This article first appeared in Digital Edge, The Edge Malaysia Weekly on May 26, 2025 - June 1, 2025

Telemedicine played a pivotal role in Malaysia’s healthcare system during the Covid-19 pandemic, offering a safe and convenient way to access medical services from home. Recognising this, the government — in collaboration with Futurise Sdn Bhd, which manages the National Regulatory Sandbox, and other industry stakeholders — launched the Online Healthcare Services Regulatory Lab (OHS RegLab) in 2022. The initiative was designed to support the development of regulatory frameworks for this rapidly growing sector.

Although the OHS RegLab guidelines lapsed at the end of 2023, they continue to be used by industry players as a stopgap measure in the absence of formal regulations. The guidelines now form the basis of the forthcoming Digital Health Act. 

“The OHS RegLab initiative dates back to 2018. Multiple labs were held, engaging digital health providers in extensive discussions. While tremendous effort went into it, the final output has yet to be released. We are now finalising these guidelines, which may either be published soon or be superseded by the Digital Health Act,” says Dr Maheshwara Appanan, director of the Ministry of Health’s (MoH) digital health division, which was set up last year to oversee digital healthcare at the policy level. 

The proposed legislation, expected to be tabled in parliament in 2026, aims to provide comprehensive guidance to ensure the safe, effective and standardised delivery of digital healthcare services. It will also support MoH’s broader digital transformation agenda, including the “One Individual, One Record” initiative, which is already underway through the implementation of electronic medical records (EMR) across public health facilities.

Proper regulations and clear guidelines for the adoption of digital health technologies remain a key missing component, one that could push the national healthcare system to the next stage of development.

Meanwhile, teleconsultation services are expanding at private hospitals, driven by providers such as DoctorOnCall, Doc2Us and Qmed Asia. According to reports, Minister of Health Datuk Seri Dzulkefly Ahmad revealed that 376 government clinics had adopted virtual consultations by 2023, with the figure increasing by 65% since.

Current MoH guidelines require first-time patients — particularly those with non-communicable diseases (NCDs) — to attend in-person consultations. Telemedicine is permitted only for follow-up appointments, as outlined in the 2022 Garis Panduan Perkhidmatan Konsultasi Secara Maya.

The ministry also utilised video conferencing platforms such as Google Meet to consult housebound patients during the pandemic. This service was extended to 300 public clinics after the pandemic.

“During the pandemic, we digitalised the entire end-to-end patient care process, with telemedicine as one of the key components. It was a breakthrough that catalysed further initiatives by the family health development division to institutionalise telemedicine more broadly,” says Maheshwara.

However, the regulatory vacuum presents several risks, including bogus doctors offering illegitimate consultations, patients receiving incorrect prescriptions and the misuse of digital platforms to access controlled medications using falsified identities.

Currently, companies are not legally required to recognise digital medical certificates (MCs). On top of that, e-prescription (including delivery of medication) is prevalent in the private healthcare sector, but has yet to be recognised by public health facilities.

“What the industry needs right now is guidance. We are pushing for health guidelines to be published soon to provide clarity for digital health stakeholders. Even though the Digital Health Act is on its way, having interim guidance is highly beneficial,” says Maheshwara.

With the increasing sophistication of artificial intelligence (AI) technology, there remains no definitive way to detect deepfakes or AI-generated filters should a patient use them during a teleconsultation. These are among the issues the forthcoming legislation aims to address, alongside broader concerns around the integration of advanced technologies in teleconsultation. The proposed law is expected to further reinforce Malaysia’s digital healthcare framework across the public and private sectors.

Checks with OHS providers indicate that the country already possesses the key components and solutions needed to build a symbiotic and comprehensive telehealth ecosystem. What is lacking are the policies to effectively integrate them.

OHS providers are optimistic that a Digital Health Act would mark a positive step for Malaysia’s healthcare landscape, particularly in the light of the pressures facing the public health system, the challenges of rural healthcare access and the needs of an ageing population.

Maheshwara acknowledges the enormity of the task ahead but remains confident in the government’s ability to deliver a comprehensive policy that addresses not only curative care but also preventive healthcare.

