해외환자에 대한 원격의료의 허용 가능성

황원재 한국소비자법학회 2020 소비자법연구 Vol.6 No.2

Along with the coronavirus crisis, interest in telemedicine is increasing. However, there is a continual debate over whether to legislate provisions of active medical care between doctors and patients. Telemedicine continues to draw attention as a new growth engine, but the medical industry in Korea has been actively opposed to telemedicine for a long time. For the opposite reason, it is suggested that the accuracy of medical treatment is not guaranteed through telemedicine, the safety of medical practices is not guaranteed, the responsibility is not clear, and patients can be concentrated in large hospitals. It is understood that the medical law is also based on the principle of prohibiting telemedicine. However, it is clear that in any case in favor of or against telemedicine, telemedicine abroad will be active and technological progress will continue. It is also clear that countries that allow telemedicine will continue to provide telemedicine services to patients in Korea. Considering that it is realistically difficult to regulate foreign hospitals that do not comply with medical laws, there is a need to pilot telemedicine for overseas patients to the extent that it does not affect the domestic medical situation. This is because telemedicine for foreign patients is free from the problems mentioned by opponents of telemedicine. Of course, the medical and technical stability of telemedicine should continue to be reviewed. If a doctor based in Korea provides remote medical treatment to foreign patients, there will inevitably arise a controversy over the violation of Article 17(1) of the Medical Act on the prohibition of remote medical treatment. Therefore, it is necessary to revise Article 16, Paragraph 1 of the Act on Supporting of Overseas Expansion of Medical Services and Attraction of International Patients to enable telemedicine for foreign patients prohibited by Article 33, Paragraph 1 of the Medical Law. 코로나바이러스 사태와 함께 다시금 원격의료에 관한 관심이 높아지고 있음에도 의사와 환자 간의 적극적인 형태의 원격의료를 입법적으로 수용할 것인지는 계속 다투어지고 있다. 원격의료는 새로운 성장동력으로 지속적으로 주목을 받고 있으나 우리나라의 의료계는 원격의료를 오래 전부터 적극적으로 반대하고 있다. 원격의료를 통해 진료의 정확성이 보장되지 않고, 의료행위의 안전성이 담보되지 않으며, 책임소재가 분명하지 않고, 대형병원에 대한 쏠림현상이 발생할 수 있다는 것이 반대의 이유로 제시되고 있다. 의료법 역시 원격의료 금지원칙에 바탕을 두고있는 것으로 이해된다. 그러나 원격진료를 찬성하거나 반대하는 어떠한 경우라도 해외에서 원격진료가 활성화될 것이며 기술적 진보가 계속될 것이라는 점은 분명하다. 원격진료를 허용하는 나라에서는 우리나라에 지속적으로 원격진료 서비스를 제공하게 될 것이라는 점도 분명하다. 의료법을 준수하지 않는 해외 의료인에 대한 규제가 현실적으로 어렵다는 점을 고려해보면, 국내의 의료현실에 영향을 주지 않는 한도에서 해외환자에 대한 원격진료를 시범적으로 시작할 필요성이 있다. 해외환자에 대한 원격진료는 원격의료에 대한 반대입장이 언급하는 문제들로부터도 자유롭기 때문이다. 물론 원격의료의 의학적, 기술적 안정성에 대한 검토는 계속되어야 할 것이며, 한국에 소재하고 있는 의사가 역외에 소재하는 환자에게 원격의료를 제공하는 경우 의료법 제17조 제1항의 적용 논란을 피하기도 어려울 것이다. 따라서 일부 법 개정을 통해 원격매체를 통한 해외 원격의료행위가 가능하도록 개정할 필요가 있다.

