ║
║ ║
║ ┌──────────────┐ ┌──────────────┐ ║
║ │ Better care │ │ Control over │ ║
║ │ through │ ⚖️ │ personal │ ║
║ │ information │ BALANCE │ health data │ ║
║ │ sharing │ │ │ ║
║ └──────────────┘ └──────────────┘ ║
║ ║
║ HIB achieves this by: ║
║ • Mandating contribution (for comprehensive records) ║
║ • Allowing access restrictions (patient choice) ║
║ • Protecting against misuse (strict penalties) ║
║ ║
╚═════════════════════════════════════════════════════════════════╝
Key Patient Rights Under HIB
1. Right to Restrict NEHR Access
Patients can choose to restrict healthcare providers from accessing their NEHR records.
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║ How Access Restriction Works ║
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║ ║
║ PATIENT ║
║ │ ║
║ │ "I want to restrict access to my NEHR records" ║
║ │ ║
║ ▼ ║
║ ┌────────────┐ ║
║ │ Registers │ ║
║ │ restriction│ ║
║ │ via portal │ ║
║ └─────┬──────┘ ║
║ │ ║
║ ▼ ║
║ ┌─────────────────────────────────────────────────────────┐ ║
║ │ NEHR │ ║
║ │ ┌──────────────────────────────────────────────────┐ │ ║
║ │ │ Patient records still EXIST and are CONTRIBUTED │ │ ║
║ │ │ But providers CANNOT ACCESS them │ │ ║
║ │ └──────────────────────────────────────────────────┘ │ ║
║ └─────────────────────────────────────────────────────────┘ ║
║ ║
║ IMPORTANT: Contribution continues even with access restriction ║
║ ║
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What this means for providers:
- •You must check for access restrictions before viewing NEHR
- •If restricted, you CANNOT access the patient's NEHR records
- •You must rely on information the patient provides directly
- •You still MUST contribute data to NEHR
2. Right to Know Who Accessed Their Records
Patients can view their NEHR access logs through HealthHub.
| Information Visible | Example |
|---|---|
| Who accessed | Dr. Tan Wei Ming |
| When | 15 Jan 2025, 10:32 AM |
| Which provider | ABC Medical Clinic |
| Purpose | Patient care |
3. Right to Request Correction
If patients identify errors in their NEHR records, they can request corrections through their healthcare provider.
4. Right to File Complaints
Patients can lodge complaints about:
- •Unauthorized access to their records
- •Misuse of their health information
- •Breaches of confidentiality
Provider Obligations
Obligation 1: Respect Access Restrictions
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║ When Patient Has Access Restriction ║
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║ ║
║ YOU MUST: YOU MUST NOT: ║
║ ───────── ───────────── ║
║ ║
║ ✓ Continue contributing ✗ Access their NEHR records ║
║ data to NEHR ║
║ ✗ Try to override the ║
║ ✓ Provide care based on restriction ║
║ information patient ║
║ provides directly ✗ Pressure patient to ║
║ lift restriction ║
║ ✓ Document the restriction ║
║ in your notes ✗ Discriminate in care ║
║ provision ║
║ ✓ Explain implications to ║
║ patient (if they ask) ║
║ ║
╚═════════════════════════════════════════════════════════════════╝
Obligation 2: Emergency Access Exception
In genuine emergencies, providers may access NEHR even with restrictions:
Emergency access is permitted when:
- •Patient's life is at risk
- •Patient cannot communicate
- •Immediate medical decision required
- •Delay would cause serious harm
Emergency access requirements:
- •Document the emergency justification
- •Access only minimum necessary information
- •Log the emergency access reason
- •Be prepared to justify to MOH if questioned
Obligation 3: Inform Patients About NEHR
| What to Inform | When |
|---|---|
| NEHR participation | During registration |
| Data that will be shared | Upon request |
| How to restrict access | Upon request |
| How to view access logs | Upon request |
Obligation 4: Handle Correction Requests
When a patient identifies an error:
- •Acknowledge the request
- •Verify the error exists
- •Correct in your system
- •Sync correction to NEHR
- •Confirm with patient
- •Document the correction process
Consent Under HIB
What Does NOT Require Consent
Under HIB, these activities do not require explicit patient consent:
- •Contributing data to NEHR (mandatory)
- •Accessing NEHR for direct patient care
- •Sharing data for care coordination
- •Emergency access to NEHR
What DOES Require Consent
| Activity | Consent Required |
|---|---|
| Research using patient data | Yes (or ethics board approval) |
| Sharing with non-healthcare parties | Yes |
| Marketing communications | Yes |
| Secondary use of data | Yes |
Practical Scenarios
Scenario 1: New Patient with Access Restriction
Situation: A new patient visits your clinic. When you try to access their NEHR, you see they have placed an access restriction.
Action: Inform the patient that you cannot access their NEHR records. Ask them to provide their medical history, allergies, and current medications directly. Document that NEHR access was restricted and care was provided based on patient-reported information.
Scenario 2: Patient Wants to Restrict Access
Situation: A patient asks how to prevent doctors from seeing their NEHR records.
Action: Explain that they can place an access restriction through HealthHub or SingPass. Clarify that their data will still be contributed to NEHR, but providers won't be able to view it. Discuss the implications for their care (e.g., providers won't see allergy information).
Scenario 3: Emergency with Restricted Patient
Situation: An unconscious patient is brought to emergency. NEHR shows access restriction, but critical information is needed.
Action: Emergency access is permitted. Access minimum necessary information, document the emergency justification, and note the emergency override in records.
Scenario 4: Patient Requests Record Correction
Situation: A patient claims their NEHR shows a medication allergy they don't have.
Action: Review the original entry, verify with patient, make correction in your CMS, ensure sync to NEHR, provide written confirmation to patient, maintain documentation of the correction.
Communicating with Patients About NEHR
Suggested Explanation Script
"Under Singapore's Health Information Bill, we share key health information—like your diagnoses, medications, allergies, and test results—with the National Electronic Health Record system. This helps ensure any doctor you see in Singapore has access to important information for your care.
You have the right to restrict access to these records if you wish. However, this means healthcare providers won't be able to see your medical history when treating you. Would you like more information about this?"
Patient FAQ
| Question | Answer |
|---|---|
| "Can I opt out of NEHR entirely?" | No, data contribution is mandatory. But you can restrict access. |
| "Who can see my records?" | Only healthcare providers involved in your care. |
| "Is my data safe?" | NEHR uses strong encryption and access controls. |
| "Can I see who accessed my records?" | Yes, through HealthHub. |
| "What if I find an error?" | Tell your healthcare provider, and they will correct it. |
Key Takeaways
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Contribution is mandatory, access is controllable - Patients cannot prevent data contribution but can restrict who accesses it.
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Respect restrictions - Never access NEHR for a patient who has restricted access (except emergencies).
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Emergency exception exists - But must be documented and justified.
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Transparency matters - Be ready to explain NEHR to patients and their rights.
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Corrections are your responsibility - Handle patient correction requests promptly and completely.
For patient-facing information, refer to HealthHub NEHR Portal