In June of 2016, Missouri established telemedicine practice standards, including explicitly allowing for the delivery of health care services using electronic information and telecommunication technology. Telemedicine became a critical and necessary part of practice for a majority of health care providers due to the Covid 19 outbreak. Following the pandemic, many healthcare providers found that telemedicine is an ideal method for managing several challenges facing our healthcare system, including accessibility, time constraints, travel issues and in some cases patient backlogs. Telemedicine currently is being used to reduce in-person clinic visits and make medicine more accessible to patients.
Telemedicine in Missouri is governed by Missouri Revised Statutes 191.1145 and 191.1146. Missouri requires that a healthcare provider establish a valid patient provider relationship prior to diagnosing, treating or prescribing for a patient. This requirement is waived if the telemedicine visit is a (a) consultation for another physician or physicians’ delegate who has established relationship with the patient or (b) for telemedicine encounters where the standard of care does not require an in-person encounter. To establish a physician-patient relationship, the physician shall interview the patient. This includes an accurate history, physical exam, and a meaningful discussion of the risks and benefits of telemedicine.
The healthcare provider needs to obtain informed consent before telemedicine is employed. This consent should be documented and cover the risks and benefits, limitations and alternatives. The informed consent document should also cover privacy, confidentiality and technology/security risks. Keystone Mutual also provides an informed consent form for its policyholders that relates specifically to telemedicine.
Missouri law generally requires all providers treating patients in Missouri to be licensed in Missouri and that telemedicine visits must meet the same standards as in-person care.
Providers must also ensure that telemedicine platforms meet state and federal privacy standards, including HIPAA. This means a secure and encrypted platform with safeguards in place to prevent data breaches of the transmission or storage of private health information. Healthcare providers should also routinely review and revise their office policies and procedures to mitigate the risks associated with telehealth. They will also need to monitor federal guidelines on telehealth. They can do so by going to the U.S. Department of Health and Human Services homepage, and reviewing the guidance and frequently asked questions pages. That website is www.hhs.gov.
Based upon the perceived benefits of telemedicine both in the state of Missouri and nationwide, many providers and patients are advocating to expand telemedicine in Missouri. Recently the legislature expanded the definition of telehealth to include audiovisual and audio-only technologies. Patients can now connect through video calls, phone calls, or secure message platforms. This continued flexibility in communication can reduce barriers to care and helps manage patient loads more efficiently.
Telemedicine offers significant benefits for healthcare in Missouri, but also poses risks that require proactive management, investment in secure technology, and proper safety protocols.
