| UHN Palm Newsletter ( 2002) - End of Year Musings Bah, humbug! It's supposed to be Christmas. I even have money to spend on new toys and tools. So, why aren't visions of sugar plums dancing in my head?
Show Me the Money More specifically, show me how my PDA is going to revolutionize my life. Again. Sure, I now carry around the equivalent of twenty kilos of textbooks in a two hundred gram pocket-sized box. And I keep all the phone numbers of every hospital clinic and doctor I ever call in that same box. And I don't carry wallet photos of my family any more either. But when I look back at the uses of my first Palm IIIx it's clear that not much has changed over the past two years. Same software, same uses. Looking forward to what's promised in the current and upcoming models, I don't see any ground-breaking new applications or potential. The new PDAs don't generate the same interest for me as the old ones - despite better colour screens, the ability to play music and video, and even cellular telephone capability. Why am I not impressed? The quest to integrate cellular phone handsets with PDAs is a good example of what's bothering me. I can buy an integrated PDA from Kyocera or Handspring today if I want. But the cellular phone and wireless data services to make full use of the technology aren't in place in Toronto. Certainly the hospital I work at isn't ready to transmit patient reports or lab data to my handheld computer, or let me order X-rays on the move, to name just a few goals of mobile medical computing. Mobile computing is in a transition similar to that which desktop computer users experienced five years ago. The rise of the Internet made linking all those desktops powerful, even transformative. Mobile computing is poised (perhaps) to move in the same direction but the rest of the world has to catch up to that vision for it to become useful. Thus this year's crop of new Palm PDAs, capable as they are, don't move me. The infrastructure to realize their potential is still not in place. When it is in place, significant other players (government, cellular phone companies, the hospital) will have to climb on board with applications and processes that enable the tools. And the final stumbling block to enthusiasm is that the new infrastructure and applications will have to be useful and not have awkward interfaces. My experiences with hospital electronic patient databases and charting leave me wary. And we all know what programming VCRs with handheld control devices is like. Now, imagine what it would be like using a hospital's patient charting software on a device with a screen and keyboard the size of your cell phone. Time will tell whether future Christmases will be bright or dreary.
New Hardware As I noted above there are hybrid devices which merge a cell phone and a Palm PDA. But if you aren't ready for the steep price tag there are alternatives. Your Palm can send a phone number to your phone if the latter has an infrared port. This does involve some juggling to keep the two devices lined up during the data transfer. Alternatively you can try iSync which uses wireless radio links to connect your PDA, various models of cell phones, iPods and Macs. You need the wireless hardware (Blue Tooth) to make this work. But iSync does reputedly perform better than True Sync. Forget combining your cell phone with your PDA: for real integration why not merge your Palm with a stethoscope? Currently only available for iPaq, the Handheld STG from Stethographics permits recording heart sounds or viewing the phonocardiogram. The Freestyle Tracker is a glucometer attached to a HandSpring PDA. The SNAP is a portable EEG device which clips to a HandSpring Visor. You can learn about development of handheld disease detectors and clip-ons for handheld computers by reading new issues of smalltimes. Right now in Toronto, a Norwalk virus detector would look good. Palm devices with barcode readers are popular in retail and warehousing. They also can be used for charting if you use, say, standardized ACLS protocols. You could make up a laminated countertop with drug dosages and procedures listed beside the relevant barcodes (like an oversized Broselow Tape for pediatric ACLS). Barcode data collection software is widely available or you can write your own with programming tools like TracerPlus. You can find lots of vendors and products with a targeted Google search. Do you want to leave your laptop at home? Margi's Presenter-to-go allows you to run PowerPoint demos from your PDA by connecting it to an  overhead projector. Now this I thought would be interesting: I don't own a laptop but I do a fair bit of teaching. Jim Thompson has written a very helpful review of the Margi device and describes all the pitfalls and tricks to help you get started . Jim uses a Handera, as I do, but many of you probably use Sony Clies, Palms or HandSprings. Fortunately, Margi has compatible models for all of these makes. Unfortunately, the Handera may be the least well-supported PDA because the company doesn't appear to be producing new models and noone else uses Compact Flash memory modules on a Palm device. And Margi's little gizmo cannot be used on multiple models of PDAs. So if I get a new PDA from a different manufacturer I have to get a new Presenter-to-go. Bah, humbug. All this stuff will suck the life out of your batteries. You may want to get an AC adapter. Or a backup battery. Or you can get both from Extend Computer which sells kits incorporating rechargeable batteries and AC adapters that permit using the PDA while recharging. If your batteries get low and you want to avoid using the backlight you can clip on the Penlight Stylus, with its a built-in battery powered light. Perhaps this saves battery power compared to the backlight but I wouldn't want to schlep around the extra gizmos and connectors. Gee, I really do seem to be in Scrooge mode here. Well, maybe there is some software I would like to spend money on.
