The Exploration of Medical Malpractice Claim Reduction Strategy Based on Blockchain Technique

• Main Authors: CHEH, YU-JEN, 陳育仁
• Other Authors: WU,CHIN-SHAN
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/9g38jd

碩士 === 東海大學 === 高階經營管理碩士在職專班 === 107 === The purpose of this study is to investigate that in traditional medical civil litigation disputes, the medical record is the main point among the evidence. The identification and assessment of the medical review committee also relies on the plaintiff and the defendant to provide sufficient and complete medical record information as the basis for clarifying the responsibility. But in litigation, the authenticity of the medical record and the items recorded on the patient consent form are actually implemented the notification and made the patient fully awar of it? It is the main point of litigation and defense, which also leads to lack of mutual trust between doctors and patients, and medical disputes have never stopped. Those circumstances lead to the lack of mutual trust and continual occurrence of medical disputes between the patient and the doctor. Not only the patients are likely to lose their cases, but the doctors that win the cases may also become timid in the future to adopt any proactive medical treatment after undergoing such lengthy litigation procedures. The results are obviously unfriendly to the medical development. In December 2017, Taiwan passed the amendment to Article 82 of the Medical Care Act to alleviate the responsibility of physicians, which means the burdens of proof on the patients are increased on the contrary. Initially, the patient as a plaintiff bears the burden of proof in the civil lawsuit, and now the scale of the lawsuit tilting towards the doctor makes the situation even more unfair to the patient. The amendment does not eliminate the causes of the failure to prove the evidence, nor enable the patients to pursue the "truth" of their cases, and therefore several controversial manners such as raising the coffin, throwing eggs or scattering ghost papers to protest by the patients and their relatives often appear during medical disputes. In order to keep the "medical record", which is often known as a silent witness, to maintain its integrity and completeness, the electronic medical records which are previously centralized and cloud-stored may be replaced by the latest developed block chain technology. With the help of the personal wearable device, all medical treatments conducted by the physicians are able to be stored instantly in the block chain, and the patient may also become one of the preservers of the medical record. The reliance on the completeness of the electronic medical record shall be ensured accordingly. With confidentiality, the electronic medical records stored in the block chain prevent personal privacy from being leaked or altered. In addition, for lack of third-party surveillance system in patient consent in the past, patients suppose that the letter of consent may be tampered or altered afterwards. By instantaneously retaining the important information such as the physician's notification and patient consent in the block chain, it may effectively urge the physician to pay attention while fulfilling his medical notification obligation and conducting medical treatments, and ensure that patients are fully aware of and understand the medical risks before they claim their autonomy to make medical decisions mutually with their physicians. When encountering unexpected medical outcomes, an accurate judgment shall be reached according to the information stored in the block chain. Thus the patients will believe that the eventual judgment is relied on the correct medical records. In conclusion, due to the revision of the Medical Care Act, the civil liability of doctors and medical institutions has been alleviated. Accordingly, the costs and expenses of constructing the block chain technical medical records should be borne by the doctors and medical institutions based on the principle of equity. Moreover, when medical disputes occur, the costs of managing medical risks in hospitals shall increase. Suppose medical disputes may be effectively reduced, the expenditures on medical risk management may then be effectively reduced as well. Therefore, it is necessary to legislate for those above-mentioned costs to be paid by the doctors or medical institutions.