| UHN Palm Newsletter (September 2002) - Back to School It was a productive summer for me. I tackled some projects I have been meaning to get after. I caught up on my reading – well, some of it. Oh, and I had some fun too. But summer is over and the mood has changed. My own holidays on the lake are only a pleasant memory. There’s nothing like working night shifts in the Emergency Department right through the Labour Day weekend to expunge the summer mood, I can assure you…
How I Spent My Summer Vacation
I got a lot of mileage out of my PDA during the summer. I used the MemoPad to keep a list of maintenance and repair issues for PCs in the Emergency Department. I used the ToDo list to jot down ideas that needed follow-up. I used it to sketch the dorsal markings on a really big spider my daughter found so I could look it up on the Internet and make sure it wasn’t dangerous to keep in the house (we evicted it anyway – the five centimetre hairy leg span proved to be too much for Mom). I even took the Handera with me to a cottage for a week at the end of August. It was very useful to have a map of the route up to Georgian Bay, using Maporama. But after we had arrived my pocket computer got no use there – kayaking and handhelds don’t mix when you flip over as easily as I do.
He’s Dead, Jim
Another thing which wound down at the end of summer was my Handera’s screen. When I got home from my holidays I went to HotSync it and discovered it had become faint and characters were broken up into hieroglyphics. Oh-oh. Fortunately it was still under warranty and there is a local dealer for Handera (Handheld Interfaces). I brought the defective device in and walked out the door with a replacement five minutes later. That’s one of the nice things about having a local dealer and it’s something to think about when deciding what to buy. You won’t have any trouble getting sales and service locally for Sony Cliés or HP iPaqs but HandSpring PDAs were only available online until last year and Toronto is one of the few places that has a local Handera dealer. But what if it had been out of warranty or I lived in Montreal? Would I have been out of luck? Fortunately, Handera (like most handheld computer makers) is willing to accept back a dead PDA and try to repair it – all you have to do is send it in. But there are still shipping costs and the time lost to consider and the chance that the techs can’t revive your PDA. Overall, a local dealer who is able and willing to give you a substitute or provide other help is worth considering. Mine certainly saved me a lot of aggravation and time. For those who want to repair their own, there’s GetHighTech which offers parts, detailed instructions, even instructional videos for many makes and models. If all else fails they offer to buy dead handhelds (but the pricess are very low and you have to ship from the USA). You can see how one adventurous geek dealt with his broken Palm IIIx screen – and installed two cooling fans as well. No, I am not making this up – see for yourself at his website. I know what you are thinking: this is only for the very geeky. But then again, what can you lose? With a trade-in value of USD20 you might as well open up your IIIx and see if you can tighten up a connector or two and get another year of life out of it.
Medication Handbooks
I have been looking at various drug handbooks I can carry around. One annoying trend is that you can’t just buy one anymore. You can only rent it. I can buy a hardcover textbook or a pick up the free 2002 edition of the CPS and use them for as long as I like, if I don’t care about staying current with all the latest meds. But many medical books for the Palm stop working after a certain date unless one keeps sending the publisher money. This is an annoying way to publish a book because it forces the user to upgrade at a pace set by the publisher’s need for cash rather than a user’s need for more recent information. It’s even more galling when one considers that the ebook version costs more than a hardcover textbook to start with. Even many of the freebies (eg. Epocrates) work (or, should I say, stop work) this way which carries some cost in convenience if not in money. So, just what is out there for prescribing guidelines and drug interactions and so on? Some examples: - LexiDrugs has, in my opinion, the best organized and most comprehensive database of medications. One of its endearing qualities is the presence of Canadian trade names. It needs 3-4 Mb or RAM and is the most expensive text of its kind (USD75). There is an add-on drug interaction checker but it costs extra.
- qRx is a free program and covers most of the meds you are likely to need to look up. Unfortunately, while you are looking up drug info, qRx is logging your activities to share with its masters. The log is uploaded to their website every time you get an update, which the program makes you do regularly. qRx has a built-in checker for drug interactions – also free. Needs about 1-1.5Mb of RAM.
- DrDrugs is intermediate in price (USD50), memory size, and the quality of medication info.
