ASIA News

Yesterday, Orion Health announced a commercial agreement with Abu Dhabi Health Data Services, a new project company established as part of the Public Private Partnership (PPP) between the Department of Health-Abu Dhabi (DoH) and Injazat Data Systems, a subsidiary of the Abu Dhabi government-owned Mubadala Investment Company, to deliver a Health Information Exchange (HIE) platform. The HIE will be known as "Malaffi" and is the first of its kind in the Middle East. "Malaffi" will provide a platform that will centrally store and enable the meaningful exchange of patient health information between healthcare professionals and will ultimately connect 2,000 public and private healthcare providers in Abu Dhabi. Officially launched last week on 23 January, “Malaffi” is initially joined by six Abu Dhabi healthcare organizations, including SEHA (Abu Dhabi Health Services Company), Cleveland Clinic Abu Dhabi, Imperial College Diabetes Centre, Healthpoint, United Eastern Medical Services (UEMedical) group and Oasis Hospital, Al Ain. The access to the centralised patient records will provide physicians with a tool to make well informed, fast decisions, enhance patient safety, reduce the duplication of diagnostic procedures and ultimately improve the quality of care and outcomes. “The Department of Health-Abu Dhabi has recognised the need to centrally and efficiently, store, exchange, and analyse the enormous amount of data that is being created in healthcare every day, and by using advanced technologies, such as Artificial Intelligence (AI) and machine learning, to drive the digital transformation of the healthcare system, for a happier and healthier Abu Dhabi. The partnership with Orion Health, will enable us to deliver a best-in-class HIE platform, that will guarantee the success of connecting all Abu Dhabi healthcare providers, and place Abu Dhabi on the top of the global map of successful HIE implementations," said Atif Al Braiki, CEO of Abu Dhabi Health Data Services. “Orion Health is delighted to be selected as the partner of choice, to deliver UAE’s first HIE platform,” said Ian McCrae, CEO of Orion Health.

Earlier this week, the Ministry of Health (MOH) in Singapore made an announcement that confidential information regarding 14,200 individuals diagnosed with HIV up to January 2013, and 2,400 of their contacts, has been illegally disclosed online and is in the possession of an unauthorised person. This was yet another serious case of data breach in the healthcare system following the SingHealth cyberattack which happened in June to July last year with 1.5 million patient records being illegally accessed. A Committee of Inquiry (COI) was quickly formed and its findings were published earlier this month. For the case of the HIV data leak, MOH was alerted by the police on 22 January and the Ministry made a police report on 23 January. On 24 January, MOH ascertained that the information matched the HIV Registry’s records up to January 2013.From 24 to 25 January, MOH worked with the relevant parties to disable access to the information. The records were those of 5,400 Singaporeans diagnosed with HIV up to January 2013 and 8,800 foreigners (including work and visit pass applicants/ holders) diagnosed with HIV up to December 2011. The information included their name, identification number, contact details (phone number and address), HIV test results and related medical information. The name, identification number, phone number and address of 2,400 individuals identified through contact tracing up to May 2007 were also included. Background The confidential information is in the illegal possession of Mikhy K Farrera Brochez, a male US citizen who was residing in Singapore, on an employment pass, between January 2008 and June 2016. Brochez was remanded in prison in June 2016. He was convicted of numerous fraud and drug-related offences in March 2017, and sentenced to 28 months’ imprisonment. The fraud offences were in relation to Brochez lying about his HIV status to the Ministry of Manpower, in order to obtain and maintain his employment pass, furnishing false information to Police officers during a criminal investigation, and using forged degree certificates in job applications. Upon completing his sentence, Brochez was deported from Singapore. He currently remains outside Singapore. Brochez was a partner of Ler Teck Siang, a male Singaporean doctor. As the Head of MOH’s National Public Health Unit (NPHU) from March 2012 to May 2013, Ler had authority to access information in the HIV Registry as required for his work. Ler resigned in January 2014. He was charged in Court in June 2016 for offences under the Penal Code and the Official Secrets Act (OSA). In September 2018, Ler was convicted of abetting Brochez to commit cheating, and also of providing false information to the Police and MOH. He was sentenced to 24 months’ imprisonment. Ler has appealed, and his appeal is scheduled to be heard in March 2019. In addition, Ler has been charged under the OSA for failing to take reasonable care of confidential information regarding HIV-positive patients. Ler’s charge under the OSA is pending before the Courts. According to an article by The Straits Times, it is understood that Ler no longer has a certificate to practise medicine in Singapore and no longer has access to the confidential information of patients in the National Electronic Health Records (NEHR), which includes all public-sector patients. Timeline of events leading up to the leak May 2016 - MOH had lodged a police report after receiving information that Brochez was in possession of confidential information that appeared to be from the HIV Registry. Their properties were searched, and all relevant material found were seized and secured by the Police. May 2018 - After Brochez had been deported from Singapore, MOH received information that Brochez still had part of the records he had in 2016. The information did not appear to have been disclosed in any public manner. MOH lodged a police report, and contacted the affected individuals to notify them. 22 January 2019 - MOH was notified that more information