Guest Column | July 21, 2015

By Rudy Richman, VP of Sales and Marketing, Privacy Analytics

We’re currently witnessing an explosion of digital health applications and software that is producing rapidly growing volumes of consumer and patient information. As a result, healthcare organizations are sitting on large stores of data that have significant value beyond the primary clinical use for which it was collected.

This data, shared responsibly, can be used to help solve some of healthcare’s most challenging problems. It can play a critical role in driving innovative research, deriving key insights and gaining new knowledge that can lead to faster and better treatments and cures for a wide range of health conditions and diseases. Other uses of the data include clinical trials transparency, quality and safety measurement, public health, payment, provider certification or accreditation, marketing, and other business applications.

For many of these uses, the data may be monetized by data custodians. Data monetization is exactly what it sounds like – making money by selling the data to another organization, or selling reports based on the data. The simple truth is our personal information is being collected, analyzed, bought, and sold on an increasingly routine basis. According to Gartner, 30 percent of all businesses will be monetizing their information assets by 2016.

Safely Managing Health Data Monetization

A large number of health and healthcare organizations share and monetize data. They include federal and state public health agencies, pharmaceutical companies, hospitals and healthcare providers, academic medical centers, cancer and birth registries, medical device manufacturers, insurance companies, EMR vendors, and health information exchange organizations.

Health data cannot, and should not, be sold or exchanged without proper consideration into what it will be used for. And it’s necessary to understand what personal identifiers exist in the data to know what could put individual patient privacy at risk.

The HIPAA Privacy Rule, by establishing national standards, requires safeguards to protect personal health information and sets conditions on how it is used. The Health Information Technology for Economic and Clinical Health (HITECH) Act strengthened the enforcement of HIPAA. It requires authorization from each individual in a data set for any sale of Protected Health Information (PHI). While this addresses important privacy concerns, it’s not always possible for health organizations to secure consent from each individual in a large data set – because they’ve moved, trauma or sensitivity of the event, or are deceased – and unless all patients consent the results of any analysis may be put into question.

Unable to sell PHI without the consent of all patients, research efforts could be severely hampered. However, there is a way to achieve HIPAA compliance, share and monetize data, and still protect patient privacy. Under HIPAA, properly de-identified data is no longer considered PHI and therefore can be shared and monetized without consent.

There are two general approaches to de-identification, the “list” approach and the “statistical” approach, exemplified by the methods stipulated in the HIPAA Privacy Rule: Safe Harbor and Expert Determination. Safe Harbor specifies 18 elements that need to be removed or modified – 16 of those are direct identifiers, such as name and social security number, while two are quasi-identifiers that provide elements of dates or geography. Safe Harbor also includes a caveat that requires there be no clear or direct knowledge that anything else in the data could be used to re-identify individuals.

Whereas Safe Harbor is a one-size-fits all approach, Expert Determination requires an assessment of risk given a specific context. Based on the level of risk, direct identifiers and quasi-identifiers can be removed or modified so that the data retains value for research and analysis.

It’s important to note that proper data de-identification is not the same as data masking. While commonly used masking techniques hide or remove direct identifiers, this still leaves risk from the quasi-identifiers. There is legal risk for non-compliance with HIPAA, financial risk from fines and lawsuits due to a data breach, and the reputational risk of losing patient trust when they learn that PHI was being shared or monetized inappropriately. Not to mention that masking to remove PHI can strip away the value of the data, rendering it less useful for research and analysis, and therefore a less valuable commodity for monetary gain.

Only one of these methods provides the most utility and value of the data while still protecting privacy, and that is de-identification. The de-identification of data is more sophisticated and leads to better results because responsible expert determination methodology and tools are used to manage the risks associated with the specific use of the data. Legal compliance is also satisfied when consistent de-identification standards and effective risk management procedures are used to protect patient privacy.

