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    UHN Palm Newsletter (July/August 2002) - The Other Foot

    It's a glorious July morning and I am on holiday this week. So why am I sitting indoors banging away at the keyboard on this newsletter? As you might gather from the headline, I have decided to roll out a double issue. There's more than enough here to keep you busy browsing and testing all summer long unless you have no life at all. And that will let me get outdoors with my daughter. She has a new water pistol she wants to test on somebody.

    It's a lot of extra work putting this omnibus issue out, so you had better appreciate every word of it!

    Window Cleaning

    I have a difficult relationship with Microsoft Windows. I take a lot of abuse from it and put up with more bad behaviour, incompatibility issues and computer crashes than any human being ought to endure. It's been about three years since I got a new PC and lately Windows 98 has been behaving even worse than usual. So I decided to start over. It wasn't quite like a divorce but it came awfully close.

    It's well known that Windows tends to accumulate junk (like dust bunnies under the couch) over time. Reinstalling from scratch is often the only way to repair some problems. Of course there are other strategies. I considered upgrading to Windows XP but decided against it due to the cost and the annoying "feature" that XP spies on every little thing you do and reports back to Microsoft about it. I downloaded and installed Mandrake 8.2 Linux and was most impressed with this almost free operating system but discovered that there is no satisfactory version of the Palm Desktop software for Linux. I considered switching to a Mac but that would have meant spending alot of money for a completely new computer, and giving up all the familiar software which I use daily. So I gritted my teeth and prepared to reinstall Windows 98.

    My reinstallation strategy had two arms. The first was to back up all data and make specific notes about my setup and software settings such as email server addresses. The second was to make sure that any really important info that I might need over the next two week period would be available on my Handera 330 PDA. Did I really think that my PC would be out of commission for that long? No, but I believe in Murphy's Law more than I do in Bill Gates or Paul Arnold. And so, to work.

    My PC has a CD writer which I used to make backups of all the data on my system. I also made sure I had all the original installation discs and codes for my software. I would use those to reinstall all my programs and data after reformatting my hard drive.

    I use my PC to manage several important ongoing tasks in my life:

    • Contact management and phone directory
    • Email and internet access
    • Reference texts (medical, mostly)
    • Appointment and "To Do" management (what I have to do and when)
    • Write monthly newsletters (like this one)
    • Miscellaneous note collection and management

    Could my Handera really handle all those tasks?

    Much of this activity is handled by just one program: Time and Chaos, which is a bit like the Palm Desktop software or Microsoft Outlook but I like it better and have used it for more than six years. One of the nice features of T&C is the conduit program that funnels phone directory listings, Todo items and memos between a Palm PDA and the PC. In fact, it was that conduit which sold me on Palm instead of WinCE handheld computers: there was no such interface program for T&C to WinCE when I started investigating handheld computers in 1998. I already knew my Palm PDA could handle most of my daily tasks with T&C. And, when I got the PC out of intensive care, I knew could update it by HotSyncing.

    Making notes for upcoming issues of my newsletters would be no problem. Not only is there the MemoPad on my Palm, but I also could dictate short notes using the VoicePad app on the HE330, something most other Palm devices don't have.

    I have Pepid ED and eMedicine's Emergency Medicine reference programs loaded onto my HE330 already so I would have quick look-up for medical questions. Also, at the hospital, I have access to the Internet and various medical references online.

    Email can be accessed from a PDA. All you need is a Modem, or a wireless networking card and a network to link to. Without going into the details here, I decided to let my email pile up or to read it from a computer in the library or my hospital. Why? Apart from the small screen (which makes reading awkward) and the difficulty of tapping out replies (using Grafitti) there's the little matter of the content. I get photos and files sent to me as email attachments. Most of those would take forever to download at 14400 baud. And most of those attachments would not be useable on the Palm PDA anyway. So I decided that email was one thing I would not try to manage on my handheld device.

    How did it go? As expected, I got plenty of surprises while reinstalling Windows 98. It took most of one day to get the operating system, my network, and high speed internet connections all working again. It took a few more days to get core applications running and configured "just so". In fact, I still haven't bothered to reinstall some software that I rarely use. My PC boots and shuts down faster, is more stable in between, and I have more room on my hard drive.