New Software There's a new version of ChaosSync (v3.5). It allows a shared PC with multiple Time&Chaos databases in different folders to sync to multiple Palms - more flexible than before. T&C's a personal appointment/phone/task manager which is popular with doctors and other mobile professionals. Another handy feature of T&C is its ability to have multiple users share a common appointment book, phone book, and more across a network. For example, a departmental secretary could maintain a list of phone numbers, memos, dates for rounds for all the residents in the Internal Medicine program at your hospital. Periodically they could update new info and changed appointments from linked PCs in the hospital or department.  Feeling more like Scrooge than Santa? Don't buy them Palm folding keyboards (US$99). Try FatFinger instead which costs only US$15 and gives people's index fingers some exercise when they have to do text entry. There are other fingertip keyboard emulators out there and even devices that fit over your fingertip to help you peck at the screen more easily (TrueTip, ConceptKitchen). I use a touchpad instead of a mouse and feel comfortable using my fingertip for pointing and clicking, but no way am I spending US$4 or even US$26 for an itty bitty piece of plastic.
Oops. I'm still not in the Christmas spirit (loosely defined as wanting to spend money on myself).
Medical "Doc" of the Month Here's a pointer not to one document but to a small goldmine of them. Jeff Mann has prepared a slew of "guidemaps" to help you sort out diagnostic and therapeutic problems from unequal pupils to ventricular tachycardia. All you have to do is convert these HTML files into something readable on your Palm PDA. You can use Avantgo or iSiloX or a number of alternatives (see previous issues). Jeff's material can be found at his website.
Hack of the Month I don't have any new hacks this month. Somehow, I find that many of them make my Handera "blow up real good". In fact, I now use Crash 1.2 all the time. When my Handera stops working, Crash displays a message then automatically performs a soft reset. Handy when a newly installed application won't let you restart using the reset switch or power button. Pick up a copy. Did I mention that it's also important to perform really thorough-going backups before and after installing new software? If you had fun with new software as often as I do you might be feeling a bit more like the Ghost of Christmas Future…
Medical Computing PalmPower Magazine has a website which is not oriented to medical computing but it has lots of news, tips, and ads for new products. I can't recommend Jim Thompson's site highly enough to those starting out or looking to enhance their PDA usage. Jim is a doctor and medical teacher and he uses PocketPC and Palm devices. He has a wealth of experience. Check it out. Meanwhile, I read an article in the December 12 issue of the New England Journal of Medicine which really ought to put a damper on our collective enthusiasm for computerizing health care. A detailed survey of medical errors and how they might be prevented revealed that fewer than half of members of the public and only a fifth of physicians believed that more computers and computerized processes would be likely to reduce medical errors and improve care. So forget about that big budget increase. Here's a brighter note. The SATELLIFE project provides handhelds for African rural MDs who don't have computer/web access. The PDAs are loaded with useful software and data for health care workers to take into the field. You can learn more about this non-profit agency and how they transfer effective technologies to the third world from their website. There is a news item at PDACortex.
In Times to Come Well, after all that it might seem that I don't have much Christmas spirit. But it's not so. I am giving you all a big chunk of my time (and a piece of my mind) to share what I have learned about mobile medical computing this past month or so. And some of you will undoubtedly find it worthwhile to spend your money on a tidbit or two from the foregoing. You may even avoid some of my mistakes and have more time to spend with your families this holiday season instead of reinstalling software on your PDA. Can't get more seasonal than that now can we?
So next month we will have a look at more stuff and how to use it. I promise to avoid jokes about leftover turkeys, er, turkey. 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 after the warranty has expired. Feel free to pass copies around electronically or on paper. To subscribe, unsubscribe, obtain back issues, change your email address or complain, contact the author at: p.arnold.mpr@sympatico.ca
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