It's that time of year, and I have been thinking of getting something Palm-ish for Christmas. But I won't - yet. Read why below.

Ho Ho Hold on a Minute

This time last year I found myself complaining about my Palm IIIx: with four megabytes (Mb) of RAM, there was not enough memory for all the medical reference texts I wanted to load onto it. So I went out and bought a IIIxe. With eight Mb on my PDA (personal digital assistant) I figured I would be all set.

Well, I maxed out my Palm memory months ago and I still didn't get all of my (expanding) list of reference texts on board, let alone texts and programs for non-medical applications.

Now there are many tempting new devices available. They all have a minimum of eight Mb of memory and most feature sockets for extra memory and other gadgets. A sixty four Mb Compact Flash card ought to be enough even for me - for a while. In previous issues I have described some of the current crop (Palm M500, www.palm.com or Handera 330, www.handera.com or various Handsprings, www.handspring.com). Furthermore some of these models have colour screens. The Handera and the Sony Clié (www.sonystyle.com) also have higher screen resolution, creating a much sharper screen image.

And prices have fallen on all models of late.

But, after some research, I decided that it is not time to buy. Why? Two reasons. The first is that the current crop of devices are about to be eclipsed by new models in January and February. The new models may include such features as even better (higher resolution and better colour) screens, faster processors, and perhaps built-in cell phone technology.

And what will happen to the older models when the new ones hit the shops? Their prices will fall. And that's when I will pull out my much-abused credit card. Will I get one of the older models or a new one? Better features or lower price? Over the next few months I will recount a little of my research on the subject. Think of yourselves as virtual voyeurs on my Palm shopping expedition….

A Trip to the Dark Side

Recently I had the opportunity to test drive a Compaq iPAQ 3670. The iPAQ runs Windows PocketPC software and is touted as a "Palm-killer". Since I am thinking of a new machine, why not look at it? After a few weeks, here are my impressions, both good and bad.

The good:

• a gorgeous colour screen which can be read easily (with the backlight on) under all ambient lighting conditions
  
• sixty four Mb of memory - enough for most users
  
• good sound subsystem
  
• handwriting recognition system is as good as Graffiti on the Palm
  
• newer models than my testbed are shipping now with wireless networking built-in - may be useful at the hospital one day

The bad:

• without the backlight the screen is unreadably dark
  
• with the backlight on the device runs out of power in less than one day of my (admittedly heavy) use
  
• the rechargeable battery cannot be swapped out - and it's awkward to carry around a recharger for a mobile health worker like me
  
• opening and closing applications is a little awkward (but third party software can help)

Some tout the ability of the iPAQ to seamlessly link to and synchronise applications and documents between a Windows PC and the handheld. This does work well, but is matched by similar software for the Palm. See Documents to Go (available from www.dataviz.com and provided free to purchasers of Palms using version 4.x of the Palm OS software) or QuickOffice (www.cesinc.com) or others. For internet documents (HTML) Palm users must buy a program like iSilo (www.isilo.com) to convert to Palm format, or use an online service like AvantGo (www.avantgo.com) while the iPAQ translates them effortlessly. One annoyance: the iPAQ will cheerfully synchronise files it doesn't have any idea what to do with (eg. sound files in WAV format) and leave you to discover only later that they aren't accessible but the Palm HotSync software has its quirks also.

Am I being too critical? My IIIxe has made two week expeditions with me to Japan and Russia, and never needed a recharge. And all I needed to carry for backup was a pair of AAA alkaline batteries.

My verdict: the iPAQ is not the best PDA to take on a week long trip out of town but its excellent screen raises the bar for other manufacturers and wireless networking is probably going to be more important in future (see the next section).

Palm Computing in HealthCare Symposium

November 10, 2001 I attended a symposium of health care workers and teachers. A long list of speakers gave quick summaries of how they used PDAs in research, education, and clinical work, such as:

• claims and billing software
  
• patient survey techniques using wireless PDAs
  
• pharmacology databases and programs for ICU pharmacologists
  
• using evidence-based guidelines in a family practice setting to guide treatment of patients and to help motivate them to change risky behaviours

Many of the ideas presented will be familiar to readers of this newsletter but two interesting themes emerged.