한중 원격의료 정책비교 및 원격의료 발전 방안

남태광,정혜인,김경한 한의병리학회 2023 동의생리병리학회지 Vol.37 No.1

Due to COVID-19, the non-face-to-face era has arrived, and telemedicine has become a demand of the times in the medical community. Accordingly, this study aims to present a way to supplement Korea's telemedicine policy by comparing and analyzing domestic telemedicine policy and China's telemedicine policy, and analyzing the success factors of Chinese telemedicine. Domestic and foreign literature was explored to compare and analyze telemedicine policy cases of Korean, Chinese. Domestic and foreign national legal databases and web DBs were used, and literature were restricted between 2009 and 2022. Prior to COVID-19, the scope of telemedicine was very narrow in Korea, and only some pilot projects were operated. After COVID-19, the scope of telemedicine temporarily expanded, but no specific policies or systems were prepared. On the other hand, in the case of China, related policy institutional discussions on telemedicine have been actively conducted since the past, and accordingly, specific scope of application and related management norms and systems have been prepared. For the development of telemedicine in Korea, it is necessary to supplement the definition of telemedicine, ensure the accuracy and safety of non-face-to-face care through telemedicine, and solve the concentration phenomenon of large hospitals through limited conditions for hospital-level medical institutions.

원격진료에 대한 의료제공자와 이용자의 인식도

이현실(HyunSill Rhee),최만규(ManKyu Choi),김광환(KwangHwan Kim) 고려대학교 보건과학연구소 2004 보건과학논집 Vol.30 No.2

  Recently telemedicine, using information and communication technologies, continues to increase. Telemedicine includes all activities that deliver longdistance medical services and information by taking advantage of an interactive information and communication technology.<BR>  This study was conducted to investigate current telemedicine practice and the differences of opinions on telemedicine among medical providers and users. For the purpose of this study, a self-administered questionnaire was conducted with 250 medical employees, 50 public officials, and 200 residents in Seoul from July 15-24, 2004. The data for the empirical study were obtained by questionnaire using a 5-point Likert-type scale. The study sample consisted of 496(99.2% of the recipients) subjects who faithfully responded to the questionnaire. The major statistical methods included frequency and mean.<BR>  The major results of this study were as follows.<BR>  First, a preference for telemedicine, upon investigation, resulted in scores of 3.6 points for inhabitants, 3.6 points for public officials, and 3.5 points for medical employees respectively. All three groups showed similar preference. Second, the results of investigating applicable diseases by telemedicine for medical employees, inhabitants, and public officials were respectively as follows: diabetes(27.1%), diet(19.2%), cancer(15.7%); high blood pressure (31.4%), diabetes(27.2%), diet(16.7%); and diabetes(27.9%), high blood pressure (24.6%), diet(20.3%).<BR>  Third, factors to be considered for the effective practice of telemedicine were considered by medical employees, inhabitants, and public officials respectively to be as follows: correct diagnosis(32.8%), medical insurance fees(21.5%), equipment and facilities(16.0%); correct diagnosis(43.1%), medical insurance fees(23.8%), patient"s education(20.7%); and correct diagnosis (35.5%), telemedicine place(22.1%), medical insurance fees(13.9%). Overall, subjects in this study thought that a correct diagnosis should be considered the most important factor in the effective practice of telemedicine.<BR>  Fourth, subjects in this study considered that the home to be the most suitable place for telemedicine(medical employees 39.6%, inhabitants 31.9%, public officials 39.2%).<BR>  Fifth, all subjects considered a price of 3,000 to 5,000 won per use to be reasonable (medical employees 52.7%, inhabitants 51.0%, public officials 48.9%). Also, subjects thought public offices(66.5%, 70.1%, 68.1%), public health centers(30.6%, 29.4%, 23.4%), and hospitals(2.1%, 0.5%, 8.5%) to be appropriate institutions for administering telemedicine.<BR>  In conclusion, medical providers and customers all recognized the importance of telemedicine practice. Therefore, the successful introduction of telemedicine in Korea requires both an analysis of operating cases in developed countries and consideration of the unique medical characteristics and circumstances of Korea. To introduce efficient telemedicine practice, sufficient studies and practice through demonstration projects must be carried out. Also, the government and related institutions must support the development of appropriate and convenient medical equipment and must also institute appropriate legal systems such as a schedule of reasonable medical fees as well as improving the accessibility of medical services for users.

