SINGAPORE: The Ministry of Health (MOH) on Wednesday (Apr 9) reminded MaNaDr, which had its licence revoked last year, that the duration of a teleconsultation is not the only thing that matters.

The company said at a press conference last week that it has introduced new safeguards, such as requiring teleconsultations to last at least one minute before a medical certificate (MC) can be issued.

The health ministry said in response that it is not just the duration but the "quality and adequacy of the medical care" that matters in a consultation.

"MOH would like to reiterate that it is not necessarily the case that so long as a teleconsultation exceeds a minute, it would pass muster," it added.

As the ministry highlighted in a press release in October 2024, short consultations raise concerns about the safety and quality of clinical assessments and care.

The duration of the teleconsultation should be "commensurate with the patient profile and presenting medical conditions", the ministry added.

It reminded licensees providing teleconsultations that they are required to put in place quality assurance measures.

This includes implementing and regularly reviewing protocols and processes to ensure that doctors are conducting proper clinical assessments, as well as prescribing and issuing medical certificates on proper medical grounds.

MaNaDr Clinic was stripped of its licence in December 2024, with MOH saying then that there was "an entrenched culture of disregard for the applicable ethical and clinical standards" within the organisation.

This meant that MaNaDr could no longer provide outpatient services at its clinic at City Gate or on temporary premises such as patients' homes, as well as remotely via teleconsultations.

GOVERNANCE

At the press conference, MaNaDr co-founder and chief executive officer Siaw Tung Yeng sought to draw a distinction between its clinic operations and its telemedicine technology platform.

The two are businesses that are run separately under its parent entity Mobile-health Network Solutions, he said. The licence that was revoked applies only to its physical clinic at City Gate, which is managed under a subsidiary called MaNaDr Clinic.

In response to multiple questions on why questionable practices at the clinic in City Gate were not detected earlier, Dr Siaw said that the subsidiary that runs its clinic operations “is independent and manages itself”.

MOH said on Wednesday that under the Healthcare Services Act, all licensees and their key officeholders are "ultimately responsible" for ensuring compliance with regulatory requirements, regardless of the licensee’s corporate structure. 

"Licensees are also fully accountable for the safety and quality of the healthcare services provided by the clinic, including telemedicine services, and must ensure that the services comply with the applicable ethical and professional standards. 

"In this instance, as the principal officer and clinical governance officer of MaNaDr clinic, Dr Siaw would have been responsible for the day-to-day management of the clinic and provision of clinical governance and technical oversight over the clinic’s services," MOH said.

It added that any doctor who practices, whether as a locum practitioner or employee, does not operate independently, but must be under the supervision and oversight of the licensee and their key officeholders.

ARTIFICIAL INTELLIGENCE

MOH also pointed out reports that MaNaDr would be implementing artificial intelligence (AI) tools to enhance clinical standards, transcribe doctor-patient conversations, and consolidate prescribed treatment plans and other relevant medical records.

It said that while AI may enhance efficiency in clinical settings and has the potential to improve patient outcomes, it also brings about "inherent risks and ethical concerns".

The ministry has put in place a framework to regulate and govern AI in healthcare.

"Licensees are reminded that, notwithstanding their use of MaNaDr platform’s AI tools, they continue to be responsible for ensuring compliance with licensing requirements under HCSA, including patient safety and welfare for all services provided," said MOH.

For instance, where AI tools are used for transcribing consultations or consolidating prescribed treatment plans, licensees must ensure they are accurate, confidential and secure.

They must also confirm if the AI tools need to be registered with the Health Sciences Authority and ensure that "fair and non-biased data" was used to train it.

"MOH would like to reiterate that licensees are accountable and responsible for the licensable healthcare service provided, including the conduct of their healthcare professionals and deployment of technological tools, and should comply with all necessary regulatory requirements," it said.