- allowing tightly focused, tree-like threads, through contextual inline replies;
- synchronous & asynchronous collaboration, wherever useful or most appropriate; and
- inclusion of shared resource files.
So, Google Wave in eHealth - how could it be used?
A few thoughts...
1. Health Conversations
- For private use...
For Patient to Patient or Clinician to Clinician conversations, Wave is a great way for individuals to share thoughts and information on any topic, health included, and no matter what the personal or professional purpose. However if the topic IS health, then there also should be a caveat that the Wave doesn’t contain any private health information. It is not unreasonable to assume that sharing health information in Wave is similar to that of using insecure emails – so just don’t do it!
- For use in healthcare provision...
As a vehicle for a dialogue between Clinician and Patient, Wave is great but it is important to keep in mind that this is not just your average chat, but another format of an online consultation, and all the complications that this brings. If Wave is embedded in an appropriately secure environment, such as an existing EHR/PHR platform with appropriate privacy provisions/authorizations etc. and where versioning of the Wave could be recorded to support the medico-legal record, then Wave could be a great tool in eHealth. Remember that this is a preview and it is a new technology, so there will be hiccups as we all learn to use Wave - there is a significant overhead to using Wave effectively.
One of my first thoughts re the potential clinical use of Wave was how it could have enhanced a Personal Health Record (PHR) that was developed for use by older children and teenagers with Insulin Dependent Diabetes at Royal Children’s Hospital, Melbourne – BetterDiabetes. There is a component within this PHR where the teens can request online assistance and advice from their Diabetes Nurse Educators (DNEs) for management of their diabetes. Armed with appropriate authorization and access permissions, the DNEs can view selected parts of the BetterDiabetes record, including glucose measurements uploaded only minutes beforehand, making informed and making real-time responses back to the teens regarding proposed changes to their care. In the online version of BetterDiabetes the secure messages flowing back and forth are similar to email, but embedded in the PHR – asynchronous, fragmented and clunky. If this was able to be transcended by a Wave-like tool for communication it could be a very useful vehicle for collaborative healthcare provision. The provision of timely information flow in both directions, and including addition of external files to the ‘Wave’ could be extremely valuable.
2. EHRs & EMRs
Wave is NOT appropriate for an EHR/EMR platform. Formal health records should be based on standards such as ISO 18308 – ‘Requirements for an Electronic Health Record Reference Architecture’ and ISO/DTR 20514 – ‘Electronic Health Record Definition, Scope and Context’. Now Wave may be very useful as an interface for communications within that EHR framework, form or structure, but it is definitely not the basis for "…a set of clinical and technical requirements for a record architecture that supports using, sharing, and exchanging electronic health records across different health sectors, different countries, and different models of healthcare delivery." Of some concern, there are some public Waves that are promoting Google Wave as the newest medium for EMRs. One public Wave as an example is: Electronic Medical Records (EMR) and Medical Information Systems: Is Wave the future of electronic medical records? which includes an EMR example.
By all means let's embed the innovative Wave interface for use within a formal EHR/EMR but we need to be careful if we are expecting more from it.
3. Clinical Decision Support
Phil Baumann’s ‘A Clinical Infusion of Google Wave’ blog, featuring Clinybot, is a fascinating, futuristic view of Clinical Decision Support provided for clinicians. Phil states that he assumes all privacy and security aspects are OK when proposing Clinybot - agreed. However, the missing ingredient in Phil’s proposal is not unique to Clinybot but the reason why we have so little Clinical Decision Support in practice. In order for Clinybot to function as described it would have to have a clear semantic handle on the data structure underlying it. Clinical Decision Support can be and is developed on a per EHR/EMR basis, however standardization of clinical content would enable universal applicability of Clinybot across all EHRs and EMRs. The combination of Clinybot and standardised content could be a very powerful potential partnership.
I’m a pragmatist; definitely not a futurist. I’ve seen some predictions and anticipated uses for Wave that I think are very optimistic, maybe even a little far-fetched. Perhaps these things might happen... probably not.
And of course there are issues and drawbacks to Wave. Tech Crunch's Why Google Wave Sucks, And Why You Will Use It Anyway is a pretty good heads up to the reality of Wave at present.
For the moment I'm more than happy to explore how the benefits of the complex, small group conversations can be leveraged in healthcare, and particularly my clinical modeling work with openEHR. I will keep an open mind to see how Waving in health develops.