국제적 원격의료에 관한 국제사법적 쟁점

김현아 한국소비자법학회 2020 소비자법연구 Vol.6 No.1

Telemedicine is a relative concept of face-to-face care and refers to non-face-to-face medical care that occurs when doctors and patients are separated. Article 34 of the Medical Law only defines telemedicine between doctors and doctors, so telemedicine between doctors and patients is prohibited. In Korea, telemedicine is forbidden by norm, but it is possible for individuals who are not difficult to use overseas telemedicine. Our major trading partners, the United States, China and Japan, allow telemedicine, and due to the international nature of the Internet, it is virtually impossible to block our patients from accessing these services. In this article, despite the provisions of Article 34 of the Medical Law, I studied the issues related to international judicial affairs. The main contents are summarized as follows. First, international telemedicine contracts correspond to consumer contracts under private international law. Second, the international jurisdiction is granted to a Korean court in case of a dispute between a telemedicine permitting country doctor and a domestic patient. Third, it is not appropriate to regard Article 34 of the Medical Law as an international mandatory rule. Fourth, if there is a dispute related to a telemedicine contract between a telemedicine permitting country doctor and a domestic patient, and the parties designated the law of a telemedicine permitting country as the governing law, then the law of a telemedicine permitting country shall be applied. If the parties didn’t designate the governing law, Korean law shall be applied. It is not appropriate to regard Article 34 of the Medical Law as a compulsory provision, so a telemedicine contract is valid. Fifth, if there is a dispute related to a telemedicine contract between a domestic doctor and a patient in a telemedicine permitting country, and the parties designated the law of a telemedicine permitting country as the governing law, then the law of a telemedicine permitting country shall be applied. If the parties didn’t designate the governing law, the law of a telemedicine permitting country shall be applied in the same manner. Sixth, the governing law of malpractice caused by telemedicine services is subordinated to the governing law of telemedicine contracts if the parties do not choose Korean law afterwards. ‘원격의료’는‘대면의료’의 상대되는 개념으로서 의사와 환자가 떨어져 있는 상태에서 이루어지는 비대면의료를 뜻한다. 의료법 제34조 제1항은 오직 ‘의사’와 ‘의사’ 간의 원격자문만을 허용되는 원격의료로 규정하고 있으므로, 의사와 ‘환자’ 간의 원격의료는 금지되는 것으로 해석되고 있다. 우리나라에서는 원격의료가 규범적으로 금지되고 있으나, 언어나 기술적으로 원격의료 서비스를 이용하는 것이 어렵지 않은 개인이 해외의 원격의료 서비스를 이용하는 것은 얼마든지 가능하다. 중국을 비롯하여 우리나라의 주요 무역상대국인 미국, 일본 모두 원격의료를 허용하고 있고, 인터넷의 국제성으로 인하여 우리나라 환자가 이러한 서비스에 접속하는 것을 차단하는 것은 사실상 불가능하므로 이로 인한 법적 분쟁이 발생할 가능성은 충분하다. 본 논문에서는 의료법 제34조 제1항에도 불구하고 국경을 넘는 원격의료(국제적 원격의료)가 실제로 행해지고 이로 인한 분쟁이 발생한 경우를 상정하여 이와 관련된 국제사법적 쟁점을 일별하였는바, 그 주된 내용을 요약하면 다음과 같다. 첫째, 국제적 원격의료계약은 국제사법상 소비자계약에 해당한다. 둘째, 허용국 의사와 국내 환자 간에 국제적 분쟁이 발생한 경우 한국 법원에 국제재판관할권이 인정되며, 국내 의사와 허용국 환자 간에 국제적 분쟁이 발생한 경우에도 환자가 의사를 상대로 소를 제기한 때에는 한국 법원에 국제재판관할권이 인정된다. 셋째, 원격의료 금지조항은 국제적 강행규정으로 보기는 어렵다. 넷째, 허용국 의사와 국내 환자 사이에 원격의료계약과 관련된 국제적 분쟁이 발생한 경우 당사자가 준거법을 허용국 법으로 지정한 경우에는 허용국 법이 준거법으로 결정되고, 준거법을 지정하지 않은 경우에는 한국법이 준거법으로 결정되지만 원격의료 금지조항은 단속규정이므로 원격의료계약은 그대로 유효하다. 다섯째, 국내 의사와 허용국 환자 사이에 원격의료계약과 관련된 국제적 분쟁이 발생한 경우 당사자가 준거법을 허용국 법으로 지정한 경우에는 허용국 법이 준거법으로 결정되고, 준거법을 지정하지 않은 경우에도 허용국 법이 준거법으로 결정된다. 여섯째, 국제적 원격의료서비스로 인한 불법행위의 준거법은 당사자가 사후적으로 한국법을 선택하지 않은 경우 원격의료계약의 준거법에 종속적으로 연결된다.