from the HIV Registry could still be in the illegal possession of Brochez. On this occasion, he had disclosed the information online. What could have happened This incident is believed to have arisen from the mishandling of information by Ler, who is suspected of not having complied with the policies and guidelines on the handling of confidential information. Additional safeguards in disease registries Since 2016, additional safeguards against mishandling of information by authorised staff have been put in place. For example, a two-person approval process to download and decrypt Registry information was implemented in September 2016, to ensure that the information cannot be accessed by a single person. A workstation specifically configured and locked down to prevent unauthorised information removal was designated for processing of sensitive information from the HIV Registry. The use of unauthorised portable storage devices on official computers was disabled in MOH in 2017, as part of a government-wide policy.

Last week, the House Committee on Health in the Philippines House of Representatives chaired by Rep. Angelina Tan approved a substitute bill seeking to establish the National eHealth Systems and Services that shall deliver health services through cost-effective and secure information and communications technology (ICT). WHY IT MATTERS The landmark measure provides for an organised and structured application of electronic health or "eHealth" integrated in the regular workflow of healthcare facilities. Specifically, it seeks to utilise ICT to deliver health services which has the potential to be profitable, improve quality, change the conditions of practice, and improve access to healthcare, especially in rural and other medically underserved areas. The bill also aims to facilitate the exchange and access to secured personal health information, ensure harmonisation or integration, alignment, and interoperability among various eHealth initiatives, and facilitate inter-agency and inter-sectoral coordination at various levels of governance in both public and private sectors. The measure mandates the Department of Health (DOH) as the lead agency to implement the Act and provides for the creation of an inter-agency and multi-sectoral National eHealth Steering Committee to serve as an executive body of the Philippine eHealth System and Services (PNeHSS). Among the changes approved and introduced in the substitute bill is the provision for public-private partnership of eHealth Services. The bill mandates the DOH to promulgate the rules regarding the participation of the private sector in the provision of eHealth services and solutions, including public-private partnerships and other suitable arrangements. An additional provision on research and development was also introduced and will be accomplished through the formulation of expanded eHealth research priority areas under the National Unified Health Research Agenda (NUHRA) as well as the establishment of knowledge hub and research centers for eHealth that study, among others, capacity building, health technology assessment, knowledge management, standards development, and research utilisation. The approved bill also details violations of the Act and corresponding liabilities and penalties. For instance, the unauthorised processing of personal information shall be penalised by imprisonment ranging from one to three years and a fine of P500,000 to P2 million. The unauthorised processing of sensitive personal information shall be punished by imprisonment of three to six years and P500,000 to P4 million. Other violations include accessing personal information and personal sensitive information due to negligence; improper disposal of personal information and sensitive personal information; procession of personal information and personal sensitive information due to negligence for unauthorised purposes; unauthorised access or intentional breach; concealment of security breaches involving sensitive personal information; malicious disclosure; and unauthorised disclosure. Any person who commits a combination or series of these acts shall be subject to imprisonment ranging from three years to six years and a fine of P1 million to P5 million. THE LARGER TREND According to the official eHealth website by the DOH, two main challenges of the Philippines’ health system are access to health care services, and access to real time information for decision making. 70% of the population living in rural areas are still struggling with no or limited access to quality inpatient and outpatient care services. Delayed access to timely, reliable, accurate, and complete health information contributes to the challenges faced by decision makers. This condition is further exacerbated by various health data coming from disparate systems that use differing formats, lacking harmonisation, and putting additional strain on already compromised data quality. Based on the Philippines eHealth Strategic Framework and Plan 2014-20, the DOH envisions that “By 2020, eHealth will enable widespread access to health care services, health information, and securely share and exchange client’s information in support to a safer, quality health care, more equitable and responsive health system for all the Filipino people by transforming the way information is used to plan, manage, deliver and monitor health services.” With the proposed National eHealth Systems and Services Act approved, there is some progress made in the governance component of the eHealth vision but much of the real work will lie in the establishment of the necessary foundations – infrastructures, standards, rules and protocols for the effective implementation of eHealth services, processes and solutions. ON THE RECORD “The Department of Health welcomes the new version of this Act because the future of health is being designed with eHealth, the use of information communications technology in health,” DOH Assistant Secretary Enrique Tayag said. He also suggested that the measure should more clearly provide that private entities are free to use ICT in their delivery of health services.