“If our regulations can catch up quickly, the workload [in the healthcare system] will be alleviated. Digital healthcare providers like us are also pushing for it because we need to move ahead with technology. All we need to do is fine-tune [the policies],” says Reuben Poh, director of BookDoc.

Despite challenges such as the rapid pace of technology adoption, regulatory gaps and the need for greater patient acceptance of telehealth services, DoctorOnCall co-founder Hazwan Najib remains optimistic. Malaysians are already digitally savvy. What remains is for the government to take on a catalytic role alongside the private sector, he says.

“Policymaking has to be advanced and industry-led. It has to move a lot faster if we were to actually adopt all this technology [to scale up in the healthcare space]. Patients are digitally very savvy, hence telemedicine specifically is the easiest form of technology to adopt,” says Hazwan.

DoctorOnCall and BookDoc were participants of the OHS RegLab in 2022.

After the pandemic, demand for telemedicine declined, particularly in urban areas, as many patients preferred visiting clinics and consulting doctors in person. However, Maheshwara maintains that telemedicine remains relevant, particularly for serving hard-to-reach communities.

“We currently have around 511 active clinics offering telemedicine, and that number is growing,” he says, adding that MoH aims to expand virtual consultations for NCDs, maternal health, family planning and more across its 1,093 clinics.

MoH is working with the Malaysian Communications and Multimedia Commission (MCMC) and plans to leverage its National Information Dissemination Centre (NADI) to support teleconsultation services.

“Our strategy is simple. This is the rationale behind the creation of a dedicated digital health division. We’re focused on addressing the digital divide through collaboration. If we lack certain capabilities, we seek support from other agencies,” says Maheshwara.

“Previously, we used Google Meet. But now, the ministry has developed its own telemedicine platform. Patients can now use MySejahtera to connect with healthcare providers.”

While telemedicine offers unprecedented access to healthcare, MoH also recognises its potential downsides, including concerns about data security and patient privacy. In addition, the digital divide threatens to worsen existing health disparities.

The power of AI is undeniable. It has enabled the healthcare sector to automate administrative tasks, enhance diagnostic accuracy, personalise treatment plans and support remote patient monitoring. AI-powered tools can also analyse medical images, predict disease outbreaks and manage preliminary patient interactions through chatbots.

MoH is exploring the use of AI-driven electronic triage systems to help reduce long waiting times at public hospitals and clinics. “This could help reduce congestion in emergency departments by enabling patients to interact with validated AI-based systems before seeing a doctor,” says Maheshwara.

Nevertheless, a number of complex technological challenges must be addressed to ensure that Malaysia’s telehealth ecosystem remains safe and secure. One such matter is the issuance of digital MCs, which continues to be contentious. Singapore’s health ministry, for example, recently tightened regulations following complaints about excessive and potentially fraudulent MCs issued via teleconsultation.

Authorities had observed repeated issuance of MCs to the same patients without physical examinations or follow-up assessments to verify the legitimacy of their illness. This raised concerns about possible malingering and abuse of medical leave entitlements.

Maheshwara notes that regulating digital MCs requires rigorous legal processes as MCs are admissible documents in court. At present, there are no laws permitting the issuance of digital MCs via phone or video consultations.

Private players, like DoctorOnCall, believe tapping into digital MCs can help alleviate the issue of unnecessary costs and waiting times in clinics. 

“[Digital MCs] can be rolled out for the, for the employees’ convenience because if you don’t allow online MC, employees still have to go to the clinic, which is going to cost more. [With players like us] you pay for the consultation and then medication. There are no additional charges for MCs or referrals,” says Hazwan. 

He says the company has the capability to offer prescriptions, MCs and referrals. However, the company adopted a cautious approach, deciding not to offer MCs directly to the general public but implementing a system where MCs are available to corporate members, contingent upon approval from their Human Resources department. 

This approach ensures that MC issuance is governed by company policy, mitigating concerns about using MCs for malingering or potential abuse.

OHS providers are similarly cautious. Patient verification is a key concern, says BookDoc’s Poh, adding that a reliable electronic know-your-customer (e-KYC) process must be in place.