For data to be considered de-identified, the context of the data release is analyzed through a risk assessment. This assessment analyzes the type and content of the data, what type of organization is receiving the data and how they will use it, as well as how the data will be protected through physical and policy measures. All these factors are considered to determine the risk of re-identification, and the data is then adjusted accordingly to provide a data set with the lowest level of risk for the highest level of use. Remember, once the data is no longer considered PHI, it is no longer covered under HIPAA.

As demand for data sharing and monetization grows, so do concerns about privacy and risk. The good news is that privacy can be easily addressed by using the right approach. Responsible de-identification is a reputable, HIPAA-compliant solution to safely monetizing the data that health and healthcare organizations have at their disposal.

Article link: http://www.healthitoutcomes.com/doc/the-monetization-of-health-data-0001?sectionCode=Articles&templateCode=Single&user=2423280&source=nl:43544&utm_source=et_6231164&utm_medium=email&utm_campaign=HCIT_2015-07-30&utm_term=0009EE33-ABCE-4D02-9B3C-4F32FFAA82BE&utm_content=The%2b%2527Monetization%2527%2bOf%2bHealth%2bData

About The Author

Rudy Richman is the Vice President of Sales and Marketing for Privacy Analytics, where he is responsible for the development, implementation and execution of strategies that deliver expert determination de-identification methodology and products to the marketplace. He uses his extensive market knowledge, business experience and leadership skills to design multi-faceted programs and provide strategic guidance to both established and emerging companies in technology, healthcare and other industries seeking to efficiently scale and monetize their assets.

July 30, 2015 | By Molly Bernhart Walker

Veterans Affairs Department Secretary Bob McDonald voiced his support for open source technology July 30, as he outlined a broad reform plan that includes streamlining information technology and taking a more “holistic” look at customer service.

“We have over 200 databases with customer information. That means if you want to change your address, you have to go to at least nine places to change your address at VA,” said McDonald during a morning keynote July 30 at a conference in Bethesda, Md.

“We want to go to one data backbone, one data inventory,” he said.

McDonald also lamented that the department has 900 1-800 phone numbers for veterans. He’d like to consolidate that down to a single contact line.

McDonald told attendees at the OSERHA Open Source Summit that VA also has hundreds of websites – 14 of which require a username and password login for vets.

“We’re going to be going to a unified digital experience for all veterans,” said McDonald.

All of these digital technologies will be open source, he added.

“There’s no other way to operate in our opinion than open source. And we’re counting on all of you to make that happen. We’re going to be open source and we want to have crowd-sourced innovation,” said McDonald.

Article link:http://www.fiercegovernmentit.com/story/va-secretary-open-source-only-way-operate/2015-07-30?utm_medium=nl&utm_source=internal

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“PrecisionFDA will supply an environment where the community can test, pilot, and validate new approaches.”

August 5, 2015

The U.S. Food and Drug Administration on Wednesday revealed that it is working to build a software platform for precision medicine and an informatics community around it.

FDA’s Office of Health Informatics, in fact, contracted with DNAnexus, to create open source cloud-based software for sharing genomic information.

Dubbed precisionFDA, the platform can be used to evaluate bioinformatics workflows and essentially crowdsource reference data sets, according to DNAnexus, which describes itself as a cloud-based genome informatics and data management company.

President Obama’s Precision Medicine Initiative will necessitate that fashion of collaboration, Taha Kass-Hout, MD, FDA’s chief health informatics officer and FDA policy advisor David Litwack wrote in a blog post.

“To begin to realize this new vision, precisionFDA is designed to develop the necessary standards. PrecisionFDA will supply an environment where the community can test, pilot, and validate new approaches,” Kass-Hout and Litwack wrote, providing as example of the opportunity for developers, research, and others to not only share but also cross-validate test results against reference materials.

When the precisionFDA beta opens, slated for December of 2015, users will be able to access independent work areas for software code or data that can either be kept private or shared with whomever the contributor chooses. The public space will host tools including a wiki, open access reference genomic data models and analytics.