In December 2018, Thailand’s Ministry of Commerce announced plans to put medical-related fees, including drugs, supplies and service charges, on the price control list of the government’s central committee on prices of goods and services. On January 9 2019, the plan was approved and the Thai government added medicine, medical supplies and medical services to its price control lists, which was announced by Minister of Commerce Sontirat Sontijirawong. A subcommittee has been formed to work out measures to control their prices, which consists of representatives from the ministries of commerce and public health, insurance associations, the Private Hospital Association, the Foundation for Consumers and the National Health Security Office, Minister Sontirat said. Impact on digital health adoption With the implementation of price controls on medical supplies and services, the impact would mostly likely be felt by the private hospitals and healthcare providers since their revenues and profits would be adversely affected. However, on a broader level, the price controls could result in a nationalised standardisation of healthcare terminologies and delivery in terms of how services are ordered. Currently, most hospitals in Thailand, especially those in the private sector, have unique software programs that are designed specifically for their internal use and operate quite comfortably within each institution’s legacy IT systems. What this also means is that it is virtually impossible for electronic information-sharing across hospitals but the price controls may pave the way for a more standardised way of recording health information to facilitate reimbursement both for healthcare providers and payers/insurance providers. A more standardised method of recording and sharing of health information at the national level using IT brings with it several benefits – patients can move across different healthcare organisations without having to bring along their physical paper medical records, reduction of diagnosis/prescription errors as clinicians have a more comprehensive medical record of their patients and potential opportunities for population health analytics with a unified national electronic health record. While the move towards a unified national electronic healthcare record in Thailand may take some time and effort to realise, the new price controls presents a shake-up and enormous opportunities for both public and private healthcare providers to provide more value and quality to their patients through leveraging health IT technologies.

In an effort to deliver on safety for patients through the establishment of protocols around AI, the Royal Australian and New Zealand College of Radiologists (RANZCR) has created a working group that determines how the technology fits into the world of radiology and healthcare. Composed of practicing radiologists, data scientists, computer scientists and professionals in AI, the working group will explore what AI means for radiologists, the safety of the technology and training needed for doctors to use it. RANZCR President Dr Lance Lawler said that the group will also be working towards evaluating the impacts of the technology, the ethics of it, as well as how it fits into accreditations and regulatory frameworks. “We’re trying to be proactive with it so that we don’t end up in a situation where implications are not thought through,” he added. “Nowhere have we seen anyone seriously looking at these issues, which is often the way that regulations and new technologies come about. We want the technology to be used so that the benefits of it are reaped without being exposed to undue risk.” According to Dr Lawler, AI is of huge potential to radiology as it’s “very good at image recognition and pattern recognition”, which the field uses for image analysis to diagnose and follow up on diseases. But, even with the increasing hype around AI, there has not been enough work done to understand what the technology is, what it will be good for, what the risks of it are and how it can be applied to deliver better quality, lower cost healthcare to Australian patients, he said. As such, the organisation is embarking on a multi-layered approach to the issue. Dr Lawler said it will be looking into how AI is working in other countries, particularly in the US, with the FDA approving certain AI algorithms for use under certain conditions. “We want to understand their approach, and how that applies to us,” he said. On the other hand, it will be looking at bringing to market a training element that educates medical practitioners about the technology. “This new technology will be a tool that doctors use, so they have to know about this technology in order to deliver safe healthcare to their patients. The training element will look into what they need to know, how it will be delivered, how it will be assessed, etc.” The working group is also collaborating with Standards Australia to focus on standards and regulation. “We’re working with Standards Australia to decide what the standards are that need to be met, as well as the minimum standards for the applications of the technology, and then use those standards as the basis for safely regulating it, the way that everything else is regulated in healthcare,” Dr Lawler said.    