Update Jan 26th, 2010: Thanks to Dr. Ves (@DrVes) for suggesting this post on Clinical Cases and Images: CasesBlog!

Let’s face it. The last two weeks of gently fiddling with Google Wave (effy [dot] han [at] googlewave.com) really weren’t all that gentle. From painful slowness on Firefox to the most awkward reply structure ever (someone please explain this to me!) to extensions that would barely load let alone function – Wave was more of a rollercoaster than the idyllic sea that its name was probably meant to evocate. I’m still just as excited about Wave in health care as I was in July, but there is plenty more to consider now that many of us have gotten our hands wet. Is our ideal feasible?

A health information system built on Wave could take patient empowerment to the next level.

My take on the utility of Wave in health care grew out of a quote from The Possibilities for Patient-Centered Communication:

Doctors and patients are able to initiate communicate around a condition and all things related to the patient’s condition are captured within a wavelet (individual conversations/collaborations). Things like MRI’s and test results can be appended to a wave and doctors and specialists can collaborate through the wave. Since the communication is server-based, these conversations can be captured, secured, tagged, searched, etc.

In my mind, it looks something like this:

The fishiness explained.

The Fishbone represents my (Liz’s) wave swimming along in a big happy ocean of health (…). The first level is an example sequence of actions (mostly from the health professional’s point of view) starting from the tail, when the patient’s problem starts.  The red terms are features that I believe should be accommodated within the wavelet. Some, like Maps and Calendar, can be readily pulled from existing Google services.

The order of the tasks/wavelets is not absolute, but I think that part of the genius of Wave is the ambition to allow an (invited) participant to join at any time and immediately understand the progression of events that has led to the current state of collaboration on the wave. Tag/group support and accurate timestamping is paramount.

At any branch, a patient can insert a reply (ugh, if they ever figure the current reply structure out, anyway), start a chat, go nuts with Playback. There should also be a gallery of useful interpretative extensions available, including live language translation, medical jargon lookup, hive mind experiences.

As DrV noted, if the physician doesn’t provide the information, the patient’s just going to go home and Google it. Even I feed many of my smaller irritations through an AskMetafilter search first because these people are fast and well-articulated.

Others have been even more productive.

And by more, I mean much, much more.

1. Siamak Ashrafi at Ylabz recently put together an excellent video depicting how a doctor and nurse could communicate in real-time [Youtube] on a Wave-based system with support for Google Health. Most interestingly, he suggests that “a hospital could install Google Wave inside their firewall and obtain full compliance”.
2. Quite appropriately, there’s a wave on this topic that is generating top-notch discussion. This is a text version, which naturally makes me wonder if public waves can be linked to (similar to the Google Reader’s public share page). The URL within Wave is here, if you’re interested.
3. And don’t forget the always-excellent Cameron Neylon of Science in the Open, who has been hard at work spreading the Google Wave love. This video demos some research-helpful extensions [Viddler] such as Nature’s adorably-named Igor (search and insert citations).

Then again, maybe it’s premature: what [the wave] is and what never should be.

So that was the good news.

Unfortunately, or perhaps not–at this stage, we are all just playing around with our new toy—the reality could rapidly devolve into this:

• Empty wavelets
• Vandalism
• Scary embedded media
• Advertising
• 100 000+ pairs of eyes glazing over

Next Wave post: I’d like to do a run-down of what I think are the most useful Wave extensions for health care. Stay tuned.

Related posts:

• Google Wave for Medicine 2.0
• The Search for Better Search in EMR