| UHN Palm Newsletter (January 2002) - Back to the Future Last year at this time I wrote about how my Palm IIIx memory was maxed out and I was upgrading to a Palm IIIxe. Now it's the IIIxe that's full to the brim. "Plus ça change…" as we say in Montreal. Let's take a look at the year past and developments in Palm computing in medicine. References to precious issues of this newsletter are highlighted.
Slower, Older, Heavier Some of you may have been reading long enough to recall that I gave my old Palm IIIx to my wife when I got the IIIxe (see the January 2001 issue). We set up her phone directory and appointments (she's a roving public health nurse) and put a variety of pediatric reference files in memory. Despite the careful setup however, we discovered that Rose doesn't like using the Palm for work and it has been languishing in her desk for months now What went wrong? Rose's office computer systems don't communicate with the Palm PDA at all. Any notes she takes with the PDA must be reentered in the charting software at the office at the end of the day. That duplication of effort was pretty annoying. Rose discovered that it was easier to use paper notes and transfer the notes than to use Grafitti on the Palm. She also found that reference materials on the desktop PC were easier to read and just as convenient to use as what she carried on the Palm. Also, Rose rarely booked home visits or made phone calls while on the road, preferring to wait until she returned to her office. The portable phone directory was less important when sitting at her desk. The moral of the story: integrating the Palm into the overall work flow is important to mobile health care workers. Without that, the Palm becomes an extra burden rather than a timesaver. Anybody want a used Palm IIIx at a low, low price?
Faster, Smaller, Cheaper As in most things computer-ish, Palm handhelds have become more powerful with each new generation. Larger memory capacity (eight megabytes is standard now) was eclipsed by the addition of removeable storage card slots. This will probably put the memory squeeze behind us for good. See last December's edition for an overview of some of the popular models with removeable storage capability. Colour screens and better audio have begun to emerge, although nothing to rival Pocket PC devices. The Handera 330 and Sony Clié demonstrated that even monochrome screens could be improved with higher resolution (May 2001). Finally, one can see ECG tracings in adequate detail to use for teaching. Other developments we reported on included: - protective cases and privacy software (June)
- photo display software (June)
- security and password software (July and Sept)
- web browsing and email (August)
- battery recharging and alternative power supplies (September)
- document conversion and application programming (October and November)
- translation software (October)
- IR and EMF radiation and its effects on medical devices and health (November)
- wireless linking of PDAs to hospital patient databases (December)
Not a comprehensive look at the industry but certainly wide-ranging.
New Trends WORD PROCESSING ON THE PALM. Am I missing something here? Why would you want to use a stylus and this little screen to write your next medical textbook? But more and more WP software is entering the market. Venerable products like Wordsmith (www.bluenomad.com), have been joined by QuickWord (part of QuickOffice www.cesinc.com) and FastWriter (www.iambic.com). And there are many more. More capable than the MemoPad applet that comes with the Palm OS, word processing programs also premit much bigger documents. WIRELESS. As I noted in the December 2001 issue, attaching wireless networking modules or wireless modems is a growth sector with handheld computers. A new network protocol called Bluetooth permits electronic devices to communicate with each other without cables. It permits your PDA to pass phone numbers to your cell phone, and to use a wireless headset with the phone. Another example, your PDA picks up lab reports on a patient whenever you pass within six feet of the patients bedside terminal. Bluetooth has already been built into Compaq PDAs. Can Palm be far behind? Apart from Bluetooth, there are older wireless networking tools with longer range that can be used to link your PDA to the Web or other networks. MORE SOPHISTICATED OS. Palm OS 4.0 has been released and continues to improve. In so doing it is encroaching on developers of nifty little add-ons and hacks. For example, the new Memopad permits sketching pictures and free-text scribbling (thus crowding HandMenu, Sketchy, and others). It also provides better tools to manage private records, locking the Palm after user-defined intervals and improved alarm-clock functions (thus crowding TealLock, BigClock, and a host of others). Integration with your cell phone has also been enhanced. System enhancements require more memory and faster processors. They imply expanding hardware capabilities also (eg. communications, networking, colour graphics) which in turn drive more software changes. This is the virtuous spiral that drove the desktop PC industry to its current heights. The big question about the OS 4.0 upgrade is: do you want to upgrade for US$40 or get it "free" in a new US$400 handheld device?