- Tarascon ePharmacopoeia is another free drug handbook that is a bit limited compared to the ones above but is bound to evolve as the different publishers compete.
There are several guides just for infectious diseases and antibiotics: - UHN Antimicrobial Guide. This can be browsed on the UHN corporate intranet but has not been released as a hard copy book or a Palm-readable file this year. That’s a pity because it’s well thought out and free to use for UHN staff and students.
- EMRA Antibiotic Guide is published by the Emergency Medical Residents’ Association. It covers a reasonable number of medications and costs only USD10. It can be a bit annoying if you want to uninstall it later as some of the support programs (based on Satellite Forms database software) can be hard to delete.
- John Hopkins Guide. This ebook requires you to register but doesn’t cost any money. The publisher collects registration info but promises to use it for “educational purposes only”. Ahem. It is said to be weak on pediatrics but will run from a memory card.
- The Sanford Guide has been made available for the Palm PDA. The second edition is easier to use than the first and costs only USD25. It used to require main RAM but now is supposed to run on memory cards (I haven’t tested it).
And this is just the beginning. There’s A2Zdrugs (600 monographs), Mosby Drug Consult, and HHM Physician Drug Handbook (with 900 product monographs). You can find extensive information on medications in the PEPID guides which also have diagnostic and treatment guidelines and has different editions for paramedics, nurses, housestaff and emergency specialists. Due to a thoughtful index style and table of contents, Pepid is easy to search by drug name but (like most of these products) doesn’t have Canadian drug names. There’s also Mobile Micromedex for drug interactions. There’s even a pocket PDR for American doctors – you must have a DEA authorization number to register just to download, so Canadian docs (and other low-lifes) can't get this yet. Even the venerable Medical Letter Handbook of Adverse Drug Interactions is available for handheld devices now, along with many more titles from Franklin Press. You can read a thoughtful review of LexiDrugs, ePocrates and DrDrugs on pages 752-3 of the April 2002 edition of the Canadian Family Physician. There is also an online review of the Palm version of the Sanford Guide. You can find a comparison of PDR (Physician Desktop Reference) with ePocrates at the Ectopic Brain. This site, by the way has lots of interesting things to read about Palm PDAs in medicine. If you can’t find one or two medication references that are fit to use, just wait a while. The field is burgeoning: it seems as though more and better products are coming to market every month.
More Input/Output: Sound
Sony Clié handhelds are well known for their MP3 file-playing ability. If you don’t want to carry a PDA and an MP3 player, this is the way to go. But what if you want to record music or voice instead of carrying around a Dictaphone? There are some options for this too: - The Handera 330 can make voice recordings now.
- Acer’s new Palm OS handheld can also record and playback but is currently only available in Europe and Asia. (see the review at InfoSync).
- Sound recording and playback modules for are available for Handspring devices.
 GoVox Digital Recorder for Palm III and V series replaces the flip case top but is very limited: 8-10 minutes max, and has no earphone. It is probably being phased out but can be found at some shops and on eBay. See a review at MacWorld.com. The illustration at right gives you a good idea of what this looks like. Not immediately apparent is the extra heft from a separate set of batteries. You can read some reviews and comparisons of various products. The AdMobis ProRecord Digital Voice Recorder and Targus Total Recall DVR module are both for Handspring PDAs. The AdMobis DVR integrates with the Palm phone book and other PalmOS applets, has 16Mb of memory for hours of data, and supports earbuds. Some of the new Palm PDAs with OS v5 due out later this year will probably have sound recording built-in as part of their music playing capabilities. No specific models have yet been announced. Think about what you will do with the recordings. Do you want to copy the files to your Mac or PC and use them there? Do you want MP3 or WAV format? Will you want to share the files with other people? The Handera 330, for example, stores VoicePad recordings as WAV files which can be played back on a PC. But these files are limited in frequency range – don’t expect high fidelity music recording. Still the Handera VoicePad is good enough for what I use it for: prerecorded questions in Chinese and Portuguese for specific medical issues. Now I can ask many of my patients if they are on medications or have medication allergies and get a “yes” or “no” answer. Handy when there is no interpreter. Now, if only I could get the patients to stop grabbing the Handera and trying to talk back to it as though it were a cell phone….
