Longer wait times, declined productivity, higher cyber risks due to Internet separation: MOH chief data adviser

SINGAPORE – Cutting Internet access in Singapore’s public healthcare institutions has caused a variety of difficulties, including longer waiting times for patients, declined productivity and increased staff fatigue.

Also, new cyber-security risks have surfaced as a result of the alternative arrangements put in place to work around the temporary Internet surfing separation (ISS).

For instance, separate Internet-enabled devices would require the latest anti-virus software but these are usually done manually by the users, which could lead to a delay in the updates.

These challenges were spelt out by the Ministry of Health’s (MOH) chief data adviser, Associate Professor James Yip, on Monday (Nov 12) before the Committee of Inquiry (COI) looking into Singapore’s worst cyber attack.

In June, the personal data of 1.5 million SingHealth patients and the outpatient prescription information of 160,000 people, including Prime Minister Lee Hsien Loong, were stolen.

Prof Yip made the case that the Internet was important for MOH to meet its long-term objectives such as promoting health and improving illness prevention, providing care for patients and caregivers and developing new capabilities to manage costs.

“Any decision on the continuation of ISS for the entire public healthcare system will need to be viewed in this context,” he said.

Temporary ISS was imposed on SingHealth on July 19, followed by the National University Health System  and the National Healthcare Group on July 22, as a precautionary move to safeguard IT systems and confidential patient data after the SingHealth cyber attack.

Health Minister Gan Kim Yong told Parliament in August that the Government was studying ways to make ISS a permanent measure in some parts of the public healthcare system following the SingHealth attack, even as he acknowledged the inconveniences such as longer waiting times for consultations.

“We will need to develop longer-term mitigation solutions to overcome the operational issues if ISS (Internet surfing separation) is to stay,” said Mr Gan.

Since the implementation of the ISS, Prof Yip said that the healthcare clusters have had problems with patient care.

For instance, without the Internet, consultation through the use of videoconferencing, which was used in a few hospitals, could not be done initially and a new dedicated leased line had to be set up.

Healthcare staff have also had to take additional steps to book screening appointments and upload test results for patients.

These steps involve the manual porting of information, causing delays in reporting and creating an additional risk of transcription errors.

Front-line patient administration has also been affected following the temporary ISS.

According to Prof Yip, staff now have to use a separate device to retrieve patient information, like medical insurance details, work permit status and Medisave balances.

“This initially led to lengthened patients’ wait times, as such Internet-enabled devices are shared. Also, such devices rely on [email protected], which has limited bandwidth and is time-consuming to log in to,” he said.

As a result, hospital staff have to use their personal mobile phones to carry out their work, and some hospitals have suspended their policies that disallowed this.

Hospitals and clinics have also spent “a significant amount of resources” to get more devices for their staff to use, said Prof Yip.

This sharing of multiple devices between staff has increased the time taken to perform tasks, he added. In some healthcare institutions, Prof Yip said staff are working overtime to do their work, which has led to an increased sense of fatigue.

Tasks associated with servicing and maintaining hospital equipment like diagnostic testing, remote troubleshooting or uploading of maintenance logs have been affected by temporary ISS, Prof Yip added.

In some cases, staff have to physically attend to these devices to update their firmware and perform diagnostics.

He said: “There is also the risk of patches or updates being missed, which could in turn pose cyber-security concerns.”

Prof Yip acknowledged that following the SingHealth attack, public healthcare staff have accepted the challenges of temporary ISS, and that patients have also accepted poorer service delivery standards, delays and inconveniences.

But the current situation is not sustainable, he added.

“The operational challenges highlighted above will inevitably translate into tangible manpower and financial costs, and reduced employee and patient satisfaction,” said Prof Yip.

“Ultimately, healthcare costs for the general Singapore public will rise. Given Singapore’s tight manpower constraints, the task of finding enough healthcare workers for the future will become even more challenging.”

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