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With increased use comes the need to design telehealth policies and procedures that ensure high quality of care and patient safety.
Abstract
Missouri is a national leader in telemedicine, and the Missouri Telehealth Network has led operational, legal and regulatory, and research and evaluation efforts since 1994. Telehealth and telemedicine have the potential to increase access to and efficiency of healthcare delivery, improve quality, and improve patient outcomes. Coverage and reimbursement rules vary by regulator, and Missouri enjoys a broad statutory definition of telehealth coverage and reimbursement parity (no distinction between in-person and telehealth services).
Introduction
Missourians face a growing demand for specialized health care and multiple impediments in accessing the health care they need. The state's elderly population is projected to increase to 1.2 million or 19.1 percent of the state's total by 2025. 1 More than 30 percent of Missouri's residents live in rural areas, which cover 97 percent of the state.2 Rural Missouri has fewer physicians than in 2011, and rural Missouri physicians are two years closer to retirement on average than their urban Missouri counterparts.3 With limited or no access to timely and quality care, rural Missourians are overall less healthy than their urban counterparts, with significantly higher death rates (867 per 100,000 rural Missourians versus 799 per 100,000 urban Missourians). 4
Telemedicine and telehealth are readily available tools in the state's arsenal for overcoming obstacles to accessing health care. Their use can improve patient outcomes, primarily by reducing the transportation time and costs and increasing the access to physicians. This is especially true for rural patients needing access to specialized physicians. Physician efficiency may also be improved resulting in overall reduction in health care costs.5 Early adopters in nearly all clinical specialties have had good results from telemedicine and telehealth, but many barriers to adoption remain. 6
Telemedicine and Telehealth
Telemedicine and telehealth are often used interchangeably. Missouri law defines both as "the delivery of health care services by means of information and communication technologies which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and selfmanagement of a patient's health care while such patient is at the originating site and the health care provider is at the distant site." 7 It is also useful to consider telemedicine strictly...