원격의료에 있어서의 의사의 설명의무에 관한 연구 - 원격의료와 의사의 설명의무 근거규정 도입에 대하여 -

최연석 ( Choi Youn-suk ) 제주대학교 법과정책연구원 2020 法과 政策 Vol.26 No.2

Telemedicine, which encompasses medical technologies and information & communication technologies, refers to the system where providers of medical care provide demanders thereof far away from them with non-confrontational medical treatment services using information & communication technologies. Benefits of telemedicine result from the absence of confrontation which enables safe medical treatment even in the midst of an epidemic, increases accessibility to health care in distant or remote areas and contributes to the efficient management of the chronically ill with no need for moving. Consequently, the telemedicine industry which features non-confrontational medical treatment without constraints of time and space is growing in the world. As telemedicine is getting attention with the spread of COVID-19, the medical treatment by telephone calls has been allowed temporarily since February 24, 2020 in Korea as well. However, despite such benefits, telemedicine also has drawbacks. Non-confrontational medical practice inevitably brings the dependence of medical treatments on information delivered via information technology equipment. Therefore, there is an increased chance of misdiagnoses due to difficulties of doctors in making an accurate diagnosis in the absence of physical examination, including palpation, percussion, etc. Patients also go through several difficulties, taking on a role in operating medical devices or performing medical activities including examination, diagnosis, injection, etc., which brings the possibility that the patients who are not skilled at handling medical devices and have insufficient medical knowledge deliver misinformation to doctors. Telemedicine is a new area of medicine which emerged with the development of information and communication technologies, and it is expected that there are increases in medical accidents and side effects in this area due to its nature of non-confrontation. In the era of telemedicine, there is an increasing need for patients to make their own decision on whether they will get treatments through telemedicine, non- confrontational medical services, and to prepare against potential dangers in the process of telemedicine. Therefore, a doctor’s duty of explanation which includes providing patients with a full explanation on medical activities and gaining their consent is of growing importance. In Korea, there have been continuous attempts for the revision of the medical law to expand the range of application of telemedicine. However, there has been no specific discussion on the duty of explanation. Since the nature of telemedicine which includes non-confrontation serves as the basis for a doctor’s duty of explanation with contents distinct from that for the area of general medicine, there is an urgent need for the introduction of applicable provisions on the duty of explanation in the area of telemedicine for the minimization of confusion arising from the introduction of telemedicine, protection of self-determination of a patient and improvement of national health.

