RingMD was one of the first two providers in Singapore’s inaugural telemedicine regulatory sandbox. The collaboration demonstrated how regulators and operators can turn uncertainty into safeguards that scale.
Healthcare regulation had learned how to regulate a place. Telemedicine required it to regulate a service.
That was the mismatch Singapore confronted in 2018. The existing licensing framework centered on physical premises: clinics, hospitals and laboratories. Doctors practising telemedicine were still bound by professional and ethical requirements, but emerging direct-to-patient platforms did not fit neatly into a premises-based regulatory system.
Singapore could have forced the new model into old categories. It could have waited for the market to mature and regulated retrospectively. Instead, it created a third option: let regulators and providers learn from real services inside a controlled environment.
On 18 April 2018, Singapore’s Ministry of Health launched the Licensing Experimentation and Adaptation Programme, or LEAP, beginning with telemedicine. MOH named RingMD as one of the first two participating providers.
The premise was straightforward: keep the clinical standard fixed, establish clear operating boundaries, observe how remote care worked in practice, and use the evidence to build better rules.
Evidence-Based Partnership
RingMD entered the sandbox with a working direct-to-patient model. RingMD had launched the first direct-to-consumer telemedicine platform and digital healthcare marketplace in Asia in 2013. Patients in Singapore could consult a doctor by video and, when clinically appropriate, receive medication delivery, an electronic medical certificate or a referral letter. RingMD’s announcement at the time described the collaboration as a way to integrate telemedicine into Singapore’s healthcare system responsibly.
This was not a simulated technology trial. Real clinical encounters created immediate operational questions:
- How should a provider verify the patient’s identity?
- How should a doctor determine whether remote care is appropriate?
- What happens when a physical examination is required?
- How can emergency services reach a patient whose location is unknown?
- Who remains responsible for follow-up and continuity of care?
- What information should providers collect, protect and share?
A joint circular from MOH and the Singapore Medical Council described participants as “MOH sandbox partners.” It explained that providers could develop new models within defined patient-safety parameters, that MOH could request relevant service data, and that the sandbox would support the co-creation of telemedicine regulations.
The word partnership matters, but also, so do its limits. Providers did not regulate themselves. MOH retained its authority, established the boundaries and remained responsible for protecting the public. Providers contributed operating experience that could not be reproduced in a conference room.
The sandbox logo signified participation in that supervised process. It was not a permanent licence, a commercial endorsement or a guarantee of clinical outcomes.
Lesson One: Keep the Clinical Standard Fixed
The most important principle was also the simplest: telemedicine remained medicine.
During the 2020 debate over the Healthcare Services Bill, MOH described telemedicine as an extension of medical practice and said doctors were expected to deliver the same quality and standard of care as in-person medicine. When a doctor could not make a sufficiently informed judgment remotely, the patient had to be referred for an in-person assessment.
The sandbox experimented with the systems required to uphold that healthcare duty at a distance, not lowering the duty of care.
That distinction remains useful well beyond telemedicine. The arrival of a new delivery channel does not make the underlying professional obligation negotiable. What must change is the surrounding workflow.
Lesson Two: The Real Product is the Care Pathway
A video call is only the visible surface of telemedicine. The actual service includes patient selection, identity, location, assessment, documentation, privacy, prescribing, escalation and follow-up.
When MOH closed the telemedicine sandbox in 2021, it identified several controls that had emerged from collaboration with the provider community. These included using live video to authenticate patients and assess visual cues, as well as obtaining a patient’s exact location at the start of a consultation so emergency services could be directed there if necessary.
These may sound like mundane operating details. That is precisely why they matter.
A polished application without an escalation pathway is not a complete healthcare service. Neither is a convenient consultation that produces fragmented records or leaves the patient unsure where to go next. In healthcare, operational details are often the innovation.
Lesson Three: Collaboration can Shorten the Learning Cycle
In a conventional sequence, companies build while trying to predict future rules. Regulators write rules while trying to imagine future business models. Both work with incomplete information.
