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    UHN Palm Newsletter (November 2002) - Mobile Medicine

    Do you own a laptop computer? I don't. But I sometimes wonder how I might get even more functionality out of my Palm PDA….

    He Ain't Heavy….

    These days, I find myself away from my office more than ever. Whether I am teaching at the hospital or attending meetings, I don't have access to my desktop PC with its high speed internet connection. Often I have a few hours between sessions but don't always know how to use that time productively. I used to read medical journals but nowadays I subscribe to them online.

    I have debated getting a laptop PC. Not only would it give me access to my files (such as half-finished issues of this newsletter) but, with the right wireless networking tools or a modem, I could get my email or surf the web. And I could read those electronic medical journal articles. I could use a keyboard to type up material or modify slides for a presentation. Of all these capabilities, I miss not being able to read my email the most: I get lots of it, and reading individual messages would be quick and easy to squeeze into spare moments.

    But my briefcase is already pretty heavy. And wireless email and cell phones don't work in many parts of the hospital. As for modems - I can't even plug into the phone jack in the hospital because it doesn't support dial-out by computers.

    These counterarguments haven't changed much over the years but alternative possibilities have emerged. Recently I took a look at squeezing the power of a laptop into my Palm handheld. Here's what I found:

    Email. Palm PDAs come bundled with a simple email program (Mail). It can't handle multiple accounts - if you have both HotMail and U of Toronto email for example. And it isn't good at opening and viewing attached files, such as Word documents or Excel spreadsheets. The Palm email conduit also relies upon you using one of a very small list of email software clients on your PC, such as Microsoft Outlook, or Eudora in order to collect your messages and HotSync them to the handheld. New mail messages can only be retrieved when you HotSync. If this capability is enough, then you are in business. HotMail users can even arrange to pass their email messages to Outlook Express, making them accessible to HotSync (Check out this article on ZDNet).

    But what if you use Yahoo mail? Or if your email program isn't supported? I use Pegasus because it doesn't pass email viruses easily, and allows me to filter out junk mail - highly recommended and free. But to get my email messages onto my PDA, I need a way to access the internet (to get at the messages) and a way for the Palm to download and read the messages. Because internet access from within the hospital is a hassle, I decided that it would be enough to be able to download my email before heading off to work, and not upload my replies or check for more mail until after I got home again.

    (I won't discuss wireless internet access any further or how to connect your Palm to your cell phone and then dial the web. These things can be done but, as I mentioned above, the hospital environment is pretty hostile to that capability. Also, each brand of PDA and cell phone has its own restrictions and hardware issues. You need a cell phone service or wireless internet account too. And just imagine how much more "interesting" it gets if you have to travel abroad…. For an just one example of a enabled-enabled service, look at WebToGo. Suffice to say, that this field is still maturing and I am content to wait on the sidelines just a bit longer. If you are interested, check your manufacturer's website and do a few Google searches).

    It turns out that there are lots of ways to get my email onto a Palm. There is no "conduit" software to HotSync my Pegasus mailbox to my PDA. But the Palm can access my email account directly during a HotSync using software that establishes an internet connection through my PC, via my HotSync cradle, to the handheld. It sounds messy, but it's actually ridiculously easy. First I had to choose an email package. Here is an incomplete selection of what's out there:

    • Eudora - makes free software for web browsing and email reading on your PDA. You can download messages or web pages for later review. The software needs a fair bit of memory, but you can choose not to install parts of the package. You have the choice of downloading to your PC (running Eudora for PC) and then HotSyncing, or downloading mail directly to your Palm. Eudora is not very good with attachments.
    • MultiMail is a small free program which will get your email messages but not attachments.
    • Mark/Space Mail is much more versatile than the basic Palm Mail program and permits multiple accounts too. Costs US$20.
    • AceMail (from AceUnion or from Palm Boulevard) is similar to the ones described above. US$15.
    • Inbox To Go is an email package that ties in with their Microsoft Office file sharing suite. If you receive a message with an attached Word, Excel or PowerPoint document, you can easily open it and even edit it. Because Documents To Go is bundled with many Palms, many of you will already have half of this powerful solution. Inbox To Go can also open PDF files on your PDA. No price is posted yet but this won't be free software. You can download the preview package for testing.
    • SnapperMail is another package which is still in development but a working demo can be downloaded to play with. In addition to numerous enhanced email capabilities, SnapperMail can also view JPEG picture files and open ZIP files. It has no special facility with MS Office documents, however. SnapperMail can save attachments to your extended memory card, to save space in RAM. Once again, this one won't be free - probably in the US$40 range.

    Eudora has the ability to get your Internet email unassisted. The others need a bit of help. I used MochaPPP. For US$10, this clever utility lets the Palm piggyback on my PC's internet connection. The Palm gets my email directly, bypassing the PC and the Pegasus email software. There are other versions for Mac, Unix, even AS400 (don't ask).

    A few caveats. None of these packages will synchronize messages with your PC email software (except Eudora, to its own PC software only, if you use it). This means that the messages will be on your Palm but not on the PC. If you get many attachments, but find your Palm email software doesn't handle them well, you'll need a way to go back and retrieve the messages to your PC later. Fortunately, all these programs give you the choice of not clearing the original messages off your mail service when you download them to your Palm - giving you a second crack at them later.

    Adobe PDF files These are accessible if you download the PDF reader for Palm handhelds from Adobe Systems. This permits me to copy medical journal articles I have downloaded to my Palm's extended memory card, to read on the subway or during a pause in my working day. I still find this software rather slow but it does work.

    Portable Keyboard There's no way I would pay US$90 retail for one of these but I did pick one up on special for C$20 plus shipping. It's a whole lot faster than Graffiti and folds up when I am done into a package only slightly bigger than my Handera PDA. I am not using this a lot but when I do need to jot down some details, this works (for me) much better than the stylus.

    Presenter-To-Go (from Margi) plugs into your Palm at one end, and an overhead projector at the other. Then you can carry your PowerPoint demo around on your PDA. With Documents To Go and a keyboard you can even modify the slides on the road.

    My last option is to move the goalposts. I could get a Dana (of which, more later) which uses the Palm OS but has a much bigger screen and a keyboard. Or I could get a Sony NX70V which is a bit bigger than a traditional Palm PDA but has a high quality screen, a tiny keyboard and a built-in digital camera. At least I could leave my digital camera at home. Or I could buy a HandSpring Treo (reviewed previously) which has a built-in cell phone. These devices blur the boundaries between traditional handhelds and laptops (and cell phones and digicams and…). But I don't have the budget to splash out on new toys just now. So I have to make do with my low-rent strategies.

    But, with my enabled, folding keyboard, cables, cell phones and what-all, my pockets are starting to bulge. And setting these gizmos up is more hassle than just opening a laptop. And that small Palm screen is not good for complex tasks - or even basic multi-tasking like a laptop running Mac or Windows software. Will a pocket full of portable devices meet your needs or do you need to shell out for a proper laptop (and shoulder bag)? Have fun exploring this question for yourself.

    Remote Control

    If you did have a wireless internet connection to your Palm, what could you use it for? How about linking to patient charts or reference data on your PC? You can even control your web browser or other software using your PDA as a sort of remote control, or virtual network computer. If you don't have 802.11b wireless or a suitable modem/cell phone, you can simulate the internet connection with MochaPPP and experiment with one of these remote control programs:

    The above-named products get installed on the PC and permit it to accept input from a remote device. You install the remote control software on your Palm: either PalmVNC, from Harakan Software or WinHand. WinHand is much faster than PalmVNC and has built-in security for a price (the no-security version is free). I found that WinHand worked well with VNC on my PC, and got acceptable results with my Handera. If I ever get a wireless networking environment, I plan to do some serious testing of this concept.

