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Joint MOH-HSA-SMC Circular on Telemedicine Services and Advertisements

22 November 2024  |  Telemedicine  |  MOH Cir 87/2024

Summary

1. Background

Joint MOH-HSA-SMC Circular 87/2024 (Nov 2024) serves as comprehensive reminder of obligations regarding telemedicine service provision and medical/healthcare advertisements. Applies to all HCSA licensees and registered medical practitioners. Reinforces compliance with HCSA, Health Products Act 2007 (HPA), and SMC Ethical Code and Ethical Guidelines (ECEG).

2. Telemedicine Service Provision - HCSA Requirements

  • Definition: Remote provision of Outpatient Medical Service (OMS)
  • Licensure: HCSA licensees approved to provide telemedicine ("TM Licensees") must comply with HCSA and subsidiary legislation
  • Clinical Standards: Same standards apply to telemedicine as in-person consultations
  • Patient Identification: Proper patient identification and informed consent required
  • Confidentiality: Patient privacy and data protection requirements same as in-person
  • Telemedicine Limitations: Practitioners must assess suitability of patient for remote assessment; cannot use telemedicine for all conditions
  • Clinical Notes: Complete medical records required for all telemedicine consultations
  • Follow-Up: Appropriate follow-up mechanism must be in place for telemedicine patients

3. Key Office Holder (KOH) Responsibilities

  • KOHs of TM Licensees: Must ensure compliance with all telemedicine requirements
  • Clinical Governance: Responsible for systems and oversight ensuring telemedicine quality
  • Staff Training: Must ensure practitioners and staff understand telemedicine obligations
  • Quality Assurance: Systems for monitoring and quality assurance of telemedicine services
  • Accountability: KOHs accountable for licensee's telemedicine compliance

4. Practitioner-Specific Telemedicine Obligations

  • Patient Suitability: Exercise clinical judgment on whether patient suitable for remote consultation
  • Consent: Obtain informed consent for telemedicine; disclose limitations
  • Adequate Assessment: Conduct appropriate clinical assessment within telemedicine constraints
  • Documentation: Complete medical records required
  • Continuity: Ensure appropriate follow-up; arrange in-person consultation if clinically needed
  • Emergency Situations: Have protocol for managing acute deterioration or medical emergencies
  • Data Security: Ensure secure transmission and storage of telemedicine communications
  • Testing/Investigations: If investigations needed, ensure appropriate arrangements (no direct tests via telemedicine)

5. Advertising Requirements - General Principles

  • Compliance Framework: Advertising must comply with HCSA, Health Products Act 2007 (HPA), and SMC ECEG
  • Accuracy: All claims must be accurate, factual, and substantiated
  • Not Misleading: Advertising must not mislead patients about services, qualifications, or outcomes
  • No Comparison: Must not inappropriately compare practitioners or services
  • Patient Safety: Advertising must not encourage harmful self-treatment or delay appropriate medical care
  • Credentials: Qualifications must accurately reflect actual credentials

6. Specific Advertising Restrictions

  • Claims Substantiation: Any clinical efficacy claims must be supported by evidence
  • Testimonials: Patient testimonials in advertising must be authentic and representative
  • Before/After: Visual comparisons must not mislead (particularly cosmetic treatments)
  • Guarantees: Cannot guarantee specific outcomes; medical practice involves clinical uncertainty
  • Unproven Treatments: Cannot advertise unproven or experimental treatments as established
  • Professional Services: Cannot advertise services beyond practitioner's qualifications/licenses
  • Emergency Claims: Exaggerated urgency messaging may be problematic
  • Pricing: If advertising fees, must be clear and not misleading

7. Digital/Social Media Advertising

  • Same Rules: Same HCSA/HPA/SMC requirements apply to digital advertising
  • Permanence: Digital content persists; ensure compliance is maintained
  • Endorsements: If using influencer/professional endorsements, ensure genuine and disclosed
  • Sponsored Content: Must clearly label sponsored/commercial content
  • Patient Privacy: Cannot use patient information/images without clear consent
  • Comments/Engagement: Responsible for accuracy of responses to patient inquiries online

8. Restrictions on Specific Claims

  • Cure Claims: Cannot claim to "cure" diseases (limited exceptions per HPA)
  • Prevention Claims: Cannot claim disease prevention without evidence
  • Lifestyle Changes: Can claim improvement with treatment, but not to mislead re: alternative treatments
  • Specialist Claims: Cannot claim specialist status without proper qualifications/recognition
  • Medical Devices: If advertising medical devices, must comply with device-specific regulations