First off, more and more people are using Palm devices collaboratively in health care. For example, general surgery residents at University of Toronto are offered Palm PDAs with references and audit tools preloaded. The residency coordinators hope to monitor educational goals by having the residents HotSync periodically to download audit data to central servers.

Secondly, hardware and software tools to enable wireless data sharing and communicating exist but need to be developed further to exploit the trend to collaborative work.

The symposium was interesting and I learned a great deal. And it got me to thinking about how computing has changed in the last twenty years.

This pattern of evolution is mirroring the development of desktop computer use ten to fifteen years ago. We all began by using standalone desktop machines, then gradually began to network and use the Internet. Meanwhile we started buying laptops for portability. Eventually we got even smaller portable computers such as the Palm PDA. And now it's the turn of the PDAs like Palm and Windows PocketPC to sport wireless LAN and email linking capability.

Next to come: hybrid devices looking like fat clipboards, with bigger screens than a Palm and using wireless to enable connections to hospital and provincial health care databases.

Dr. Arnold's Palm Daydream

In the future, I can foresee a time when emergency care will look like this:

• EMS picks up a patient to rush him to hospital. The medics use PDAs to do charting, check ECG, access his OHIP card for medical history, med list and allergies. The same device, using a few wires monitors the patient's vital signs and wirelessly contacts the base hospital to show the ECG to a physician.
  
• At the ED, the medics "beam" their report and info to the triage nurse's PDA. She uses it to wirelessly process info to make a hospital card, set up an electronic patient record, program a patient ID badge, and wirelessly interrogate the provincial health infobase. (Once back at base station, the medics will hotsync to update the City's logs and database - used to analyse performance, utilization and other issues - useful at budget time).
  
• A ward clerk uses her PDA to fill out charts of patients sitting in the waiting room or at the bedside if they are on stretchers.
  
• The ED doctors, nurses, and students use PDAs for charting, summoning old file info, ordering tests, receiving test results, checking for med dosages and interactions, and ordering takeout food. That new curry place can deliver and will take orders and bill your credit card with only an email….
  
• Students use their PDAs to keep procedure logs that help demonstrate that they met educational goals. A few (well, most) also play multi-player Doom for cash prizes, using their PDAs to transmit their moves to the online game server. (Cutbacks in student funding mean that this is the only way that most will ever have a hope to pay their bills).
  
• And, with all the power those batteries use, at break time the hospital workers can turn on their PDA backlights to warm up lunch….?

I think we are still a little ways off from that scenario. I hope to retire before some of it comes to pass. But some of the ideas expressed here are already in use or in field trials. Bar code scanners for patient ID badges and medications; charting tools for paramedics using drop-down menus and pictures of the human body to chart injuries; software to develop questionnaires that pass the answers back to the hospital network - these are all real and available now.

Unusual Gizmo of the Month

The Stinger (http://www.stingerstylus.com/products/) is designed to provide a handy way to use your PDA without fumbling for the stylus. Of course you'll need to find a place to put it when you want to examine a patient, but I can see some benefits if you work on your feet and on the move.

Medical Computing

Active Corp (www.activecenter.com) has released their ECG module for the Palm. Attach a few wires to the patient to see and record an ECG tracing. More portable than the usual twelve lead machine but the health care facility will need a compatible printer wherever the device is likely to be used as the Palm screen is too small to appreciate the entire ECG "at a glance".

Read about patient charting software for the Palm in this news item from RNPalm (www.rnpalm.com/R-EMstat.htm).

News and reviews about Palm computing in medicine can be found at
www.medicalsoftwareforpdas.com.

In Times to Come

Next month I will present an end of year wrap up of sites and news. I'll let you know how my search for a new PDA is going. Until then, enjoy!

This is the latest issue of a newsletter on Palm handheld computers, prepared for doctors, nurses, paramedics, IT professionals and others who need tools that work. Feel free to pass copies around electronically or on paper. To subscribe, unsubscribe, present burnt offerings, obtain back issues, change your email address or complain, contact the author at: p.arnold.mpr@sympatico.ca

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