“We believe precisionFDA will help us advance the science around the accuracy and reproducibility of next generation sequencing-based tests, and in doing so, will advance consumer safety,” Kass-Hout and Litwack noted.

Tom Sullivan, Editor-in-Chief, Healthcare IT News

Article link: http://www.healthcareitnews.com/news/fda-building-open-precision-medicine-platform

It is only after a revolution concludes that one can clearly look back and fully understand what triggered the revolution. External factors such as technology shifts can create the conditions for a revolution where it may not have been possible before. A generation that has a different worldview than their elders may not accept that status quo. From what I’m observing, I believe we are seeing a revolution’s first phase happen before our eyes.

I’m convinced that the only way there will be a true revolution in healthcare is if there is a partnership between clinicians and individual citizens (aka patients/consumers/people). One without the other isn’t sufficient to unseat deeply entrenched systems. However, I feel doctors will play a unique role in catalyzing the revolution (not to say that clinicians of all types won’t play important roles as well). As I’ve been a Johnny Appleseed of sorts chronicling the far-reaching and transformational work of doc-entrepreneurs, it feeds my optimism that it’s possible to overcome the “Preservatives” who have 3 trillion reasons to protect the status quo.

For those of us who have seen how much better the system can work when goals are properly aligned, it’s “good news” that doctor burnout and dissatisfaction is at an all-time high (see The Quadruple Aim: A Square Deal for Clinicians for more). Why? Dissatisfaction is the seed corn for change and revolution. Make no mistake. There is extremely high level of dissatisfaction amongst a large chunk of doctors who yearn for change. The contrast between those inside of flawed versus optimized care delivery and payment models is stark. One the one hand, I have heard and seen docs who are seeing 30-50 patients a day, dealing with unwieldy/outdated EHRs optimized for billing (vs. care) and getting more bureaucracy thrown on top of an already-flawed model. On the other hand, it’s breathtaking when I visit clinics like CareMore, ChenMed, Iora Health, Qliance, Vera Whole Health and others where the clinicians and patients are both extremely satisfied.

In the video below, Dr. Zubin Damania powerfully captures the sorts of internal dialogue doctors have had one by one with themselves.

When people would talk about their careers or their lives, the ones that were most passionate and were loving what they did always aroused in me an unease. It was almost an anger or jealousy and I would see them and go, “Why is he so happy and fulfilled and doing what he loves to do and I’m doing everything I’m supposed to do but I feel empty?” On the other side of this waking up and being who I am suddenly, I felt like, “Oh my god, that’s me now.”

I suspect all the doctor entrepreneurs/leaders I’ve highlighted below had some similar internal discussions. This is how revolutions begin. By no means is it limited to young doctors but typically it’s the young who foment revolutions and they are then joined by those older than them. As you can see in the picture accompanying this article after the post-Velvet Revolution celebration, it’s all ages who celebrate. It’s worth noting that the Velvet Revolution was triggered by a crackdown on students.

Harvard Medical School students stage a die-in. Photo from Tamara Rodriguez Reichberg, Harvard Medical School student

Ignoring Exponential Growth Has Devastating Consequences for Incumbents

Skeptics may say that these revolutionary practice models are a drop in the bucket and in most places, it’s business as usual. That is true just as it was true that the newspaper business looked fantastic in the late 1990s and early 2000s while digital media was going from tiny to small. However, the mistakes made by newspapers and their Zero Sum Game thinking were happening simultaneous to startups getting funding that would ultimately crush the most profitable portions of the newspaper business, not to mention create new sectors far bigger than the newspaper industry. Sadly (for the newspapers), they could have owned, invested or partnered with these players yet most arrogantly dismissed them.