우리나라의 원격진료에 관한 문헌 분석 : 탐색적 연구

조다소리,황성완,백미라 경희대학교 경영연구원 2019 의료경영학연구 Vol.13 No.4

Telemedicine has advantages and controversies at the same time, which arise from the peculiarities of Korea medical system. Therefore, it is necessary to understand the nature of telemedicine, effectiveness and management methods. Telemedicine research has been conducted since 1995. In this study, a total of 65 research papers related to telemedicine published in Korean journals over the past 25 years (1995 ~ 2019) were investigated. In this study, the search keywords such as “telemedicine” and “telehealth” were used in this study in consideration of various terms referring to telemedicine. A total of 65 research papers were reviewed by period, starting in 1995 and increasing in the early 2000s, and the largest number of studies on telemedicine from 2014 to 2016. The papers were classified into 1) telemedicine awareness and intention of consumers, 2) customer satisfaction, 3) telemedicine effectiveness analysis, and 4) legal considerations. The papers included in this study have a fundamental limitation that there is no practical analysis on the telemedicine in Korea. In order to overcome these limitations, the papers attempted to overcome the limitations of the study by conducting an overseas case study, the analyzing effectiveness of domestic demonstration cases, and simulation. Many countries allow telemedicine to expand the scope of private health care institutions, increase access to medical care and strengthen medical capacity, while at the same time benefiting from the management of chronic diseases and the reduction of national health care costs. In Korea, as mentioned in particular, the introduction of telemedicine is inevitable due to the structure of the disease becoming chronic. Korea, one of the fastest aging countries in the world, needs to manage chronic diseases and geriatric diseases at the same time, improve the accessibility of medical vulnerable groups and solve medical vulnerable areas. Problems to be solved such as the quality of medical care, the possibility of misdiagnosis, and the leakage of personal medical information will continue to arise, but consequently, efforts to sustain medical system and solve blind spots in our society should continue.

비대면 진료 경험 의사들의 비대면 진료 수용성에 대 한 설문조사: 성향점수 매칭 방법

박정훈,김진숙 대한의사협회 2023 대한의사협회지 Vol.66 No.6

Background: The purpose of this study is to analyze the differences in the acceptability of telemedicine between telemedicine-experienced and -inexperienced physicians. Methods: A questionnaire survey was conducted using the Doctor Survey of the Korean Medical Association. A total of 1,385 physicians were included in the analysis. Propensity score matching was used to control selection bias. The chi-square tests were used for bivariate analysis. Multiple logistic regression analysis and multinomial logistic regression analysis were used to adjust for covariates (gender, age, working area, working type, institution type, and the specialty of physicians). Results: Physicians with experience in telemedicine were 2.53 times more likely to accept to allow telemedicine as a medical system than physicians without experience in telemedicine. Physicians with experience in telemedicine responded that telemedicine should be allowed to returning patients only and not be allowed to first-time patients. This response of telemedicine-experienced physicians was 3.73 times higher than that of telemedicineinexperienced physicians. Physicians with experience in telemedicine responded that telemedicine for first-time patients should be only allowed under specific situations. This response of telemedicine-experienced physicians was 2.59 times higher than that of telemedicine-inexperienced physicians. Conclusion: Telemedicine-inexperienced physicians were more acceptable to telemedicine as a medical system than telemedicine-inexperienced physicians. Physicians with experience in telemedicine suggested that telemedicine should be allowed to returning patients only and might be allowed to first-time patients only under specific situations.