No Sé Habla Ingles Enough of this brooding over technology changes (none of which I managed to get on any of my toys). Let's look at how I met a typical challenge for medical professionals using Palm PDAs. I see a large number of Spanish-speaking patients in the Emergency Department. Many have no translator with them and I can't speak Spanish very well. On the Web I found a standardized questionnaire in English and Spanish. It even came with front and back drawings of the human body for patients to point to when describing their symptoms. It could be useful but it was in PDF format (a standardized formatted document for viewing on desktop computers). How to get it onto the Palm? Being naturally frugal, I also wanted to do this with only a modest investment in software - like for free. Here's what I came up with (it's not elegant but it does work): - First, I used the AportisDoc Converter to change the PDF file to a Palm PDB file. This produced something readable but most of the formatting had been wiped out and the pictures were no longer part of the document.
- I used PalmDoc Converter (available from www.tucows.com) to change the Palm PDB file into a text file for editing on a PC.
- Using Windows NotePad, I cleaned up the text
- Using PalmDoc again, I converted the text file back into a PDB
- I used IrfanView to cut the drawings out of the original PDF and save them as a standard BMP image.
- Finally I used FireConverter to convert the BMP into a PDB file.
 After transferring the image and text files to my Palm with HotSync I can open up a text viewing program (I like iSilo, ) to look at the Spanish (or show it to the patient). And I can use the sketches if I think that will work better than having them point to their own bodies (or to mine). I use ImageView for displaying image files.
I could have used commercial software (look at www.adobe.com for ideas) to convert the PDF file to HTML (web format). Then Microsoft Word could clean up the text and iSiloX could convert the HTML to Palm format. Other solutions also exist. For example, I have a Medical Spanish dictionary file in HanDBase format. No help with actually putting together a sentence, but it will allow me to search for specific words.  By the way, your application launcher (either the standard Palm one or a commercial program) can organize all these translation support tools into one screen to make finding them easier.
That's what I like about the Palm device. Lot's of choices to solve problems, most of which are easily managed by a non-technical type like me. Provided I want to invest the time and effort, specialized solutions can be found.
Where to Go A reminder for those who still have memory free on their PDAs. There are many useful programs and reference files out there. Where? Try these sites:
Recovery For those who don’t have any more free memory to install new software, then shame on you! Seriously, you can recover some space by cleaning up your PDA. Here’s a checklist of things to do: - Review what’s loaded already – programs you don’t use can be deleted; last year’s lecture notes can go.
- databases and data files can often be thinned out – I had a few dozen patient records that were just hanging around.
- Memos in the memopad app may no longer be useful.
- Tasks in the ToDo list that have been completed can be purged.
- Old appointments can be purged.
The last two items were the most valuable for me this year – I recovered 500 Kb this way.
Medical "Doc" of the Month John Doyle, of the UHN Department of Anaesthesia, has produced a fine little reference text that ranges over issues such as critical care decision-making, care of alcoholic patients, pre-op assessment and local anaesthesia. Get it from http://gasnet.med.yale.edu/esia/ or from http://doyle.ibme.utoronto.ca.
Hack of the Month Did you ever want to capture a screenful of text from your Palm but didn’t know how. Some application screens or data can’t be saved. You could try to scribble a note to yourself. You could run the application on the Palm Emulator (from Palm) on your desktop PC and try to capture the screen that way. ScreenShot Hack (I just happen to have a copy here too) gives you another arrow in your quiver. It captures the active screen from the Palm and saves it in a file that can be converted to a Windows BMP image file on your desktop PC. What you do with the info after that is up to you….
In Times to Come So I what am I waiting for to get a new Palm with higher res screen and more storage? Well, I did recover enough memory at the end of the year to limp along for a few months. I’m still hoping to see a price drop on the Handera 330. Failing that, I might go for one of the Palm M500 machines or a Sony Clié. And why not a PocketPC? – I still don’t like the software interface. And I wouldn’t mind a cell phone built-in (eg. HandSpring Treo). One thing for sure: whatever I do about a new PDA, I won’t be passing my IIIxe down to my wife. Hmmm. Looks like I’ll have two used PDAs to sell…. See what I end up with next month. I hope you can stand the suspense…. 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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