Those startups were easy to ignore or diminish just as incumbent providers are blind to the exponential growth and funding (figures in parentheses) that organizations such as Aledade ($34.5M), Alignment Healthcare ($125M), Iora Health ($48.3M) and One Medical ($116.5M) are receiving. Further, other revolutionary organizations have already been acquired. CareMore was acquired for $800M by WellPoint and and HealthCare Partners was acquired for $4.4B by DaVita. It’s worth noting that the acquisitions weren’t by traditional providers. Rather, it was deep-pocketed players seeing an easy mark in soft oligopolistic health systems.

Not unlike digital media startups of the late 1990s and early 2000s, the next generation care delivery organizations are focused on adding value and scaling their business and not particularly focused on the incumbent organizations. Yet, the byproduct of their rapid growth and optimization is they devastate the incumbent’s bread and butter business. One of those CEOs of the aforementioned organizations said they observe that at least 50% of the care their patients had been receiving before moving into their model was waste. Or worse, it was harmful. In other words, it’s like shooting fish in a barrel to remove the waste while improving outcomes. They reduce hospital days, ER visits and unnecessary surgeries by nipping issues in the bud before they blow up. Note that each of those items are the profitable lines of business for health systems.

Change Starts at Home

Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has. – Margaret Mead

I put my family where my mouth is and convinced my folks to move into one of these revolutionary practices. They had been going to a well-regarded, large multi-specialty group in Seattle. However, the care they got was typical of our misaligned healthcare system. When my father was diagnosed with a significant chronic condition, he received a couple prescriptions from a specialist and told to check back in 6 months with the doctor. His PCP had no idea he’d been diagnosed with a significant condition. Meanwhile, his world came crashing down and a huge amount of anxiety and stress was thrust on him — surely, not the best “prescription” for his condition.

While it’s rarely easy to get someone to change their doctor, let alone a senior who has a significant condition, I ultimately prevailed in convincing my parents to make the move. Six months into being in Iora Health’s Medicare Advantage program, the change is dramatic. So much so that my dad told me last weekend he’d be happy to be a testimonial for them.

Creating the New Ecosystem

You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete. Buckminster Fuller

In their own way, each of the doctors listed below is contributing to building the new ecosystem and ignoring the Preservatives who are wedded to the status quo. As mentioned above, there are non-physician clinicians and individual citizens having a big impact but I focus on doc-entrepreneurs and intrapreneurs here.

• Dr. Rajaie Batniji co-founded Collective Health in the belief they could help employees receive better care and coverage than what many experience with incumbent health plans
• Dr. Steven Eisenberg for adding love & music to #oncology and humanity to medicine (h/t Bunny Ellerin)
• The late Dr. Tom Ferguson coined the term e-patient many years before others were focused on equipped, enabled, empowered and engaged patients. This is a whitepaper (PDF) finished by his colleagues after his untimely passing.
• Dr. Rushika Fernandopulle founded Iora Health to restore humanity to healthcare. They have proven to take on the most challenging patient populations and achieve outstanding outcomes and even take on individuals not addressed by the new health law with the support of a Nobel Prize winner.
• Dr. Paul Grundy has led IBM’s transformation in healthcare shifting their thinking from healthcare as a soft benefits item left to HR to something that is a critical supply chain cost and source of competitive advantage.
• Dr. Rob Lamberts showed how an independent family physician can strike out on their own and provide better care and be more professionally satisfied
• Dr. Risa Lavizzo-Mourey is leading the Robert Wood Johnson Foundation spearheading their major re-focus on creating a Culture of Health that is impacting communities throughout the country.
• Dr. Harry Leider is leading Walgreens retail clinic and telehealth expansionthat promises to reach half of the country by the end of the year.
• Dr. Geraldine McGinty for her work creating innovative radiology payment models & spearheading payment reform (h/t Bunny Ellerin)
• Dr. Farzad Mostashari described Aledade’s goals as follows: ”It’s to help independent primary care doctors re-design their practices, and re-magine their future. It’s to put primary care back in control of health care, with 21st century data analytics and technology tools. It’s to support them with people who will stand beside them, with no interests other than theirs in mind.”
• Dr. Stan Schwartz saw what Dr. Keith Smith was doing and has been creating a true transparent medical network and making that available to employers  — both doctors and patients are saved from excruciating amounts of bureaucracy in a very appealing economic model to both parties. It’s also the first Health Rosetta item to be delineated.
• Dr. Danny Sands co-founded the Society for Participatory Medicine while practicing and famously taking care of ePatient Dave.
• Four years ago, I observed how doctors such as Wendy Sue Swanson, Natasha Burgert & Howard Luks were doing something similar to how Sal Khan had “flipped the classroom”. This led to the Robert Wood Johnson Foundation initiating a major program called Flip the Clinic to improve outcomes and participation by patients.
• Dr. Mike Sevilla for using #hcsm to educate, elucidate and save family medicine #FMRevolution (h/t Bunny Ellerin)
• Dr. Eric Topol has written and spoken extensively about how central the patient will be as a participant in their care compared to traditional practices. He highlights how the smartphone is the equivalent of the Gutenberg Press for medicine
• Dr. Bryan Vartabedian is showing other doctors how to be a “public” physician & the impact that can have on outcomes
• Dr. Sheldon Zinberg founded CareMore creating a national leader in treating the frail elderly.

