The Ministry of Health (MOH) has introduced a voluntary listing of direct telemedicine service providers to help patients make an informed choice when selecting a telemedicine service provider. The list will comprise service providers that have committed to meeting essential training, process and governance measures stipulated by MOH. As of 22 February 2021, close to 500 providers have declared to meet MOH’s process and governance measures and are listed.
2. MOH has been working with the telemedicine industry since April 2018 through a telemedicine-specific regulatory sandbox under the Licensing Experimentation and Adaptation Programme (LEAP). The telemedicine sandbox sought to co-create process and governance measures to support an effective and efficient regulatory regime and allow the safe growth of telemedicine. With the introduction of the listing and the objectives of the telemedicine sandbox having been met, MOH will discontinue the telemedicine sandbox.
3. Telemedicine is increasingly becoming an important feature of our healthcare landscape, by offering greater convenience, improving accessibility to medical care and medications, and strengthening continuity of care. It also supports MOH’s care transformation efforts by complementing the functions of general practitioners, polyclinics, specialists and the intermediate and long-term care sector in areas such as triaging, follow-up management, chronic condition/symptom management and healthcare administration. In the past year, telemedicine has been an important pillar in our fight against COVID-19, by ensuring patients have access to healthcare while supporting safe distancing measures and mitigating the spread and exposure to the virus.
4. With the growth in the number of telemedicine providers over the last few years, there is a need to ensure such providers offer services that prioritise patient safety and welfare. There is also a need to help patients identify providers who are aware of the risks of telemedicine, have put in place mitigations to address these risks, and agree to comply with MOH’s measures.
5. As such, before direct telemedicine services are licensed under HCSA in 2022, MOH will, in the interim, list providers that have committed to abide by specific process and governance measures on the MOH website. To be eligible for listing, these providers must first:
a. Have their doctors and/or dentists complete MOH’s telemedicine e-training;
b. Put in place professional and process measures to provide safe telemedicine care (e.g. having in place appropriate follow-up protocols to direct patients to in-person care where needed, verifying patient identity, and requesting for patient’s current location during the teleconsultation to direct emergency services if required), and ensure compliance to these measures; and
c. Submit an application form to MOH to be listed (including declaring compliance to MOH’s measures).
6. From 1 April 2021, only listed providers will be allowed to offer Community Health Assistance Scheme (CHAS) subsidies and/or submit MediSave claims for the follow-up of chronic conditions via video consultations under the Chronic Disease Management Programme (CDMP). Providers currently on the CHAS/ MediSave video-consultation list  have been earlier informed to resubmit their applications to continue providing claimable video consultations. Patients who have scheduled a follow-up for their CDMP condition through video consultation on or after 1 April 2021, and intend to use CHAS subsidies or MediSave, should verify beforehand that their provider is listed by checking the voluntary listing.
7. While listing is voluntary, MOH strongly encourages providers to participate in the listing, and to address risks and comply with measures early. Doing so will facilitate providers in their transition to becoming licensees under the Healthcare Services Act (HCSA) in 2022.
8. The full listing of direct telemedicine service providers can be found on the MOH website .
Closure of LEAP Regulatory Sandbox
9. Since 2018, MOH has worked with 11 telemedicine providers, with varying business and care models, to meet the objectives of the LEAP regulatory sandbox for telemedicine:
a. Ensure patients and caregivers have early access to telemedicine services with essential safety and risk mitigation measures in place;
b. Allow participating sandbox providers to introduce new care models or evolve their current models in a safe manner, with early visibility over the eventual regulatory environment; and
c. Allow MOH to keep in step with the evolving healthcare landscape and to co-create fit-for-purpose and effective mitigations.
10. In the last three years, these 11 providers have offered over 40,000 unique teleconsultations through the sandbox with no major patient safety issues or complaints reported. Through close collaboration with sandbox providers, and interviews with doctors and patients, MOH co-developed key process and governance controls with the telemedicine community to enable the safe growth of the modality. Some examples include using live video consultation to authenticate the patients’ identity, assess visual cues and build better rapport with the patients, and determining the patient’s exact location at the start of the teleconsultation to direct emergency services when necessary.
11. These insights were collated into a free telemedicine e-training programme  launched in March 2020 to guide doctors and other healthcare professionals and staff on the safe use, limitations and implementation of telemedicine into their current practices. As of 22 February 2021, over 6,200 learners have completed MOH’s telemedicine e-training.
12. This open collaborative effort between private providers and MOH has shown how active engagement and participation in the regulatory sandbox can guide better regulatory clarity and also enable a safe space for providers to innovate. This is in line with MOH’s efforts in adopting a participatory approach in engaging providers on new models of care. MOH would like to express its appreciation to all 11 telemedicine providers for working with the Ministry to develop fit-for-purpose regulatory requirements.
MINISTRY OF HEALTH
26 FEBRUARY 2021