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t m c » p u l s e | a p r i l 2 0 1 9 17 breaths because his brain doesn't send a signal for him to breathe the right way, so we have to help him with additional machines." An emerging access-to- care tool Thomas Kim, M.D., a leading telehealth crusader in Texas who advocated for changes in the state's telemedicine laws during the last legislative session, said children with special medical needs are among those who can benefit most from this method of health care. In 2017, Senate Bill 1107 removed rules that required face-to-face consultation between a patient and physician providing a telemedi- cine service if the physician had never seen the patient. The law also compels insurance plans to cover services delivered via telehealth, so long as the consultation is not simply audio or written—the appointment must involve more than a phone call or text. Most of the act took effect in 2017, with the remaining sections taking effect on Jan. 1, 2018. "That is the first step in what I am hoping is a continued journey in making telehealth more accessible and more helpful to the people who need it," said Kim, who is based in Austin. "Telehealth care is health care. Full stop. It is simply a means to delivering actual health care." A study published in Health Affairs in December found that 15.4 percent of physicians worked in practices that used telemedicine for a broad range of patient inter- actions. Radiology, psychiatry, car- diology, pathology and emergency medicine were among the medical specialties with the highest rate of physician-to-patient telehealth use. The data was derived from the American Medical Association's 2016 Physician Practice Benchmark Survey and provided the first nationally representative estimates of physicians' use of telemedicine. "Any provider could develop what I call the skill of telehealth," Kim said, "which is to say: How do I leverage technology to help me do my job better and deliver better care for my patients?" Kim envisions mobile devices— specifically smartphones—as the health care delivery platform of the future. Receiving telehealth insur- ance reimbursements at the same rate as in-person visits, he added, is "the next hill to climb." Mosquera's next challenge is to determine how to make his clinic more helpful to the parents and other people who take care of his patients. "I feel really good about this program. We love our patients," he said. "I'm going to keep going. I want to keep doing more. I want to be the best program in the country for children with medical complexities." When Cheryl Lingenfelter takes Nathan to the doctor, she must also haul his wheel- chair, diapers, clothing, leg braces, medications and breathing gear.