    I had no surprises from my Handera during this interregnum. Everything just worked. At the hospital or at home and in between I jotted down notes, looked up phone numbers and kept track of appointments. For safety, I made daily backups to the Compact Flash memory card in the Handera. Once Time and Chaos was running on the PC, I restored data to it easily by HotSyncing, specifying that the handheld should overrule the desktop. This is exactly the reverse of what I had to do when I bought my new Palm PDA in March and wanted to transfer the same data to it as had been on the old PDA. What goes around comes around….

    One minor issue was what to do about Palm programs that have corresponding software on the PC. For example, HanDBase, creates databases and tables which can be viewed on the Palm or on the PC. When I reinstalled it on the Palm it wanted to reinstall itself on the Handera too. The same applied to iSilo (for reading texts), BrainForest (for making and reading outlines) and my reference texts like eMedicine and Pepid. This would have made for a very long HotSync and drained my batteries. To prevent these unnecessary uploads, I opened the Palm Install Tool (part of the Palm Desktop suite) and deleted from the queue the programs that I knew were already installed on my PDA. Just you try anything so neat and tidy with a Windows program installation - it can't be done.

    But that's why I like Palm devices and their software: tidy and robust solutions to everyday problems. Careful advance planning and the right sacrifice to the Computing Gods are important, but brain surgery on a Windows PC goes better if you have a Palm in your pocket.

    Mr. Fix-it

    I have been accumulating notes on a variety of software upgrades, patches, and programs to improve your Palm computing experience. Continuing in the vein of repairing, enhancing and improving, I report some of them here. This should keep you off the streets all summer.

    You can take notes faster and enhance the Graffiti recognition system using any of a number of products from CIC Software. WordComplete tries to guess the rest of a word as you print it. RecoEcho, InkSnap and QuickNotes also improve making notes quickly with your Palm PDA. Take a look.

    Another way to enhance text entry is to use a keyboard. Many people prefer the thumb KB on the new Handspring Treo to Graffiti with a stylus. There are several portable keyboards available (eg. ThinkOutside's Stowaway) but are you ready for these new ideas? Virtual keyboards using projected IR light or lasers are coming to market (see illustration). Read articles at:

    One of the nice things about these devices is their ability to work with any Palm PDA which has an IR link port. Unlike various brands of folding keyboards, no physical connector is required.

    Even more exotic is the RAST Vario keyboard, which can use physical connectors or BlueTooth or 802.11b wireless networking to interact with the PDA. The Vario stretches instead of folding because it is made out of fabric and rubber. It can be as small as a postcard or as wide as a regular keyboard. Why not add a zipper and make a fabric keyboard into a case? Somebody already has: the KeyCase flexible keyboard from Logitech - it literally rolls up around the PDA "like a nylon burrito". You just can't make up stuff like this so it must be real.

    You can throw away your stylus altogether if you use the PDA mouse from Targus. Unbelievable as this may seem, stick this gizmo onto your PDA and use it for cursor control and for data entry. Targus also has a line of thumb keyboards and other data input tools for Palm handhelds. All these ideas will appeal to people who are accustomed to using their fingers instead of the stylus for many tasks on their PDA.

    If you like to use a stylus but find it awkward to get both hands free to hold and write on the PDA, then look into the new cases at PDA Skins. These clever new case option for PDAs feature ashoulder strap or belt attachment for one-handed operation.

    To print out your prose, there are a few portable printers available, like the Pocket Printer from Sipix. A different idea is to combine printing with delivery service. Qxprint is an online service that will email, mail or fax your documents to your clients. The documents and client info have to be preloaded onto Qxprint's website. In effect it turns a Palm into a remote control for faxing, printing and shipping documents. Qxprint charges a small fee for each document. Field workers and home-visit staff may find this useful, although it was conceived to help travelling salespeople reduce the variety of brochures they had to carry.

    Palm has released an updated Mac version of Palm's Desktop Suite. This would be useful for all PalmOS devices and brands.