By no means is the list above complete. Add your comment below on a revolutionary doctor that has inspired you. Let us know what they are doing. Whether it is private practice, venture-backed startups, public health or health benefits, each doctor is contributing to the revolution. In their own way, they are fostering a Velvet Medical Revolution.

Dave Chase: Entrepreneur (2 exits), prof. speaker, new venture advisor, intrapreneur (2 $1B+ businesses), author & aspiring documentarian.

Article link: http://www.forbes.com/sites/davechase/2015/08/05/medicines-velvet-revolution/

What is the greatest impediment preventing Americans from getting good health care? Surprisingly, it’s not the cost of care. Instead, according to new research from the Center for Talent Innovation (CTI), the fundamental issue is the health care industry’s failure to develop a nuanced understanding of, and commitment to, women as consumers and decision makers.

According to our report The Power of the Purse: Engaging Women Decision Makers for Healthy Outcomes, which was based on a multi-market survey of 9,218 respondents in the U.S., UK, Germany, Japan, and Brazil, health care consumers are overwhelmingly female and have huge unmet needs. For women, time is at a premium — 77% don’t do what they know they should do to stay healthy because, according to 62%, they lack the time. Women are swimming in health information but don’t know which sources to believe: 53% think they can get the best health information online while only 31% of these women trust online sources. Not only are women starved for resources, but they don’t trust the professionals who try to serve them. Of the women surveyed, 78% don’t fully trust their insurance provider, 83% don’t fully trust the pharmaceutical company that makes their medicine, and 35% don’t fully trust their physician.

Without the time, information, and trusted relationships that inform good decision making, we found more than half (58%) of women surveyed lack confidence in their ability to make good health care decisions for themselves and their families.

These findings should be a huge cause for concern among all players in the health care industry. Women account for a significant chunk of the market. Fifty-nine percent of women in our multi-market sample are making health care decisions for others. That number shoots up to 94% among working mothers with kids under 18. These women set the health and wellness agenda for themselves and their families, choose treatment regimens, and hire and fire doctors, pharmacists, and insurance providers. Given the influence of these consumers, you would expect that the health care industry would be supporting them with tools and services. Yet, strapped for time themselves, many doctors focus on patients to the exclusion of the decision maker accompanying them to the exam room; drug trials continue to ignore sex differences in medical trials and the impact that may have on dosage; and much information about insurance policies continues to be confusing and, at times, opaque.