He addressed the need for a more combined, coherent response from government departments to actively investigate the use of this technology and involving medical academia and healthcare providers in strategy for it. “The ministries and regulatory bodies have been conspicuously quiet with AI, so we’d like to start engaging them in even basic discussions about this technology because it will make a very big impact, it’s only a matter of when.” Is AI replacing radiologists? Dr Lawler also spoke about concerns that roles will change significantly with AI infiltrating the market, in terms of machines replacing work done by radiologists. “There has been a lot of hype around this technology, some resulting in statements made about the future of radiology. They suggest that radiologists will be replaced by machines. Hypes aren’t based on facts and this is just an assumption,” he said. “There’s always going to be work for radiologists and it may just be an issue of reapplying people to different areas. There is fear of the unknown and the purpose of the working group is to put some shape around this whole issue so that people aren’t afraid of it.” At the moment, there’s very little impact of AI on health and radiology because it’s not being used to its full potential and is still under development, according to Dr Lawler. But he said AI is the “next big thing for the industry” and “is a great move for society as a whole”. “This is because there are some things that AI can do better than humans, but there are also some things that humans do better than AI so, we need to find a way to balance the two to deliver better quality healthcare overall,” he said. “And the best way to do that is to get ahead of the curve than be chasing our tails, which happens a lot in healthcare. “We want to get to a point where there’s an accepted and routine use of certain AI tools for some clinical circumstances. For radiology, that may be for breast cancer or lung cancer screening, or comparing responses to treatment – basically in high volume, repetitive cases that machines can do easily.” This article originally appeared on Healthcare IT News Australia.

DeepQ, the healthcare division of HTC, yesterday announced a deployment of HTC VIVE™ hardware at Taipei Municipal Wan Fang Hospital to create the first multiuser patient education room in VR. Using VIVE Focus (a stand-alone VR headset from Vive) with the VR human patient education application, surgeons and families can join a shared VR world where surgeons can explain surgical procedures and educate patients. “Vive Focus can be used as a tool to break down barriers between doctors and their patients to improve care and drive education of patients to new levels,” said Edward Chang, President of HTC’s DeepQ division. “With Vive Focus, medical consultation can become mobile and more approachable to patients and doctors alike. We’re proud to work with Taipei Municipal Wan Fang Hospital to explore how VR can begin to change medicine.” “In the past, it has been difficult to educate patients on the impacts of a procedure or medical need. Through VR, physicians can now easily talk to patients about human organ structures and treatment plans in a shared environment,” said Kuan-Jen Bai, Dean of Taipei Municipal Wan Fang Hospital. A typical patient consultation today can involve human anatomy models, however, micro structures such as nerves, vessels, and lymph nodes are difficult to be displayed. Using VR, patients can more easily understand the impact of diagnosis and treatment plans alongside their physicians.  In the future, Wan Fang Hospital will also integrate the VR education platform with the Health Information System (HIS) system of the hospital's patient educational review system. After each VR patient education, the public, the family, and healthcare personnel’s review will be digitalised. According to a market forecast on VR in the healthcare market that was published in March 2018, it is predicted that VR technologies will enjoy a 54.5 percent compound annual growth rate in healthcare over the period of 2017-2023. Currently, most of the established VR offerings in healthcare often fall under a few major use cases, including education and training for physicians, and distraction therapy for inpatients and seniors. However, ever-advancing technology and growing acceptance by physicians and patients alike has many digital health researchers excited to investigate more novel clinical use cases and tackle the various hurdles that remain for VR.

New Zealand’s largest primary health organisation (PHO), ProCare, has selected Indici after a year-long practice management system (PMS) review. ProCare chief executive Steve Boomer says, “The ProCare PMS review steering group and ProCare Board have reached agreement that Indici is the system best suited to our needs. “However, we cannot recommend this as a preferred system until we have reached a suitable commercial agreement with Valentia Technologies, Indici’s parent company.” Indici was developed by Valentia in conjunction with Ventures, the commercial and innovation arm of Pinnacle Primary Health Network. The cloud-based mobile PMS supports the Health Care Home model of general practice, which is being adopted by PHOs across the country, and involves improving access to care by offering telehealth options for patients. Seven vendors started in the review process and were narrowed down to Indici and US-based Epic in mid-2018. Tū Ora Compass Health, Te Awakairangi Health Network and Central PHO have also committed to rolling out Indici. Valentia president technical services Ahmed Javad says the review was an extremely thorough and well-managed evaluation process. "We are looking forward to completing contractual arrangements and then embarking upon an exciting transformation journey with ProCare member practices," he says. Boomer says the PHO’s members were updated on progress at the end of last year, and are “encouraged to get in touch with us to discuss any specific needs they may have with their PMS”. “We thank the steering group, made up of GPs, practice nurses and managers from our network, for their dedication to the 12-month review process,” he says. “There were many different perspectives provided by steering group members based on their own PMS experiences, all of which contributed to robust discussion and debate before reaching consensus.” Practices in the region predominantly use Medtech or MyPractice systems currently. An industry expert, who asked not to be named, says the decision is a major accomplishment for Indici. He predicted a steady flow of GPs changing systems.  “Practically the change burden around a practice migrating from one PMS to another is a non-trivial undertaking,” he says. This article first appeared on eHealthNews.nz.

