SINGAPORE: MaNaDr, which had its clinic licence revoked last year for providing very short teleconsultations, has introduced new safeguards such as requiring these sessions to last at least one minute before a medical certificate (MC) can be issued.

This is one way the company is looking to tackle the questionable practices that were uncovered at its clinic located at the City Gate mixed development mall along Beach Road last year.

At a press conference on Wednesday (Apr 2), its co-founder and chief executive officer Siaw Tung Yeng said that the firm has also mandated audio recordings for all teleconsultations held, as well as tightened the onboarding process of clinics and doctors using its platform.

In addition, artificial intelligence (AI) has been used to enhance clinical standards such as an AI-powered note-taker that transcribes interactions between doctors and patients, as well as to consolidate prescribed treatment plans and other relevant medical records.

Having such an automated tool will allow doctors to “focus more on patient care”, Dr Siaw added.

So far, the AI model has been trained through 6,000 teleconsultations and has a “more than 90 per cent” accuracy rate.

Moving forward, MaNaDr intends to build on that and roll out an AI-powered “checker” that can assess these patient notes and suggest questions for doctors to ask during consultations and recommend alternative treatments.

“We respect and acknowledge the findings and decisions by (the Ministry of Health) … and have strengthened our platform’s governance and compliance, training and education with AI safeguards and innovation,” Dr Siaw said.

“While we are not able to govern doctors or clinics as a tech provider, we know we can better ourselves by implementing these guardrails, engaging more with our stakeholders – including clinics and doctors directly – and working closely with the relevant authorities to ensure alignment with best practices.

“Together, we aim to collectively uphold a safe, ethical and effective platform for digital care,” he added in a statement sent to the media after the press conference.

WHAT HAPPENED

On Dec 20, MaNaDr Clinic had its licence revoked by the Ministry of Health (MOH), which said that there was an “entrenched culture of disregard” for ethical and clinical standards.

This meant that the clinic could no longer operate at City Gate or on temporary premises such as patients' homes or remotely via teleconsultations.

MOH said then that its investigations revealed inappropriate practices such as more than 100,000 teleconsultations in a sampled month lasting one minute or less, with the shortest being just one second.

Others included patients being given multiple MCs over a short period, as well as “questionable and poor” documentation of patient case notes.

SEPARATE OPERATIONS

During the press conference, the company’s management sought to draw a distinction between its clinic operations and its telemedicine technology platform MaNaDr.

The two are businesses that are run separately under its parent entity Mobile-health Network Solutions, Dr Siaw said.

The licence that was revoked applies only to its physical clinic at City Gate, which is managed under a subsidiary called MaNaDr Clinic Pte Ltd.

Therefore, MOH’s order does not affect other parts of the business, notably its primary revenue driver: The technology platform that continues to provide telemedicine services to “50 to 100” clinics here in Singapore.

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”.

Echoing that, Dr Rachel Teoh, co-founder and board chair at Mobile-health Network Solutions, said: “I can tell you honestly, I do not see the management of MaNaDr Clinic.

“I run the holding company and what it means is that I run the day-to-day operations, hold meetings with my programmers to make sure the UX-UI (user experience - user interface) of the platform is done properly. That’s my role. "But if you ask me, do I run the clinic? The answer is 'no'.” 

As to why better technology safeguards were not put in place earlier, Dr Siaw said that the experience has been a learning process and the firm “will continue to innovate”.

He added that while the clinic was managed independently as a standalone entity and served by locum (relief) doctors, it was “still part of our network and fell short of our own and our stakeholders’ expectations”. “This is why it was a pivotal learning moment for us.”

MOH said earlier that 41 doctors who conducted teleconsultations for MaNaDr Clinic would be referred to the Singapore Medical Council for possible professional misconduct.

On whether these doctors have been banned from its platform, Dr Siaw said that the company continues to await a decision by the council. The company is also “not privy to all the information” in MOH’s investigations such as the identities of these doctors.

With the licence revocation, the company no longer operates any clinics in Singapore.

Although other parts of its business continue to operate, the incident has inevitably affected its business and overall trust in telemedicine services, Dr Siaw added.

However, the group continues to believe that telemedicine will be the “core modality” for affordable and accessible healthcare services, which is why it has put out more measures in the hope of regaining trust.

“We’ve been around for very long and we worked very hard to build trust in telemedicine,” Dr Teoh said. “We are not going to allow this to set us back and we will work even harder to … regain the trust.”