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    UHN Palm Newsletter (November 2001) - Win Some, Lose Some

    It’s been one of those months. One step forward, one step backwards on all fronts. Along the way, some useful ideas and products may have emerged from the clutter. Let me share a few of them with you.

    See No Evil

    I am trying to branch out with my Palm into computing tasks within the hospital emergency department where I work. We use an infrared tracking system with sensors mounted on the ceiling in each room and clip-on badges for the staff. Enter the room; press the button on the badge, just like a TV remote control; the system puts my name beside the patient’s room on the Big Board. However, the badges often lose battery power but give no indication at the bedside. It’s only later, when I leave the patient’s room, that I learn I am not logged in.

    Hmmm. Palm devices have IR ports which permit users to share files, or to send data to a printer (if it has an IR port). Could I use the IR beamer in the Palm PDA to tickle the tracking sensor, and reduce the number of badges, pagers, cell phones and other hardware I carry?

    In fact, such a comm link has been touted for a few years for everything from unlocking secure doors to networking with hospital databases to updating patient charts and checking lab reports. But this technology has not caught on for use in the clinical environment. The two main problems are speed (IR links are a lot slower than ordinary computer network cables) and the need to have an unobstructed line-of-sight to the receiving sensor.

    After a few phone calls, help from my hospital’s IT department, and some digging around on the Internet, I discovered that the Palm and tracking system don’t share similar frequencies. As any couch potato could have told me, not all TV remotes are alike and what works for one brand doesn’t work for another. Strike that plan.

    Hear No Evil

    To add insult to injury, I opened a whole can of worms with my questions about IR beaming: I had to deal with a flurry of inquiries about the safety of Palm PDAs. It seems some hospital staff had been reading emails about the risk of infrared radiation damaging equipment or frying nearby human beings. Not to mention the possibility that radiofrequency emissions might leak out of electronic devices and shut down a ventilator or telemetry device. Just how dangerous are cell phones and PDAs anyway?

    Most of you are probably aware that electronic devices emit radiofrequency spectrum radiation. In some cases, such as cell phones and two-way radios, such emissions are the whole point although there may also be unintended sideband interference or other leakage. In other devices, such as computers, the emissions are an undesireable side effect of normal operation. Hence the need for shielding on computer cases. Hence also the familiar injunction against use of cell phones in hospitals.

    Typically, when a cell phone rings, a burly security guard steps up to the offending user and demands that they shut it off or leave the building. (All the while the guard’s walkie-talkie is squawking and hissing in its holster.) How real are these threats?

    For a recent study, see and for a recent article and editorial respectively in the Mayo Clinic Proceedings. Their conclusion was that 7-8% of medical devices might be susceptible to interference from cell phones and the like. There has been a lot of other research, most of it bad, and a mountain of anecdotal reports about pacemaker failures and so on.

    But read more carefully before you toss out your cell phone. Researchers held these devices right up within three inches of a ventilator telemetry port and then pushed the “send” button or keyed a radio. How many patient visitors perch on top of the ventilator while making outside phone calls at your hospital or in your ambulance? Even twelve inches of separation from the telemetry port would reduce the emission strength by a factor of sixteen. How about from the hallway or lobby? Vulnerability would appear to be low under reasonable.operating assumptions. I am not so sure about that security guard’s radio though….

    PDAs emit even less radio wave power than a cell phone so my personal opinion is that they are most likely safe in the hospital environment. Don’t take my word for it, however, do your own reading. Definitive answers are not yet available however.

    Oh, and the concern about infrared emissions and health? PDAs emit IR in the same power range as a TV remote. Noone ever died from that. I bet a decent sunny day exposes me to more IR wavelength light than my Palm ever would, although with my shift schedule I may never find out for sure.

    Speak No Evil

    In my continuing quest to extract some additional medical value out of my Palm I found,24195,3357388,00.html. This article claims one can will soon be able to use a plug-in module on a Palm for scanning under the couch to make sure that the dust bunnies don’t harbour anthrax or plague. A more ludicrous example of pre-marketing a non-existent device and exploiting popular fears I haven’t seen for a long time. By the way, using a laser to volatilise the specimen for analysis brings a new dimension to the term “vapourware” (ie. products announced before they actually exist, in geek-speak).

    Spread the Word, Lighten the Load

    I’m still looking for the best way to share educational handouts with students, housestaff and other colleagues. In last month’s issue I discussed at some length many of the software packages that can help.

    The distribution mechanism also has to be developed. Over the past two years I have considered:

    • Using a PC as a central server that everyone has to line up to HotSync with.
    • Setting up a website which users log into to download the files.
    • Handing out floppy disks with the course files
    • Having users beam the files to one another like a chain letter.

    All these problems have their pros and cons. Central servers need a multiplicity of different HotSync cables to accommodate all the different brands of Palm PDAs out there. Websites are cheap to rent but need a webmaster or other support personnel to maintain and that needs funding. Floppy disks are a nuisance if you need to issue a new one to each and every user whenever the course content changes. Beaming is slow and noone wants to stand rock-still for ten minutes downloading a big file.

    Whichever technique I opt for, I need a standard format for the text and a standard reader program to view it. Why? To save memory! On my Palm I have AvantGo ( for reading material captured from websites, iSilo v2.5 ( for reading text files, BrainForest ( for creating and looking at outlines and lists, and a graphic viewer for looking at pictures, charts and nomograms scanned into the Palm’s crowded memory. I’m down to 125 Kb of RAM in an 8 Mb machine. Ouch!

    If I move to a standard software package (iSilo v3 and its conversion program, iSiloX, for converting HTML and text, then I can do away with AvantGo and BrainForest, freeing up perhaps half a megabyte of RAM on my Palm handheld computer. My students won’t thank me if I ask them to load another reader into their Palms either, unless it allows them to get rid of something else.

    Another advantage of standardization: reduced clutter in my application launcher. I can have just one document reader, and use its indexing system to categorize the documents, making it easier to locate a file when I need it. In this iSilo screenshot you can see the pop-up category list on the right of the screen, allowing me to select which group of documents I want to see in the listings running down the left hand side of the screen.


    Medical "Doc" of the Month

    At last, there is a Palm version of the Sanford Guide available from This has long been one of the premiere antimicrobial therapy guidebooks and its availability for handheld computers is long overdue.

    Hack of the Month

    Do you have trouble getting your Palm to distinguish “A” and “R” when you write in Grafitti? Grafaid will help you polish your Grafitti skills. This is a free program that lets you see what you are writing. You can even cut and paste the results to another application. Try it.

    Medical Computing

    At is an all-too-brief article on how home care nurses use PDAs for charting and reference tools. This is a promising area for PDAs in health care. These users did what all health professionals do: rolled their own software rather than using off-the-shelf products.

    Here’s a story on using Bluefish wireless networking and Palm IR beaming for commercial transactions. Once again, this combination of technologies has potential for charting and patient tracking and logging (

    In Times to Come

    Next month I will have a report on the one day Palm in Health Care seminar ( There will be some more software reviews and links to sites of interest to Palm-toting health care workers. Perhaps I should include a list of items for people who want to give hints to Santa….

    Until then, enjoy!

    This is one of a continuing series of newsletters on Palm handheld computers, prepared for doctors, nurses, IT professionals and video game afficionados at the UHN. Feel free to pass copies around electronically or on paper. To subscribe, or complain, contact the author at the following address:

    Visit our website for the latest Medical Palm Review newsletter and the archive of back issues.