원격진료의 지역적 차별성과 정보격차에 관한 연구

박수경(Sookyung Park) 대한지리학회 2015 대한지리학회지 Vol.50 No.3

원격진료는 정보통신기기를 활용해 의료정보를 주고받는 의료 혁신으로 인식되고 있지만, 사실상 오프라인의 여건에 따라 그 적용이 다양하게 나타난다. 예를 들어, 우리나라에서는 원격진료 시행의 기초 단위인 각 시군의 행정권에 따라 같은 의료권에 내에서도 원격진료는 차별적이다. 이에 본 연구에서는 강원도 원격진료 사례를 통해 원격진료의 지역적 차별성의 원인을 알아보았다. 더 나아가 이러한 차별성은 정보격차와 연관성이 있어 원격진료로 인해 유발되는 정보격차의 문제에 대해서도 고찰하였다. 본 연구의 주요 결과는 다음과 같다. 첫째, 원격진료의 도입과 더불어 행정 인력의 증원, 실질적인 행정 책임자에 대한 경제적 보상, 원격진료 기기에 대한 교육 등이 제대로 마련되지 않아 이를 수용할 수 있는 지역만이 원격진료를 활용하고 있는 것으로 나타났다. 둘째, 원격진료의 차별적 활용은 지역의료의 최고 결정자라 할 수 있는 시장 혹은 군수, 그리고 보건소장의 관심 여부와 연결된다고 할 수 있다. 셋째, 공중보건의는 원격진료의 실질적인 수행자 역할을 하고 있지만, 원격진료에 실시에 반대하고 있는 의사회와의 관계, 실질적인 지역의료 여건의 개선 미비 등으로 원격진료에 대해 회의적 입장인 것으로 드러났다. 넷째, 원격진료 활용의 지역적 차별성으로 인해 나타나는 정보격차는 아직까지 가시적인 것은 아닐뿐더러, 다른 차원의 격차(의료격차, 지역격차 등)로 전이되지 않았다고 판단되나, 앞으로 원격진료를 기반으로 하는 다양한 서비스가 이루어질 것을 예상한다면 이에 대한 적절한 대책이 필요할 것으로 보인다. Telemedicine, which gives or receives medical information via ICT (information and communication technology), is regarded as innovation in a medical field and its application is various according to offline conditions. For example, the utilization of telemedicine in Korea is unfair because of the administrative discretion, which is the basic unit of telemedicine for its practical operation, in spite of the same diagnostic area. With this mind, this study investigates the cause of regional differences of telemedicine through a case of Kangwon province. Furthermore, the crucial matter is that regional dierences of telemedicine are associated with digital divide; therefore, this research considers digital divide triggered by telemedicine. The core results are as follows. First, there are little measures such as increase of the staff, economic compensation for public officials, education of telemedicine facilities; accordingly, only regions, where can accept these insufficient conditions, manage the telemedicine system. Second, the interesting of a mayor or a governor and a head of a health center as a highest decision maker has something to do with dierent utilization of telemedicine. ird, public health doctors play a role as practical operators in telemedicine, but their stance is skeptic about telemedicine somewhat because of the relationship with the medical association opposing the implementation of telemedicine, unimproved regional health care condition, etc. Forth, it seems that the digital divide caused by the regional differences of the present telemedicine utilization does not led to tangible results and is not turned to another disparity so far, the proper measures are required considering that various health care services based on telemedicine will be extended.