    Nuts and Bolts

    Odds 'n ends of hardware and software that caught my eye this past month:

    • Progect - an outliner and hierarchical list maker like BrainForest - but FREE. It works but is still being developed.
    • Pyramid Solitaire - a free card game
    • PhoneWatcher - Are you looking for a way to call phone numbers listed in your PDA without having to punch them in each time you call? Hold your PDA near the mouthpiece and this program dials your phone. It uses the speaker on your Clie or Handera (US$10).

    It's getting close to Christmas and new Palm devices and accessories are hitting the shelves.

    • New PDAs from Palm are here. The Tungsten T model features a better screen, faster processor and built-in wireless networking (BlueTooth). Read a review at PDA Cortex or check out the bundled software and hardware at the Palm site (here or there).
    • Sony is also pushing a new model out the door: the Peg-NX70V. It boasts 16Mb RAM and a digital camera (640X480 - good enough for snaps of that cellulitic leg, to see if it is improving the next time you do rounds), MPEG-4 video recording, voice recorder, built-in KB, 320X480 screen (but smallish). This is so new that as of yesterday Sony's website hadn't updated from boasting about the NR70V -- which now looks decidedly anemic. The only major downsides with the Sony NX70V are its smallish screen, the tiny thumbelina keyboard, and the somewhat large case.
    • Envious of the Sony? Get the Photo Traveller camera for PDAs with SD or CF slots - it offers 640X480 like the Sony.
    • Here's a Palm OS computer that has a much wider screen: the Dana Palm-OS "laptop replacement". I note sadly that it was developed by Handera as consultants to the manufacturer. This looks like further evidence that Handera is withdrawing from designing new models of its own to compete with Sony and Palm. Thus, the Handera 330 I bought just eight months ago is probably now an orphan. Well, at least it is still working….
    • Magnifico is a clip-on magnifier for the Palm screen. C'mon, admit it, it's getting harder to read that screen every passing year! And this is a much more affordable Palm-oriented gift than a whole new PDA. This company also makes folding keyboards.
    • PCMCIA cards were developed to give swappable components like memory or modems to laptops PCs. If you want to share a PCMCIA card with your PDA, the Guyver is a sled that clips on to the back of your Palm. Unfortunately, by the time you have paid for the sled and the PCMCIA card, you may find it would have been cheaper to get a new Palm OS5 handheld with built-in functionality instead.

    Medical "Doc" of the Month

    If you carry your PDA with you at work, you are probably looking for websites with clinical reference data you can use.

    MedMole is a search engine for online CME courses for paramedics, nurses, and doctors. Online course materials can be copied to your PDA and read offline. All you need is Plucker or iSilo to capture the material, or a web interface and browser such as the ones we discussed above.

    The FP Notebook is an online textbook packed with tips and tricks for working family doctors (and others). Besides its utility for quick consults on managing a wide range of problems, the FP Notebook pages can be captured with your web browser (or Plucker or iSilo) and downloaded to your PDA.

    Hack of the Month

    Pop! gives you a pop-up menu of shortcuts for text entry. This program is customizable so you can create your own preferences and customized menus to speed up your work. For example, you could assemble boilerplate sections for consult notes or charting. You could then create a quick consult letter in MemoPad which you could then HotSync to your PC for final editing and printing. Try the free demo available from DigitalGlyph's website.


    Medical Computing

    Stanford Medical School instructors are using wireless Palms to poll students. Stanford has been a leader in deploying Palms for many other medical education projects -- see their website for more details.

    There has been a fair amount of interest and research in the use of handhelds in medicine. The University of Arizona maintains a bibliography of PDAs in medicine.

    In Times to Come

    I am still tinkering with the newsletter format - looking for ways to get organized and reduce the size of the file in your inbox. I hope that you find the constantly changing appearance interesting or at least not too distracting.

    Until next month, 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:

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