9. Sector-Specific Considerations

  • Fertility Services: Special restrictions on assisted reproduction advertising per HPA
  • Mental Health: Cannot exploit vulnerable populations in mental health advertising
  • Cosmetic Services: Enhanced scrutiny of cosmetic procedure advertising
  • Alternative Medicine: If claiming disease treatment, subject to evidence requirements

10. Action for Your Practice

  • Review Telemedicine Protocols: Ensure compliance with all HCSA telemedicine requirements
  • Staff Training: Conduct training on telemedicine clinical standards, patient suitability assessment, documentation
  • Quality Assurance: Implement systems to monitor telemedicine quality and safety
  • Advertising Audit: Review all advertising materials (website, social media, print, digital) for compliance
  • Accuracy Check: Verify all claims are accurate and substantiated
  • Credentials Verification: Ensure qualifications accurately represented
  • Testimonials: Ensure patient testimonials are authentic and properly obtained
  • Documentation: Maintain records of all advertising materials and substantiation
  • Regular Updates: Keep updated on regulatory changes affecting telemedicine and advertising
  • Compliance Officer: Designate responsibility for telemedicine/advertising compliance monitoring

11. Non-Compliance Consequences

  • HCSA Breach: Regulatory action by HSA up to license suspension/cancellation
  • SMC Discipline: Disciplinary action by SMC for unethical advertising/telemedicine practice
  • HPA Violations: Regulatory action for false or misleading health claims
  • Patient Complaints: Increased complaint risk if advertising/telemedicine not compliant

12. References

Healthcare Services Act 2020, Health Products Act 2007, SMC Ethical Code and Ethical Guidelines 2016, HCSA subsidiary legislation, HPA regulations

Copy for WhatsApp / Telegram 
𝟭. 𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱
Joint MOH-HSA-SMC Circular 87/2024 (Nov 2024) serves as comprehensive reminder of obligations regarding telemedicine service provision and medical/healthcare advertisements. Applies to all HCSA licensees and registered medical practitioners. Reinforces compliance with HCSA, Health Products Act 2007 (HPA), and SMC Ethical Code and Ethical Guidelines (ECEG).

𝟮. 𝗧𝗲𝗹𝗲𝗺𝗲𝗱𝗶𝗰𝗶𝗻𝗲 𝗦𝗲𝗿𝘃𝗶𝗰𝗲 𝗣𝗿𝗼𝘃𝗶𝘀𝗶𝗼𝗻 - 𝗛𝗖𝗦𝗔 𝗥𝗲𝗾𝘂𝗶𝗿𝗲𝗺𝗲𝗻𝘁𝘀
• Definition: Remote provision of Outpatient Medical Service (OMS) • Licensure: HCSA licensees approved to provide telemedicine ("TM Licensees") must comply with HCSA and subsidiary legislation • Clinical Standards: Same standards apply to telemedicine as in-person consultations • Patient Identification: Proper patient identification and informed consent required • Confidentiality: Patient privacy and data protection requirements...

𝟯. 𝗞𝗲𝘆 𝗢𝗳𝗳𝗶𝗰𝗲 𝗛𝗼𝗹𝗱𝗲𝗿 (𝗞𝗢𝗛) 𝗥𝗲𝘀𝗽𝗼𝗻𝘀𝗶𝗯𝗶𝗹𝗶𝘁𝗶𝗲𝘀
• KOHs of TM Licensees: Must ensure compliance with all telemedicine requirements • Clinical Governance: Responsible for systems and oversight ensuring telemedicine quality • Staff Training: Must ensure practitioners and staff understand telemedicine obligations • Quality Assurance: Systems for monitoring and quality assurance of telemedicine services • Accountability: KOHs accountable for licensee's telemedicine compliance

𝟰. 𝗣𝗿𝗮𝗰𝘁𝗶𝘁𝗶𝗼𝗻𝗲𝗿-𝗦𝗽𝗲𝗰𝗶𝗳𝗶𝗰 𝗧𝗲𝗹𝗲𝗺𝗲𝗱𝗶𝗰𝗶𝗻𝗲 𝗢𝗯𝗹𝗶𝗴𝗮𝘁𝗶𝗼𝗻𝘀
• Patient Suitability: Exercise clinical judgment on whether patient suitable for remote consultation • Consent: Obtain informed consent for telemedicine; disclose limitations • Adequate Assessment: Conduct appropriate clinical assessment within telemedicine constraints • Documentation: Complete medical records required • Continuity: Ensure appropriate follow-up; arrange in-person consultation if clinically needed • Emergency Situations: Have protocol for...

Documents

Circular

Annexes

Official Source

View on HCSA website

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