    Another enhancement from Palm is DualDate (see picture at right). Beam your schedule to another Palm user to share/synch/compare, then view both schedules side-by-side on your Palm screen. This datebook enhancement may be quite useful for married couples, coworkers and others who use Palm PDAs and need to coordinate their work.
    Other add-ons for your DateBook include Keep In Mind and Today. Today is a different take on the combined appointment and Todo list view in the Palm Datebook version 3.5 or newer. Keep In Mind is a pop-up reminder program.

    You may also like ToDoPlus which provides many little utilities to the task manager application. Redo (see illustration) makes adding recurring tasks to the ToDo list much easier. One caution: it only works one way; task list items don't get inserted into ReDo. For tasks that "float" (ie. recur after a period relative to the last occurrence), BlueMoon is very clever. For those who got used to more than the five priority levels Palm lets you assign to tasks, BigToDo v1.0.4 is available from PalmGear and lets you assign ten priorities to ToDo list items.

    Newer PDAs with extended memory on CF or SD cards can develop a certain amount of clutter. A variety of software can be purchased which gives more control over files and folders. Two popular ones are FilePointPro and McFile. Both these programs provide hierarchical folder systems for the PDA, and will launch apps. FilePoint also can work from the PDA or from your desktop PC. McFile is particularly recommended to Sony Clie users due to the extras available to permit file viewing, displaying pictures and processing email.

    Clie and Mac users will also find MissingSync useful. It provides great tools to link Sony Clie PDAs to Mac PCs.

    Some Clie users find the built-in fonts difficult to read. You can address this with any of:

    Want to find your way around but GPS systems too expensive? You can find your way by the stars or the sun with StarPilot or Sun Compass N. Star Pilot is also good for stargazers who are working outdoors without access to more powerful PC-based software.

    If your PDA lacks a memory card altogether but you want more space for programs, you can send your Palm to the folks at PalmUpgrade for ROM and RAM increases. I don't personally know anyone who has tried this and there are shipping costs but here it is anyway: Another strategy for Visor owners is to get Memplug modules from PiTech. They permit you to plug in Sony Memory Sticks, Compact Flash, or SD/MMC and come with excellent backup software.

    If your PDA has a memory card but did not include a program to backup your Palm data onto it then you should definitely invest in some software such as PiBackup2.

    For accessories of all kinds you can look at the online catalogue at Actually the screen protectors are not quite free, but at USD5 per dozen plus shipping they aren't too expensive either.

    New Palm PDAs

    Palm has developed a new operating system for its future handheld computers. Designed to be faster and have better graphics and wireless networking, the new devices will be competing with Compaq in the corporate world. They may be appropriate for your hospital or EMS service. Will they be worth the increased price to users like thee and me? Although Palm OS 5 devices will be shipping soon, they will be competing with the first wave of Symbian phones from Nokia and with upgraded Treos from Handspring (colour + phone + builtin keyboard). And we can be sure that Sony is going to have something to show also.

    Reports about Palm OS 5 have been circulating widely lately so you might as well get informed about it. Here is some reading for you:

    We can be sure that when the new devices come out, the old models will fall in price. Should you get a new one and pay more, or should you get an older one and save money?

    In my opinion this is not the right way to look at the problem of buying a PDA. The real question to be answered is "What do you need a PDA for?". No matter what one chooses, it will cost less or be declared obsolete by some pundit within months (days, if you're really unlucky) of your purchase.

    So what should you consider? Here are my suggestions for what to think about before buying your first or your next PDA:

    • What's the most important thing you need to be able to do (sometimes referred to as a "killer app")? As long as the device you buy can do that job, it will never be obsolete. Think of a ten year old Honda. Mine still runs….
    • If your "killer app" is reference text tools, you probably need to be far enough along in your training to know what you want to look up. And it helps if you have had some exposure to different programs so you know which ones you want to use and what they need to perform adequately.
    • For many people, the key issue is what their peers are using. If you see yourself needing to share patient data and references, or beam reports to one another, or tap into a wireless network with coworkers, then take this into account.
    • Does your work environment infrastructure support your planned purchase? For example, for patient management, using a PDA to take notes is a bit slower than pen and paper but if it can be printed or beamed or uploaded into the hospital database, then utility is enhanced. Is that how you are going to be working? Do printers at your facility have IR ports so you can beam notes to them for fast printouts? Is there wireless LAN to hospital databases? Are there base stations with HotSync cables for you to share?
    • Do you ned to look at pictures? If so higher screen resolution and colour may be of benefit.
    • How long do you need to keep going? If battery life is an issue (and it will be for heavy use of colour PDAs or long shifts at the hospital) then how will you deal with it?
    • In general, don't pay a premium for leading edge features unless you know you need them right now. Many leading edge products and features wither due to poor sales. And then, if you still want them, they can be bought for much less. Buy what you need and try to include some flexibility or expansion capability in case of changing future requirements.
    • No matter how hard you try, your future needs will not be foreseeable. Buying today's most powerful device is as short-sighted as buying the minimum acceptable PDA: both will be wide of the mark in two years. So get what you think you will need for about two years.
    • Cost. Notice it's at the bottom of my list. It's nice to be rich….

    So, since I'm such a guru, how have my Palm purchases fared against the slings and arrows of outrageous fortune? My fist device (Palm IIIx) had 4 Mb or RAM. I bought it for its daytimer functions. After less than two years I became interested in portable medical reference texts, so I got a Palm IIIxe with 8 Mb of RAM (still monochrome screen). Two weeks after I bought it it was eclipsed by newer models and its price fell by a third. I filled up its memory after only one year. Now I have a Handera. It has only 8 Mb or RAM and a mono screen but its CF card holds 128 Mb of data. I can lug around a lot of photos and texts in 128 Mb. Not every program I would like to use is happy with the Handera's memory system, so I have some issues, but four months later I have still got more than 4 Mb of RAM on the Handera and lots of room on the CF card too. I expect that in another year or two I will want colour or some way of doing email and cell phone calls. Heck, I'd go for that stuff now if it was available, but that's a story for another day….

    The bottom line: think about what you want and why. Don't insist on being on the bleeding edge.

    Medical "Doc" of the Month

    Here's a smorgasbord of software and info for nurses (mostly).

    Read how nurses at one health care facility are using Palm PDAs for tracking and managing patient pain.

    You can purchase the CheckMate program at NNCCUSA. It is supposed to have treatment algorithms, drip calculations, drug info and more for adults and pediatrics. Unfortunately, there is not much info about what it looks like or how it works. You have to buy it on faith or on the strength of recommendations of colleagues. If anyone has more info about CheckMate, please let me know and I will publish it here.

    The Davis Nursing Drug Guide is now available from Skyscape. This package aims to provide nurses with the information they need to administer medications.

    ER Suite from Medical Wizards performs many of the same functions as the Davis Nursing Drug Guide but also helps you calculate dilutions and drip rates and has additional modules for toxicology and a "wizard" for determining drug dosages for rapid sequence induction.

    Hack of the Month

    Crash is handy if you frequently test software on your Palm and it goes bad. The Hack intercepts the request to reset the PDA and performs the reset automatically. Why bother? Apart from saving you the bother of looking for a paperclip, it also protects your batteries if you aren't there to see the software crash and reset manually.

    MultiClip is useful if you do a significant amount of text entry or repetitive data entry in your Palm applications. MultiClip keeps track of the last sixteen such operations. It also enlarges the copy buffer so that you can cut and paste larger chunks of text than the Palm usually permits.

    Medical Computing

    Check out the Geripalm site. This is the home of a research project for geriatrics clinicians involving the use of Palm PDAs. There's even a Handera emulator (click on the picture of a Handera PDA on the home page) loaded with clinical SW just for fun - but you can use it as a Palm emulator on your PC if you don't want to bother setting up the original Palm POSER emulator or if you don't have a Palm PDA to set up POSER's memory.

    Here's a story about how the tail didn't wag the dog. Frustrated by the difficulty of making patient lab data available at rounds, physicians at one hospital began using PDAs to collect data before rounds. It's a cautionary tale.

    In Times to Come

    So we won't be back next month. Enjoy your summer and look out for the September issue.

    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:

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