Queensland Ambulance Service (QAS) has rolled out a digital system that aims to give paramedics greater access to a patient’s vital medical information in an emergency. The SafeMate emergency medical information program is under trial for Medibank customers with chronic illnesses that are living in Queensland. Patients must be enrolled under Medibank’s CareComplete chronic disease management service. The SafeMate program houses a patient’s medical and personal information that they enter online. QAS personnel can then access this data by scanning a QR code on a patient's SafeMate card using iPads. “This is crucial information that a patient wants the paramedic to know in a medical emergency,” Queensland Government Minister for Ambulance Services Steven Miles said. “Paramedics will use their operational iPads to tap the patient’s SafeMate card or device, and the medical information will appear on the screen. It eliminates the time it would normally take a paramedic to ask the patient a range of questions in order to obtain their medical history and other pertinent details.” This gives paramedics access to important information, such as details on allergies and medical history, letting them identify best courses of treatment earlier and improving patient outcomes. It also aims to reduce paramedic and patient stress, time-consuming hospital visits and costs in the health system, in addition to improving ambulance efficiencies. Prior to December 1 last year, paramedics were unable to access these records as the organisation was not in the Australian Health Practitioner Regulation Agency (AHPRA) regulated health profession registry.   The digital system is a testament to Queensland’s ongoing digitisation journey, with the launch of a digital hospital program to improve the state’s healthcare and patient outcomes.  In December last year, through findings from a report tabled by the Queensland Audit Office (QAO), Miles outlined the benefits of the digital hospital program in Queensland. He said that as a result of the digital hospital program, Queenslanders face improved health service delivery and patient outcomes, including a reduction in unplanned readmission rates, faster access of clinical information by medical staff and more legible patient records. “Digital hospitals are making Queensland hospitals safer than ever before. Doctors and nurses have told me when I’ve visited hospitals that the digital system helps them do their jobs and helps patients,” Miles said. Ambulance Victoria has also ramped up its digitisation strategy, with the organisation most recently announcing that it will soon deploy a predictive analytics platform for its paramedics to access real-time information, enhancing and accelerating its decision making as the need for emergency services grows. This article first appeared on Healthcare IT News Australia.

Northland District Health Board (DHB), which is based in Whangarei and covering the northernmost part of the North Island in New Zealand, has launched a web-based interactive version of the Health Needs Assessment (HNA). DHBs must produce an HNA report every 5–7 years as a way of monitoring the health and wellbeing of the population, as well as their need for health services. The reports are typically published as lengthy paper-based or PDF documents. Former Northland DHB clinician Juliet Rumball-Smith was instrumental in driving the development of an online HNA, which is intended to make the data easier to access and understand by anyone. Research associate Edith Bennett and data scientist Shameer Sathar at Northland DHB’s Health Intelligence Hub built the tool in-house using open-source software such as Python and Django. “There’s a lot of data already published, but it’s quite hard to access or understand, so we thought why not create an application where people can access information themselves and with interpretation already there,” Bennett says. “We can also update it as data becomes available, such as the Census 2018 data which will be published soon.” A survey completed with stakeholders before the new tool was published found that 86 per cent of respondents said the web-based format improved their ability to access the data. Sathar says future plans include making the tool more mobile compatible. “We’re also hoping to use it beyond the HNA by having forecasting and projections data available,” says Bennett. “Our real aim is to get a one-stop-shop for people to go to look for population health data specific to Northland.”   A version of this article first appeared on eHealthnews.nz.  