The good news: By engaging this market segment and rebuilding trust, health care companies can have a first-mover advantage. They must first develop gender smarts with customers and exhibit the behaviors women seek, as decision makers, to serve their needs. As part of our study, we uncovered the behaviors that make the biggest difference in building trust and satisfaction with women:
•Doctors can foster dialogue and provide clear communication. Reporting test results in an understandable way, openly discussing preventative care, and proactively managing the health of women and those they make decisions for, as well as providing them with information that help them make those decisions, all go a long way toward creating a trusted partnership.
•Insurance companies can provide the coverage women want by making preventative care affordable, making it easy to find doctors in-network, and by providing easy, friendly, informative customer service. These seem like no-brainers, but in our interviews and focus groups, women continually report these provisions absent in their own relationships with insurance providers.
•Pharmaceutical companies can win trust by ensuring that clear and comprehensive information accompanies prescriptions and is available both online and by telephone, and by providing gender- and ethnic-specific drug recommendations.

Next, health care companies can see an instant benefit from both putting women in positions of leadership and encouraging them to use their personal experiences and perspectives to shape their approach. After all, women comprise 88% of the health care workforce — but only 4% of health care CEOs. In our report, we uncovered story after story of female health care professionals who use their personal experiences as a family health decision maker to inform their work. Those who have found their way to leadership positions, or who work within forward-thinking organizations, have achieved incredible connections to the female market.

Consider Cleveland Clinic family doctor Lili Lustig, who felt ignored by the physicians treating her mother’s illness and now uses that experience to inform her own approach with patients and female decision makers in the low-income neighborhood where she works. “I am so driven to make a difference, because I understand their frustrations and desires to be taken seriously,” Lustig says. If a patient visits with a family member, she makes sure to treat both with dignity.

Or consider Meredith Ryan-Reid, MetLife senior vice president and mother of two, who draws upon a standout customer service experience she had when she ordered supplies from Diapers.com to inform her contributions at work. After all, it’s directly relevant as MetLife works to ensure its customer service operation is sensitive to the time limits, information needs, and confidence of its accident and critical illness customers — the majority of whom are women.

“It is so complicated for the health care industry to move to a new model,” says Lynn O’Connor Vos, CEO of Grey Health care Group. “Understanding the role and importance of [these female decision makers] can really help get us there faster.”

The more health care companies elevate and amplify women inside their organizations — and build trust with them externally — the better positioned they are to become truly consumer-centric. The roles women play in the lives of others lend a multiplier effect. Their role as decision maker is not receiving the notice or respect it deserves, which is why we have named the women in this market segment the “Chief Medical Officers” of their families. Developing a keen understanding of these women’s wants and needs in health care, and using that understanding at every stage of product development and commercial relations, will help companies uncover and leverage huge market opportunities as well as surprise and delight their customers.

Carolyn Buck Luce is executive in residence at Center for Talent Innovation and senior managing director at Hewlett Consulting Partners. She is an adjunct professor at Columbia’s Graduate School of International and Public Affairs and was previously the Global Pharmaceutical Sector Leader at Ernst & Young LLP.

Julia Taylor Kennedy, vice president and senior fellow at the Center for Talent Innovation, drives qualitative research and writing for CTI. A seasoned producer and interviewer, she also hosts a Carnegie Council for Ethics in International Affairs podcast called Impact: Where Business and Ethics

Article Link: https://hbr.org/2015/05/the-health-care-industry-needs-to-start-taking-women-seriously?utm_campaign=Socialflow&utm_source=Socialflow&utm_medium=Tweet

June 02, 2015 3:38 AM ET

Lauren Silverman

On a recent trip to Chicago, Patti Broyles felt like she was looking at the world from the bottom of a fish bowl.

“This weather was really cold and rainy and I had a lot of pressure in my sinus areas,” Broyles says.

Since she was nowhere near her primary care doctor in Dallas, she called Teladoc, the largest telemedicine provider in the U.S., for advice. Patients whose employers or insurers have deals with the Dallas-based company can call any time and be connected with a physician on duty within minutes.

Broyles says the doctor on the call gave her a prescription for antibiotics that soon cleared up her sinus infection.