“Validating the person is important because how will the doctor know if the person they are speaking to is really them and not a deepfake? This also translates to the digital MCs because what if it is issued to the wrong person for the wrong diagnosis? Currently, there is limited legal recognition of digital MCs in Malaysia and it remains unclear how courts would treat them in disputes,” he adds.

“Right now, it’s up to the company to accept it. But I hope it will be accepted because most people need an MC to have a day to rest and recover. Driving to the clinic when sick, just to get an MC, could be cumbersome and costly, especially if it’s something like the flu or fever and the person already has the medication at home.”

BookDoc currently operates primarily on a business-to-business (B2B) basis, working with companies to promote proactive health initiatives such as healthy living challenges and digital wellness tools. Partner companies have the option to recognise digital MCs issued via the platform’s doctors, depending on internal HR policies.

Blockchain is one of the several technologies that can be explored to enhance the security of digital MCs, says Maheshwara. As blockchain records cannot be altered, any legitimate MC recorded on the system would have its details — including the issuing doctor, patient, signature, date and duration — securely preserved. Any attempt to tamper with the information would create a permanent and auditable trail, making unauthorised changes easily detectable.

“Digital MCs are better and more secure. A QR code can be encrypted onto them to validate and verify the certificate, unlike traditional paper MCs with stamps, which can be tampered with. We need to have the right guardrails in place,” he says, adding that he is optimistic about the idea, as it could help address many challenges.

“In the government sector, digital MCs are currently not permitted, and we do not issue MCs through teleconsultations. However, we are exploring this as a potential future option.”

Generative AI’s potential in telemedicine is shadowed by the deceptive threat of deepfakes. The ease with which AI can now fabricate seemingly authentic medical guidance from virtual personas or even manipulate real-time video consultations for impersonation, presents a critical risk. Such capabilities could erode public trust in the healthcare system.

“It is against regulations, but at the same time, the responsibility also lies with the doctor to determine what is real and what is fake. This issue carries significant ethical and legal implications that we must examine in depth,” says Maheshwara.

In the private sector, communications satellite operator Measat Satellite Systems Sdn Bhd, together with healthcare management and consulting firm Mudah Healthcare Sdn Bhd, is rolling out telehealth kiosks in rural areas, particularly in Sabah and Sarawak.

Leveraging Measat’s CONNECTme NOW broadband solution, the initiative aims to deploy 2,000 telehealth kiosks to support at least 1,000 rural doctors operating in areas covered by the service. The goal is to deliver timely healthcare and reduce health risks, says Measat’s chief commercial officer Ganendra Selvaraj.

“There are rural communities who have to travel 30km to 40km to the nearest clinic. If they have a serious health issue, the clinic is too far away for them to get critical care. But beyond just critical care, we also realised that for the ageing community, they would need to go for routine follow ups at the clinics. [And] that in itself is going to cost money and hours of travel time,” he points out.

Measat has already launched a pilot kiosk — Sihat Xpress — in Kampung Togop Darat 1, a village in Ranau, Sabah. The kiosk enables villagers to check their vitals for various non-emergency health concerns and consult doctors remotely from a secure, soundproof booth equipped with iPads. The booth includes devices to measure blood oxygen levels, blood pressure, body temperature, blood glucose and body weight — all connected to the system and the doctor on the other end of the line.

“[The kiosks] work better in environments where access to a doctor is difficult, so they would be more inclined to use this,” Ganendra explains.

The pilot has already delivered encouraging results, identifying individuals either living with or at risk of NCDs. “The data [collected from the villagers] showed that nearly 50% of the villagers were either hypertensive or near hypertensive,” he says.

With continuous monitoring, preventable NCDs such as high blood pressure, heart disease and diabetes can be better managed, reducing the need for frequent clinic visits.

From a rural healthcare perspective, this represents a game changer in delivering preventive care. From an urban standpoint, such kiosks could help ease overcrowding in healthcare facilities and reduce the overall burden on the healthcare system.

“These kiosks, we looked at it from a point how we could complement the healthcare system and not a kiosk that solves what a general hospital would do or even replace what a klinik kesihatan could do in entirety. Therefore the focus on NCDs.  We see ourselves as enablers of internet services that can drive essential applications in rural communities,” says Ganendra.

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