의료기관의 민사책임에 관한 고찰 - 원격의료를 둘러싼 미국의 사용자책임과 직접책임을 근거로 삼아 -

김항중 ( Kim Hang Jung ) 홍익대학교 법학연구소 2020 홍익법학 Vol.21 No.4

전 세계적으로 지속되고 있는 코로나19, Coronavirus Disease 2019(COVID-19) 대유행으로 인해 비대면 의료서비스의 형태인 원격의료에 대한 사회적 관심이 증가하고 있어 이와 관련한 법적ㆍ정책적 이슈들 또한 새롭게 논의되고 있다. 현재 우리나라의 의료법 제34조는 의료인과 의료인간의 원격의료는 허용하지만 의료인과 환자간의 원격의료는 허용하고 있지는 않다. 하지만 현재 코로나 19 사태로 인해 의료서비스 시장에서도 높은 비대면 서비스의 필요성과 시장 수요를 확인하여 이로 인해 의료인과 환자간의 원격의료를 한시적으로 허용하고 있어 이에 대한 법안 마련이 시급한 상황이다. 이러한 현실을 반영한 듯, 2010년 이후 세 차례 원격의료 허용방안 등 의료법 개정안에 대한 법안이 국회에 제출되어 있지만 여전히 계류 중에 있어 법안통과 여부에 이목이 집중되고 있다. 하지만 원격의료에 대한 ①안전성과 효과가 검증되지 않았고 ②의료사고가 발생한 경우 의료인의 과실 여부에 대한 책임 주체와 소재가 불분명하며 ③대형병원 쏠림현상을 우려하는 목소리도 있다. 이러한 사회적 분위기를 고려하여 본 논문에서는 원격의료에서 제기되는 이슈 들 예를 들면 ①의사의 책임 ②설명의무 ③의료기기 결함으로 발생한 피해에 대한 책임 ④진료보수 청구 그리고 ⑤비밀유지 중 특히 의료사고 발생 시 의료기관인 병원의 책임(일부 의사의 책임 포함)에 대한 문제를 해결하기 위해 적용할 수 있는 법은 무엇이고 이 관련법을 기존의 법리에 어떻게 적용하여 해결할 것인지 미국의 관련법과 사례를 통하여 해결방안은 무엇인지 가설적 사례를 통하여 면밀히 검토ㆍ분석한다. 구체적으로 ①미국법상 병원의 의료기관책임 ②미국법상 사용자책임 그리고 ③ 미국법상 직접책임 등의 법리 등을 주요 사례와 함께 자세히 살펴본 후 ④국내 현황 및 분석(의사의 민사책임과 연관지어) 등의 주요 법리를 자세히 고찰한다. 이미 미국(1990년대), 중국(2014년) 그리고 일본(2015년) 등의 국가는 의료인과 의료인간의 원격의료를 보건의료전달체계로서 허용하고 있으며 이를 더욱 활성화하기 위한 여러 움직임(예를 들면 보험급여 인정)을 보이고 있다. 앞으로 새로운 보건의료전달시스템인 원격의료에 대한 수요가 더욱 증가할 것으로 예상되는 바 이에 대한 새로운 법의 영역이 필요하다. 그러나 이 새로운 법의 영역은 현재 존재하고 있는 채무불이행책임(계약책임)과 불법행위책임에 근거하여 논의되어야 한다. The continuous spread of the Coronavirus Disease of 2019(COVID-19) pandemic across the world has posed some social issues related to telemedicine, which is one type of non-contact medical service that has a growing demand in the present day. Therefore, new legal policy discussions need to be evaluated on the current issues within policies. Current Korean medical laws of article 34 allow telemedicine between a physician and a physician; not a physician and a patient remotely, so new legal and policy framework should be effectively addressed. Reflecting on this social environment, there have been three submissions to the National Assembly since 2010 allowing telemedicine between a physician and a patient. Medical law revisions including telemedicine are still pending and there are questions of whether the National Assembly will pass the laws in a positive direction. There are some arguments that allowing this service has no clear evidence that telemedicine is safe, and its effectiveness has not fully been verified yet. In addition, dividing legal liability issues are not clear when medical malpractice occurs in telemedicine between attending physicians and remote physicians. Even more patients would more likely use big hospitals causing smaller hospitals and clinics to experience financial difficulties. Considering this social mode, the main purpose of this article is to overview and analyze how to apply existing laws into telemedicine in order to provide specific solutions when medical malpractice happens in a telemedicine settings. This can be performed by focusing on cases and legal applications that are still being discussed in the United States. Specifically, important issues that are being addressed in the United States are institutional liability, vicarious liability and direct liability, which are all discussed by the application of hypothetical cases. The United States, China, and Japan have already accepted telemedicine as an effective tool within their health care delivery systems. Currently, they are actively trying to utilize telemedicine while also dealing with reimbursement issues. As time moves forward, the need for new health care delivery systems such as telemedicine will increase, so new bodies of law will be addressed to provide specific implications on telemedicine. This kind of new law should be based on the existing legal liability framework.

