The authors bring up a whole group of points that I agree with:

• Email is already verging on obsolescence for people under 30
• The patients under 30 don’t understand why anyone providing a service wouldn’t answer text messages
• Psychiatrists tend to be late-adopters of technology
• Email delivery is sometimes delayed and isn’t suitable for emergency communications in many cases

They also bring up a couple of other issues that make good sense to me. First, email isn’t usually encrypted. I discourage patients from saying anything very personal in emails. I think an email with content like “Your labs looked fine,” isn’t likely to hurt many people, but “I’m having an affair” could be really dangerous.

The obvious solution to this problem is the more widespread use of encryption technologies like PGP . I can use it, but I doubt that most of my patients even know what it is. PGP is a great idea, but as far as I can tell, it never really caught on, primarily because it can involve so many steps to exchange keys, enter passwords, decrypt the text, and so on.

The second issue is that despite mentioning IM, Twitter, social media and the like, they barely mentioned Google Wave and Skype. Google wave (old post here) isn’t really ready for prime time yet but Skype’s been around for a while. Basically, I think Skype could be for real-time (synchronous) communication, while Google Wave would basically do the asynchronous communication that the authors of the article are talking about. All that’s really necessary is for Wave to get some better security features, and for someone to start a “medical Wave” server to make sure the data are secure.

Basically, I think Google Wave and Skype are going to take over a lot of what the under-30 crowd is using.

Let them know how being obsolete feels like for a change.

It’s hard to explain exactly what Google Wave is, but I like Google’s description that it’s “what email might look like if we invented it today.” To me, it’s email, blog, instant messenger, Facebook, wiki and Skype, all rolled into one thing.

Google bills Wave as a “personal communication and collaboration tool.” A “Wave” is like a shared email/web page that people who need to work together on something to use to communicate, to share images and files, to chat, and build a document collaboratively.

I don’t really want to go through all the features here, but I can see two really fabulous uses for Wave in telepsychiatry.

Telepsychiatry is mostly real-time, but, like most doctors these days, I’ve also got several email threads going with patients every day. I prefer to handle routine stuff like “can I change my appointment?” and “I’m confused about the CBT homework you gave me last week” via email. A private Wave with me and the patient as participants would be a wonderful record of things that are scattered over several emails right now. I could also think of ways to incorporate homework and rating scales and other things into a wave.

A more exciting use would be for the patient to control the wave and add or subtract providers onto a personal “medical wave.” The idea would be that I as a patient, for example, could grant access to my personal “medical wave” and that would facilitate communication between different caregivers really easily. The other is that my personal medical wave could, in some sense, be my portable medical record. It wouldn’t be hard, even now, to put in pdfs of labs, consults, etc, and just have this data be available to anyone who takes care of me in the future.

Really, there are two things that are stopping me from starting to experiment with Wave right now. First, the program is still in the alpha stage, and probably needs to mature a bit to get stable. The second is security. I like Google a lot, but would really like it if there were a wave server out there that was hardened to the security needed to manage medical information. Right now, Google’s got the only wave servers out there, but they claim they will make the specifications public in the future.

Somebody’s going to start a medical wave server company and that just might be part of the breakthrough in medical records that everyone is looking for these days.