The sandbox put those activities into the same feedback loop.
The programme eventually expanded to 11 providers with different business and care models. Across that full cohort, MOH reported more than 40,000 unique teleconsultations, with no major patient-safety issues or complaints reported. MOH also interviewed doctors and patients while developing process and governance controls. Those results were reported when the sandbox closed in February 2021.
One of the key value adds of this regulatory approach was that it replaced some assumptions with actual, observed behavior.
The learning then became reusable. MOH launched a telemedicine training programme in March 2020. By February 2021, more than 6,200 people had completed it, and close to 500 providers had committed to the training, process and governance measures required for an interim voluntary listing.
A small supervised cohort had helped turn tacit experience into controls that a much larger market could understand and adopt.
Lesson Four: Regulate the Service Instead of Its Address
LEAP did not create the Healthcare Services Act. Singapore was already developing a services-based licensing framework. The sandbox helped ensure that telemedicine-specific requirements reflected actual practice.
The resulting framework represented a significant conceptual change. Instead of regulating healthcare primarily according to the premises from which it was delivered, the HCSA regulates licensable services and their modes of delivery - including remote provision.
Teleconsultations and telemedicine platforms entered formal service-based licensing on 26 June 2023. Current requirements address such matters as real-time audiovisual communication for first-time patients, determining whether a condition can be managed remotely, arranging in-person care when it cannot, and completing prescribed telemedicine training.
The application may change. The location may change. The accountability follows the service.
Looking back in 2025, the CEO of Singapore’s Health Sciences Authority said the telemedicine sandbox had allowed regulators and private providers to understand risks, examine different business models and co-create mitigations. He concluded that it had paved the way for licensing under the HCSA.
Lesson Five: Graduation Initiates Governance
A successful sandbox should eventually make itself unnecessary.
MOH discontinued the telemedicine sandbox after determining that its objectives had been met. Its lessons had moved into training, market-wide process controls, interim governance measures and, ultimately, formal licensing.
But graduation from a sandbox is not permanent certification. As the market scales, incentives change and new risks emerge. In 2025, MOH reported investigations into providers for issues including inadequate clinical assessments, failure to conduct required video consultations and inappropriate advertising.
That later enforcement does not invalidate the sandbox. It reinforces its central principle: regulation must remain connected to what providers and patients are actually doing. The learning loop cannot close simply because legislation has taken effect.
RingMD’s Foundational Place in the Story
Being one of the first two participants did not make RingMD the sole author of Singapore’s eventual telemedicine rules. That being said, RingMD played a critical and fundamental role in helping to develop the initial regulatory sandbox guidelines, requirements and governing approach. RingMD’s team worked closely with the Singapore Ministry of Health and other regulatory bodies for nearly 1 year before the launch of the sandbox.
RingMD’s role was more precise - and more credible. It was among the earliest companies to put a functioning direct-to-patient model inside the collaborative learning process, at a moment when the rules for that category were still being developed.
RingMD brought the provider’s view of clinical workflows, technology and patient experience. MOH brought a system-wide perspective, regulatory authority and responsibility for public welfare. The value came from placing those different forms of knowledge against the same real-world problems.
That is what genuine regulatory collaboration looks like.
The Lesson for the Next Generation of Healthcare Technology
The same model can be applied to AI-assisted care, remote diagnostics, home monitoring and other services that do not fit comfortably inside established categories:
- Preserve the underlying clinical duty.
- Define the risks and operating boundaries.
- Test real services under supervision.
- Collect evidence from providers, clinicians and patients.
- Convert the learning into controls and training.
- Establish a path into permanent regulation.
- Continue monitoring after the market scales.
The choice is not between innovation and regulation. It is between regulation written at a distance and regulation informed by the system it must govern. That’s the key nuance.
Singapore’s telemedicine sandbox succeeded not because rules disappeared. It succeeded because uncertainty became specific obligations - and those obligations could scale. RingMD was humbled and honored to support and play a key role in making healthcare more accessible and safer in Singapore and beyond.