Jason Gorevic, Teladoc’s chief executive officer, says such encounters use familiar technology, “whether it’s your cellphone, your laptop that has a webcam built in to it, or simply the phone.”

In Texas, hundreds of employers offer Teladoc’s services to more than 2 million employees, Gorevic says.

But new rules from the Texas Medical Board could make it a lot harder for people like Broyles to get antibiotics that way. In response to the board’s restrictions, Teladoc has filed a lawsuit that accuses the medical board of artificially limiting supply and increasing prices.

“The rules, as they’re written today, only allow a physician who has seen a patient in person to interact with them remotely,” Gorevic says. “That’s basically saying you can’t go shop anywhere else.”

The rules do allow for certain exceptions that would permit a physician to diagnose or prescribe medications via phone or video. It would be OK, for example, if the patient were at a medical clinic, or another health care worker were with the patient and could do a sort of surrogate exam. There’s also an exemption for remote mental health visits.

Mari Robinson, executive director of the Texas Medical Board, says the rules aren’t meant to stifle competition. They’re meant to ensure patient safety.

“How can a physician make an accurate diagnosis when they have no objective diagnostic data?” Robinson asks. “All they have is what the patient has told them.

And that’s not enough information, she says.

“No one would think if they showed up at their doctor’s office they would go back to a room, have the doctor stand on one side of the door, they would stand on the other, they would tell the doctor their symptoms and the doctor would slip a prescription out from under the door. No one would think that was good care,” says Robinson. “That is exactly the same as doing it over the telephone or over some system where a physician can’t get objective diagnostic information.”

But Dallas health care attorney Brenda Tso says that if you peek behind the curtain, the strict rules aren’t just about patient safety.

“Doctors are trying to protect their practice from telemedicine, basically,” she says.

Still, Tso says she thinks Teladoc’s motivations are also financial.

The medical board is not suggesting that telemedicine should be completely stopped, Tso says. “That would be stupid. And nobody is saying that. Now, what the Texas Medical Board and the doctors are saying [is], ‘Well, we should use it in a limited sense, as long as it doesn’t affect the standard of care.’ ”

While the Texas Medical Board doesn’t think it’s good practice for patients to be sending photos, videos and text messages to unfamiliar doctors, attorney Rene Quashie points out that other states permit all those activities.

“If you look at states like Virginia, Maryland and New Mexico, they have laws and regulations that really facilitate the greater use of telemedicine,” Quashie says. “Texas is not one of those states.”

He says that maybe especially in a state like Texas, where 200 counties are considered medically underserved, and more than a dozen counties have just one primary care doctor — there’s a larger role for telemedicine.

“There’s a huge underinsured population in Texas,” Quashie says. “Even people who have insurance, sometimes have problems accessing care. So we’re balancing access to care along with patient safety issues — misdiagnosis and over-prescription. But we also want to allow companies to innovate in this space.”

Access to doctors is the main reason insurer Blue Shield partnered with Teladoc in California. Executive Vice President Janet Widmann says that, initially, telemedicine was meant to help rural members reach specialists.

“Now there’s quite a bit of interest from our members in having the convenience of a telehealth visit. Folks want that,” she says.

By next year, 800,000 of the Blue Shield of California’s 3.5 million members will be able to use Teladoc.

In Texas, the medical board has already received more than 200 comments on the change of rules. It says key players, such as the Texas Medical Association, support the stringent regulations. Teladoc points out, on the other hand, that the vast majority of the comments were in opposition. The new rules governing virtual visits were supposed to go into effect June 3rd, but have been delayed until the case goes to trial.

This story is part of NPR’s reporting partnership with local member stations and Kaiser Health News.

Strengthening health care’s supply chain: A five-step plan

Dramatically changing the sector’s inefficient supply chain may eliminate the dangers posed by counterfeiting and medication errors.

September 2013 | byThomas Ebel, Erik Larsen, and Ketan Shah