臺灣遠距醫療發展之臨床經驗回顧：1996-2026

A Clinical Experience Review of Telemedicine Development in Taiwan: 1996–2026

遠距醫療已由早期試驗性應用，逐步成為臺灣醫療體系中實際運作之照護模式之一。臺灣具備離島分布廣泛、多層級醫療體系與全民健康保險制度等結構性條件，提供了觀察遠距醫療臨床落地的重要場域。本文採敘述性文獻回顧方法，整合1996年至2026年間PubMed收錄之相關研究，並輔以政策文件與歷史資料，從臨床應用視角梳理其發展脈絡。結果顯示，臺灣遠距醫療起始於離島視訊會診與精神科遠距評估信度驗證，隨後逐步發展出以靜態影像非同步判讀為核心之服務模式，並隨行動通訊與雲端技術進展，擴展至心電圖、傷口照護、皮膚科及眼科等領域。2018年健保給付政策開放促成遠距醫療之規模化發展；2020年COVID-19疫情進一步加速即時視訊應用之普及；2023年「在宅住院」全國計畫則將遠距醫療整合進臨床照護流程，結合遠距監測與視訊查房，展現其於實務醫療系統中的應用潛力。整體而言，臺灣遠距醫療之發展反映臨床需求、技術演進與政策制度之交互作用，並呈現由單一應用走向跨場域整合之趨勢。本文期能拋磚引玉，鼓勵更多來自臨床、政策、公共衛生及醫療經濟等不同領域之專家，共同投入臺灣遠距醫療經驗之整理與發表。

Telemedicine has evolved from experimental applications to an essential component of health care delivery. Taiwan, characterized by its offshore geography, tiered health care system, and universal health insurance, provides a unique context to examine the integration of telemedicine and digital health. This narrative review synthesizes PubMed-indexed studies on telemedicine in Taiwan from 1996 to 2026, supplemented by policy documents and historical records, to analyze its clinical evolution and health informatics development. The findings show that telemedicine in Taiwan originated from offshore teleconsultation and early validation of remote psychiatric assessments and subsequently evolved into a system predominantly based on store-and-forward image interpretation. With the advancement of mobile communication and cloud-based technologies, applications expanded to electrocardiography, wound care, teledermatology, and teleophthalmology. The 2018 National Health Insurance reimbursement reform enabled large-scale implementation, while the COVID-19 pandemic in 2020 further accelerated the adoption of synchronous video consultations. The nationwide Hospital at Home program launched in 2023 has integrated telemedicine into acute care delivery through remote monitoring and virtual rounds. Overall, the development of telemedicine in Taiwan reflects the dynamic interplay among clinical needs, technological infrastructure, and policy frameworks, marking a transition from isolated applications to integrated cross-setting care. This review aims to provide a basis for further interdisciplinary research and discussion on Taiwan's telemedicine experience from clinical, policy, public health, and health economic perspectives.