개인정보 보호를 위한 의료영상 발급 표준 업무절차 개발연구 (Development of Standard Process for Private Information Protection of Medical Imaging Issuance)
-
- 대한방사선기술학회지:방사선기술과학
- /
- 제32권3호
- /
- pp.335-341
- /
- 2009
목 적 : 기존 필름으로 발급되었던 의료영상은 IT기술의 발달로 디지털화 되어 CD로 발급되고 있다. 그러나 발급 시 신분확인을 하고 있는 의무기록과는 달리 필름을 사용하던 시절부터 의료영상은 별다른 신분확인을 하지 않는 의료기관이 많다. 이에 신청자의 개인의료정보 보호에 대한 인식 실태를 조사하고 여러 의료기관의 CD 또는 DVD 등의 매체를 통한 의료영상 복사 현황을 조사, 정보보안에 관련된 국, 내외 법률 및 권고안을 분석하여 국내 환경에 부합하는 의료영상 복사 발급과 절차를 마련하는 기준을 제시하고자 한다. 대상 및 방법 : 첫째, 2008년 5월 1일부터 7월 31일까지 수도권에 있는 33개 종합병원을 대상으로 의료영상복사 신청 시 구비서류, 발급절차 등을 전화를 통한 유선 조사를 시행하였다. 신청자에 따른 구비서류를 의료법 제 21조 2항에 의거 (1) 본인일 경우 신분증 확인, (2) 가족일 경우 신청자 신분증, 가족관계 서류(건강보험증, 가족관계증명서, 등본 등), (3) 제 3자 대리인일 경우 신분증, 위임장, 인감증명서로 기준을 마련하여 조사하였다. 둘째, 연구기간 동안 위의 기준에 따라 의료영상을 발급해 주고 있는 K 의료원에 복사를 신청하는 신청자들이 준비해온 구비서류 여부를 파악하였다. 셋째, 구비서류의 확인 및 미비 시 조치 등에 대한 발급절차의 기준을 정립하여 프로세스를 개발하였다. 결 과 : 수도권 33개 의료영상 발급현황을 조사한 결과 모든 조건을 충족한 병원은 16곳(49%), 신분증만 있으면 가능한 병원은 4곳(12%), 누구나 신청 가능한 병원 4곳(12%)이었으며 의료영상을 발급하는 부서가 아닌 진료과에서 신청하는 곳이 9곳(27%)으로 구비서류 조건여부는 알 수 없었다. 또한 신청자들이 복사 신청시 준비해온 구비서류가 조건에 충족한지 3개월간의 조사 결과 모두 준비한 경우(완비)는 629건(49%), 일부만 준비한 경우(일부 미비) 416건(33%), 모두 준비하지 않은 경우(미비) 226건(18%)이였다. 위의 연구결과를 근거로 의료영상 복사 신청 절차에 대한 프로세스를 정립하여 객관적인 응대를 할 수 있도록 하고, 환자와의 마찰을 줄이고 불편을 최소화 하면서 환자의 편의를 도모하고자 세분화된 발급절차 모형도를 작성하였다. 결 론 : 다른 전산 시스템과 달리 의료영상 시스템인 PACS가 의료기기로 분류되어 있는 것은 그만큼 의료정보의 중요성이 크다는 의미이다. 또한 의료영상의 학문적 성격으로 의학교육 및 연구에 많이 쓰이는데 이러한 이유로 쉽게 인용되고 남용 될 수 있다. 따라서 의료영상은 전문적인 교육을 받은 의료영상 관리자에 의해 적절한 발급 기준으로 발급, 관리되어야 할 것이며 이에 관한 개인정보보호와 의료영상에 대한 적극적인 홍보가 필요할 것이다.
과학기술의 발전과 더불어 보건의료분야는 괄목할 성장을 가져왔고 국민생활 수준의 향상과 건강에 대한 관심이 고조됨에 따라 의료서비스의 수요가 급증하고 있다. 이 과정에서 국민의 권리의식의 신장, 의료행위의 본질에 대한 이해부족, 의료기술에 대한 지나친 기대, 상업화된 의료공급체계, 의사의 윤리의식 저하 및 의료법리에 대한 무지 그리고 사회적 불신풍조의 만연, 분쟁해결을 위한 제도적 장치의 결여 등이 요인으로 작용하여 의료사고 및 분쟁이 급증하는 추세이다. 본 연구는 치과관련 단체에서 보유하고 있는 소송과 관련된 자료 및 연세대학교 치과대학병원 구강내과에서 신체감정을 시행한 재판기록을 중심으로 하여 판결전문을 확보할 수 있는 치과 의료사고 판례 중 1994년부터 2004년까지의 민사소송 30례의 판례를 분석하여 다음과 같은 결과를 얻었다. 1. 소송의 연도별 분포에서 2000년 이후 급증하는 추세를 보였다. 2. 소송의 유형별 분포에서 발치와 관련된 소송이 전체의 36.7% 이었다. 3. 소송의 원인을 분석한 결과 불편감, 치료불만족과 관련된 것이 전체의 36.7%, 사망 및 영구손상이 각각 16.7% 이었다. 4. 원고의 소송결과 승소 및 강제조정, 화해권고결정이 60.0% 이었다. 5. 소송에 관련된 병원유형은 치과의원이 60.0%로 가장 높게 나타났다. 6. 소송의 심급별 구성비율에서 2,3심 이상 진행된 경우가 전체의 30.0% 이었다. 7. 손해배상 청구금액은 5천만원 이상 1억원 미만이 36.7%, 1억원 이상이 13.3% 이었고 손해배상 판결금액은 1천만원 이상 3천만원 미만이 40.0%, 1억원 이상이 6.7% 이었다. 8. 소송과 관련된 치과의사수는 2명 이상이 26.7%이었다. 9. 판결까지의 소요기간은 11개월에서 20개월이 46.7%, 21개월에서 30개월이 36.7% 이었다. 10. 의료과실 유무에서는 과실을 판정한 경우가 46.7% 이었고 소송과정에서 신체감정이나 사실조회가 이루어진 경우는 70.0% 이었다. 11. 의사패소 판례(18건)에서 판결의 주안점은 주의의무위반이 72.2% 이었고, 설명의무위반이 16.7% 이었다. 치과 의료분쟁의 경우 치료의 긴급성이 상대적으로 적어 의사의 설명의무 중요성이 폭넓게 요구되며, 주관적인 치료 만족도가 중요시되는 분야이기 때문에 결국 분쟁을 줄이는 방법으로 기술적인 과실도 줄여야 하지만 치과의사와 환자와의 신뢰 관계를 개선하는 것과 의사집단의 자율성(autonomy)의 회복이 중요하다. 그리고 불합리하게 시행되고 있는 의료배상책임보험의 보완과 함께 치과의사단체와 학계가 주도하는 교육 및 의료분쟁시 자문을 구할 수 있는 체계의 확립으로 의료분쟁에 대한 대처가 이루어져야 할 것이다.
Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.