Editor’s Memo

Telehealth Still Being Screened

Peter Wehrwein

Reed Hastings, the co-founder of Netflix, was inspired to found the company partly by a problem he worked on as a graduate student in computer science at Stanford. The exercise involved calculating the advantages of transporting computer tapes by car. As it turns out, the bandwidth of moving large quantities data physically—via the “sneakernet”—can be amazingly high. So when a friend told him about DVDs, Hastings saw bandwidth: 5GB chunks of data that could be sent cheaply through the mail.

“I realized that is a digital-distribution network,” Hastings said at a mobile communications meeting last year.

Of course, the bandwidth of today’s internet, along with the processing power of devices, has made streaming possible and snailmailed DVDs obsolete. Netflix adjusted, figured out streaming, and is now a $62 billion company.

Its proponents believe that telehealth can emulate Netflix and envision health care leaving its sneakernet days—as well as earlier eras—behind.

Enormous amounts of health care information can now travel digitally. That information may be in the form of an MRI or CT scan; the American Telemedicine Association says there are 8 million users of teleradiology. It may be in the tone of voice, and gestures during a telemental health visit.

Henry DePhillips, MD, the chief medical officer of Teladoc, says flu is an ideal application of telehealth because an accurate diagnosis can be made based on a patient’s description of her symptoms during a telemedicine visit and whether flu is circulating in the community.

But Netflix has had outages, and telehealth is not without its problems. Teladoc has had to work to keep antibiotic and steroid prescribing for acute respiratory infections in check. Researchers have cast doubt on the cost effectiveness because telehealth increases utilization. A NICU-based telemedicine program at the Mayo Clinic had connectivity and other problems.

How telehealth plays out is going to be must-see viewing.