The National Electronic Health Record (NEHR) is a key enabler of Singapore’s strategic vision for “One Patient, One Health Record” where patients move seamlessly across the national healthcare network, receiving coordinated patient-centric care at the most appropriate settings. It provides secure access to a patient’s summary health record by authorised clinicians and healthcare professionals to:
NEHR is a repository that manages patient’s summary health record centrally by storing clinically relevant information from their encounters with clinicians and healthcare professionals across the national healthcare network throughout their life.The goal of the NEHR is for patients to enjoy hassle-free healthcare delivery, higher quality of care, fewer duplicate or unnecessary tests and/ or referrals, reduced medical errors and adverse drug events.
To ensure security and confidentiality of patient data while the best care is provided, the NEHR enforces measures to authenticate, authorise and audit healthcare institutions and users' access to patient’s health record.
The NEHR receives and consolidates key health summary (not doctor's notes) from various healthcare institutions and national registries into a holistic health record. It includes information such as:
All public healthcare institutions (restructured hospitals, polyclinics, and speciality centres), some private healthcare institutions (e.g. GPs), community hospitals, nursing homes and government agencies that have requested to participate in the NEHR and were authorised by MOH are able to access to the information in the NEHR. You can find the list of healthcare institutions participating in the NEHR from MOH website.
The NEHR is owned by the Ministry of Health of Singapore and managed by the Integrated Health Information Systems (IHiS), Singapore's HealthTech Agency.
Presently, anyone regardless of residency or citizenship status, will have a record in NEHR if he/she has seen an authorised healthcare professional in an institution which contributes data to NEHR.
The NEHR is a central repository which draws information from various contributing source systems and organises them in a summarised form which authorised clinicians and healthcare professionals can access.
There is a set of data requirements for contribution to the NEHR. With the backend system to system integration of the source IT systems to the NEHR, the data transmitted to the NEHR would be the same data entered into the system at source.
Any correction or updating of data would need to be done at contributing source. Data on the NEHR system is date-time stamped so it would be clear when the information was last updated.
While the NEHR serves as an excellent resource for healthcare professionals to support them in patient care, the patient needs to play their part by providing additional information, such as if they are consuming other medication bought from pharmacies or if they sought medical treatment overseas or if treatment was performed by sources not contributing to NEHR.
The NEHR has been subjected to a series of cybersecurity reviews conducted by the independent firm PricewaterhouseCoopers (PwC), Cyber Security Agency of Singapore (CSA) and GovTech. MOH and IHiS have reviewed the findings from these reviews and implemented the necessary enhancements. MOH and IHiS will continue to work with GovTech and other government agencies to regularly review and enhance the overall cybersecurity posture of NEHR to address evolving cybersecurity threats.
Two-factor authentication using CorpPass is required for logging in to NEHR to ensure only authorised access. There are also features in the system to detect suspicious access and usage. Audits are also being conducted for the NEHR system (e.g. regular user accounts review) and on NEHR access to ensure proper use of the NEHR by clinician end-users.
NEHR potentially helps you to save time and money, as it reduces the need to take duplicate tests or scans at different healthcare institutions. MOH is also helping healthcare providers to defray some of their costs of upgrading their IT systems by making available various financial support schemes.
By default, all patients' summary records are sent through contributing systems that are integrated with the NEHR for seamless provision of care. Currently patient records from the public healthcare institutions are in the NEHR and we are working with private healthcare institutions for their contribution to the NEHR.
Access to the NEHR has to be authorised by MOH and is granted primarily to healthcare professionals who are involved in direct patient care such as doctors. In a GP clinic setting, clinic assistants would not be provisioned with an account, as they do not provide direct patient care. All clinicians and healthcare professionals accessing the NEHR are also bound by law (e.g. Computer Misuse Act) and professional ethics to keep patient health record strictly confidential.
Employers, insurers and patients are not granted with NEHR access.
Yes, you will be able to see the access history via HealthHub (under the NEHR Access History section) from 28 Nov 2021. The names of the private healthcare institutions and public healthcare clusters that have accessed your records in the NEHR will be listed in reverse-chronological manner for the past one year, with access history starting from 28 Nov 2021.
If you are using HealthHub application, you may also opt for notification service so that you will be notified when accesses are made.
The NEHR is intended primarily for the provision of patient care, and provides continuity of care, especially when the patients move between institutions within the healthcare ecosystem. It provides a record of the patient's journey with each healthcare encounter, viewable across the care continuum (e.g. polyclinics, hospitals, specialist clinics, GP) to support seamless transition of care. This will enable healthcare providers to provide more accurate diagnosis and better treatment.
The NEHR may not be used by doctors when writing medical reports for pre-employment medical screening and insurance claims. Doctors will have to rely on their own patient notes.
Data with the identities anonymised can be used for research and population insights purposes. Additionally, NEHR data can be used for purposes of public health; fulfilment of public functions and where legislatively required. These accesses have to be approved by MOH.
Yes, you have the option to opt out of the NEHR.
By default, all patients' summary records are sent through systems that are integrated with the NEHR for seamless provision of care. Following feedback from the consult sessions conducted in 2018, MOH is reviewing the various opt-out options. IHiS will also be exploring the setting up of a central opt-out helpdesk team to ensure an efficient opt-out process. More details of the alternative opt-out options will be announced when ready.
The current opt-out process available is to obtain and submit the opt-out forms at any Restructured Hospitals or polyclinics. Patients who wish to opt out will be counselled, to ensure that they fully understand the implications of this decision to their care as their providers will not have access to their records.
Once you have opted out, your past and future records in the NEHR will be blocked from view to healthcare providers authorised with NEHR access, including those providing care to you. You will also not be able to see your summary health records via HealthHub.
At any time, you may choose to opt back in again.
To opt back in/out of the NEHR, please approach the frontline staff of any restructured hospital or polyclinic.
It does not have to be an institution that has your records. They will validate your identity in person and facilitate the process.
Since 2011, over 500 patients have opted out of NEHR and more 40 have opted back in after being counselled on the benefits of NEHR.
Access to the NEHR has to be authorised by MOH and is granted primarily to healthcare professionals who are involved in direct patient care such as doctors. In a GP clinic setting, clinic assistants would not be provisioned with an account, as they do not provide direct patient care.
Only the healthcare professionals authorised to access the NEHR and who are managing your care can access your health records for provision of care. The NEHR may not be used by doctors when writing medical reports for pre-employment medical screening and insurance claims.
Additionally, NEHR data can be used for purposes of public health, fulfilment of public functions and where legislatively required. These accesses have to be approved by MOH.
Permission is not needed for healthcare professionals to view your health records. However, only authorised healthcare professionals providing care to you can view your records.
Patients have no direct access to NEHR, however they do have access to some of their clinical records, through HealthHub. At present, HealthHub provides access for patients to view the following records, which includes:
One may also view his or her children's medical records which also includes school health records, school dental records and children immunization records. In addition, caregivers may also be able to access patients' medical records with the appropriate consent granted by their parents through HealthHub.
For more information on the HealthHub, click here.
Currently, relevant health records are uploaded to the NEHR directly from the healthcare institutions. You are unable to add information directly to the NEHR.
Data contribution to the NEHR is voluntary for all private healthcare providers. The MOH has been reaching out to them to encourage sharing of clinical data with the NEHR.
What are your thoughts on on-boarding all healthcare providers for data contribution and access to enable better patient care?
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