Minister for Health Gan Kim Yong delivered a ministerial statement on the Committee of Inquiry (COI) report on the SingHealth cyberattack in the Singapore Parliament on January 15 2019. In the statement, he said that the Ministry of Health (MOH) has appointed a Cybersecurity Advisory Committee to conduct a horizontal review of the cybersecurity governance structures and processes across the public healthcare clusters and Integrated Health Information Systems (IHiS), the IT agency for the Ministry. He also outlined four key responses to the COI report’s recommendations. The first is enhancing governance and organisational structures as there is a “need for clearer cybersecurity risk ownership and accountability between IHiS and the public healthcare clusters, underpinned by a strong relationship to avoid fragmenting the Ministry’s healthcare IT strategy.” At MOH, the Chief Information Security Officer (CISO) is currently also the Director of Cyber Security Governance at IHiS but these roles will be separated. The MOH CISO will be supported by a dedicated office in MOH and report to the Permanent Secretary. The MOH CISO office will be the cybersecurity sector lead for the healthcare sector. It will coordinate efforts to protect Critical Information Infrastructure in the healthcare sector, and ensure that the sector fulfils its regulatory obligations under the Cybersecurity Act.  For its part, IHiS will have its own separate Director of Cyber Security Governance. At the clusters, the cluster Group CIO office will now be made fully accountable to the respective cluster management and Boards. The GCIO office will be adequately resourced to carry out its role. The position of the Cluster Information Security Officer will be elevated to report directly to cluster management, and be accountable to the IT and Risk Management Committees of the cluster Boards. Secondly, a cybersecurity model with multiple lines of defence will be put in place. A more robust ‘Three Lines of Defence’ structure within the public healthcare: The first line comprises units and personnel who develop, deliver and operate the IT systems. This is the Delivery Group. MOH will strengthen the IT delivery group to better integrate cybersecurity into IT delivery initiatives, improve the management of network security, and increase emphasis on security architecture and monitoring.    The second line of defence comprises units and personnel who have the specific responsibility to oversee security strategy, risk management and compliance. MOH will strengthen and elevate this second line of defence by establishing a dedicated Cyber Defence Group in IHiS headed by a senior leader at or equivalent to the Deputy Chief Executive level. The strengthened group will have independent oversight of cybersecurity implementation, compliance and risk management, and will oversee incident reporting and management. This will ensure that cybersecurity is managed at the senior management level, and an appropriate balance is struck between service delivery and cybersecurity considerations.   The third line of defence comprises checks and assurances independent of IHiS and our healthcare clusters, and independent of the first two lines of defence. MOH Holdings Group Internal Audit will continue to play this role. MOH also intends to commission and tap on independent third parties where appropriate. The third aspect would be improving the cybersecurity awareness and capacity of staff. Starting this year, IHiS will engage specialist providers to conduct realistic hands-on “Cyber Range” simulation training to raise the competence of their security incident response personnel. IHiS also intends to learn from GovTech’s bug bounty and vulnerability disclosure programmes and start similar efforts. Lastly, a tiered model of Internet access will be considered. In its report, the COI has recommended that an internet access strategy which minimises exposure to external threats should be implemented. Following the cyberattack, temporary Internet Surfing Separation (ISS) was implemented across Singapore’s public healthcare sector. However, the implementation of the ISS has posed several challenges in the provision of patient care in some areas such as emergency care, decision-support for prescriptions and treatments, access to patient education resources, and booking of clinical appointments. ISS also caused delays to frontline patient management and backend administrative tasks. Research and education initiatives in the public healthcare institutions have also been impacted by ISS. The current model of ISS is still workable but there needs to be longer-term solutions that are more efficient and sustainable. One such solution is the “virtual browser”, which allows access to the Internet through strictly controlled and monitored client servers. The client server acts like a decontamination room in which a file is opened and only an image/copy of the file is taken and sent to the recipient. In this manner, any malicious material or hidden content is ‘left behind’ in the decontamination room, greatly reducing cybersecurity risks. This “virtual browser” pilot will begin in the first quarter in 2019 at the National University Health System. “Virtual browsers” will be deployed in selected job functions at selected departments and clinics. Some of the job roles participating in the pilot include frontline pharmacists, and emergency department clinicians. The conduct and evaluation of the pilot is expected to take about 6 months and MOH will closely with the Cybersecurity Agency of Singapore (CSA) to assess the cybersecurity adequacy of the solution. The effectiveness of the Virtual Brower will also be assessed. Mandatory contributions to the National Electronic Health Record (NEHR) system will continue to be deferred as it is undergoing a series of cybersecurity assessments conducted by the CSA, GovTech, and independent firm PwC. The NEHR will also be subject to further testing and reviews, including exercises to test its defences against targeted attacks, as well as business continuity and disaster recovery plans.