원격의료를 활용한 가정형 호스피스 활성화 방안

조병모,조현 사단법인 대한보건협회 2023 대한보건연구 Vol.49 No.2

Purpose: This study proposed a home-based hospice model and activation plan using telemedicine as a way to solve insufficient bed problems and limitations of medical resources, reduce the economic burden of hospitalization, and improve the quality of life of patients. Methods: In this study, domestic and foreign cases of home-based hospice and telemedicine were analyzed through the review of related statistical data and literature and expert advice, and a plan to activate home-based hospice using telemedicine was proposed through case studies in advanced. Results: Hospice and palliative care should be activated as a prerequisite for the activation of home-type hospice; 1) Improving access to home-based hospice 2) Providing active pain and symptom control and establishing a home care service system 3) Establishing a hospice linkage system 4) Establishing a hospice cluster 5) Supporting professional care providers 6) Providing hospice in nursing homes. Improvement tasks for promoting home-based hospice using telemedicine, First, doctors are given separate qualifications for telemedicine, Second, the scope of patients subject to telemedicine is limited, Third, legal requirements or standards are eased to enable telemedicine on-site, Fourth, it is necessary to prepare regulations on where to be responsible, such as immunity measures in the event of a medical accident, in a situation where certain procedures cannot be observed and controlled. Telemedicine is now not the subject of debate, but a demand of the times that needs to be implemented. As the number of terminal patients who want hospice and palliative care is increasing, the quality of life of terminal patients and their families should be improved by expanding home-based hospice utilizing telemedicine. A telemedicine model for home-based hospice patients was presented by referring to the above and telemedicine cases using hospice information system in Taiwan. Conclusion: Since most of the home-based hospice are provided to patients who need care through home visits by medical staff without requiring separate surgery or treatment, telemedicine can be a good way to improve the quality of patients' lives by reducing the time and cost for home visits. 연구목적: 입원형 호스피스·완화의료 환자들의 부족한 병상 문제와 의료자원의 한계를 해결하고 입원에 따른 경제적 부담을 줄이며 환자의 삶의 질을 제고할 수 있는 방안으로 원격의료를 활용한 가정형 호스피스 모델과 활성화 방안 모색연구방법: 관련 통계자료 및 문헌 고찰을 통하여 각국의 가정형 호스피스와 원격의료 사례를 분석하고 전문가 자문 실시연구결과: 가정형 호스피스의 활성화를 위한 방안으로 1) 가정형 호스피스 접근성 제고 2) 적극적인 통증 및 증상 조절 제공 및 가정 간병서비스 체계 구축 3) 호스피스 연계 체계 구축 4) 호스피스 클러스터 구축 5) 전문적인 돌봄 제공자 지원 6) 요양 시설의 호스피스 제공. 원격의료를 활용한 가정형 호스피스·완화의료 활성화를 위한 개선과제로 첫째, 의사에게 원격의료에 관한 별도의 자격을 부여하고 둘째, 원격의료 대상 환자의 범위를 한정하며 셋째, 방문간호 및 응급 상황 시 현장에서 원격의료가 가능하도록 법적 요건이나 기준을 완화하며 넷째, 일정한 절차를 준수하고 통제할 수 없는 상황에서 의료사고 발생 시 면책 방안 등 책임 소재에 대한 규정 마련이 필요하다. 호스피스·완화의료를 희망하는 말기 환자들이 늘어나는 추세이므로 원격의료를 활용한 가정형 호스피스·완화의료의 확대로 말기 환자와 가족의 삶의 질 향상이 이루어져야 한다. 대만의 호스피스정보시스템(HIS)를 참조한 원격의료 활용 가정형 호스피스 환자들을 위한 모형을 제시하였다. 결론: 가정형 호스피스는 임종이 얼마 남지 않아 별도의 수술이나 치료가 필요없이 의료진의 가정방문을 통한 돌봄이 제공되고 있어 의료진의 가정방문을 원격의료로 대체하면 방문에 필요한 시간과 비용을 줄이고 가족들의 간병부담을 줄일 수 있어 환자들의 삶의 질 향상을 위한 좋은 대안이 될 수 있다.