探討後疫情時代遠距醫療的法制規範與走向

Study in the Legal Norms and Trends of Telemedicine After Post-pandemic Era

新冠疫情期間，為避免眾多人與人的接觸以及居家隔離不得外出的就醫限制，世界各國紛紛鬆綁遠距醫療的法規管制，促使遠距醫療的蓬勃發展。但是疫情過後，是否仍然採取鬆綁措施？還是回歸醫師法第11條第1項但書原有的規定，僅限山地、離島、偏僻地區民眾可以使用？倘若解封之後，仍然維持鬆綁措施甚至開放跨國的遠距手術的適用，將有以下諸多的法律議題有待解決，例如：是否對於要求遠距醫療的「初診」病人拒之門外？一旦遠距醫療發生醫療糾紛，醫師、平台、病人三方面的舉證責任如何分配？告知後同意法則應如何修正，以期適用於無法當面溝通的醫病關係？遠距醫療造成醫療過失的歸責問題，皆需要釐清。全民健康保險是否仍然對於全民有遠距醫療給付？遠距醫療的視訊傳送過程，比電子病歷多出許多手續與經由操控網路的工程師或電腦機組的維修人員，電腦公司保全人員也非醫事人員，不受醫師法第23條或護理師法第28條保密義務的拘束，並且成員眾多且複雜，個人病歷的資訊應如何保護才可以相較於單純的電子病歷管理更加妥善？跨國遠距手術對近端的病人而言屬於無照行醫，再加上語言隔閡，病人對於手術的術式（如惡性腫瘤切除範圍的大小、取走淋巴結的多寡等）選擇將影響術後的生活品質，若有歧異應如何防範？在無法面對面的情況下如何建立良好的醫病關係？對於上述法律議題，本文以遠距醫療歷史最悠久的美國法為主，以及歐盟、日本等先進國家的法律規範，尋求解決之道。

During the COVID-19 pandemic, in order to avoid a lot of people-to-people contact and the restrictions on medical treatment that are not allowed to go out at home, countries around the world have loosened the regulations and controls of telemedicine, which has promoted the vigorous development of telemedicine. However, after the pandemic, will relaxation measures still be taken? Or return to the original provisions of Article 11, Paragraph 1 of the Medical Care Act, which can only be used by people in mountainous areas, outlying islands, and remote areas? If after the lockdown is lifted, the loosening measures are still maintained or even the application of transnational telesurgery is still open, there will be many legal issues to be resolved, such as: Should “first-time consultation” patients who require telemedicine be revised? Once a medical dispute occurs in telemedicine, how will the burden of proof of the physician, the platform, and the patient be allocated? How should the informed consent rule be amended to apply to doctor-patient relationships where face-to-face communication is not possible? The issue of attribution of medical negligence caused by telemedicine needs to be clarified. Does our country’s universal health insurance still pay for telemedicine of everyone? The video transmission process of telemedicine requires many more procedures than electronic medical records, such as requires engineers who control the network or maintenance personnel of computer units. The security personnel of computer companies are not medical personnel, and are not subject to Article 23 of the Physicians Act or Article 28 of the Nursing Personnel Act. Due to the constraints of confidentiality obligations, and many and complex members, how should the information of personal medical records be protected so that it can be more properly managed than the simple electronic medical record management? Transnational telesurgery is an unlicensed practice for near-end patients, coupled with language barriers, the patient’s choice of surgical procedures (such as the size of the tumor resection range, the number of lymph nodes removed, etc.) will affect the postoperative outcome. How to prevent differences in the quality of life after telesurgery? How to establish a good doctor-patient relationship when face-to-face is not possible? Based on the above legal issues, this article focuses on the US law with the longest history of telemedicine, as well as the legal norms of the European Union, Japan and other advanced countries to seek solutions.