More Input/Output: Images You can take low-res pictures with add-on camera modules for some PDAs. This allows you to carry around photos of unusual clinical findings or technical procedures that can be shown to students and patients. Some devices to look for: - Kodak PalmPix. Kodak has recently announced that they will discontinue the PalmPix series but they can still be found at retailers and mail-order outlets.
- HandSpring EyeModule and EyeModule 2. Read about them at the HandSpring site.
- Sony's newest NR70v Clié has a built-in camera. Read about the Sony NR series at PDA Buzz and Sony Style.
 Sony also has a MemoryStick Camera for any PDA with a memory stick slot. See the specs here. Quality is moderately high and looks good on a Clié with its high resolution screen. See the photo at right.
A camera module won’t give you a high quality image: usually 320 X 240 pixels. Alternatively, you can take a picture with a good camera and transfer it to your PDA. A digital camera (or digicam) with Compact Flash (CF) (eg. Canon), Memory Stick (Sony), or MMC (eg. Toshiba) storage card will let you instantly transfer and view your snaps on various models of PDA – all you need is a compatible card slot and appropriate software. Sony Clié PDAs all have memory stick slots. Handera uses Compact Flash and, like Sony, has a higher resolution screen. Unlike Sony handhelds, Handeras don’t have colour. You can get HandSpring modules that accept different types of memory cards. Newer Palm brand PDAs accept MMC, and Secure Digital (SD) cards. Another strategy is to take pictures from your PC and transfer them to your Palm handheld. Firepad's FireConverter 6.0 and FireViewer (5.x) convert images, Quicktime MOV files and web pages to Palm-viewable databases. To organize the images on your handheld there are a raft of programs available. Photo album software is standard on Palm’s M515 (www.palm.com). Some other available programs include FireViewer, PhotoSuite Mobile (may have been discontinued by the time you read this), ACDSeeMobile, TealPaint, JPGview (look on shareware and freeware sites for these last three), Documents2Go and SplashPhoto. Another one is PalmJPegWatch for reviewing JPEGs from digicam CF cards - if your Palm can accept CF cards. You can even use database software to organise and archive images. Two examples are HanDBase and ThoughtManager. Remember that a 4 megapixel digital colour photo of a skin rash will look quite different on a monochrome Palm 160-by-160 pixel screen. Higher resolution devices with colour will work better. If imaging is important to your Palm plans, definitely test the models you are interested in with some representative sample images before proceeding.
Leftovers - Keyboards
In the summer issue, I wrote about a variety of keyboards and keyboard replacements. Here are some I left out. Do you own an older model Palm? Are you feeling left out as others get newer and fancier toys? There is a solution. Get a Palm folding keyboard. Some are quite exotic and eyecatching (see the summer issue) but Palm has stopped using the original style of connector. This means that older style keyboards can be had for a song. For example, recently NetLink Computer in BC has been selling the Palm KB (for models III, VII, and M100 series) for just C$33. Look around for similar deals now that these are out of fashion. If your friends aren’t stunned by the technology, they’ll be floored by the price. And these are handy little things for notetaking – much faster than Grafitti if you are a touch-typist. ThinkDevice has new cases with built-in keyboards and stands for some models of PalmOS PDAs. Think outside the box: how about a laptop that uses the Palm OS? Well, kinda…. Check out the Dana pentablet computer which also has a KB. You get a bigger screen and a keyboard but keep the familiar programs and interface. The intermediate size will be either too big or too small for some users but it’s, well, neat…. Can a Palm OS-based laptop or pentablet computer replace paper charts or handhelds? There are possible transscription savings: look here for a case review. However, at present it seems like trying to square the circle: you want handhelds for their compact size and portability, but for charting you want a bigger viewing surface for reading. Perhaps the answer is with head-mounted displays that project a simulated 800 by 600 PC screen right onto your retina, and with new flexible writing surfaces that you could literally attach to your wrist. And just how comfortable would the patient be if the nurse kept writing on his sleeve and squinting over the patient’s shoulder with his funny eyeglasses?
More Leftovers
I also have a few more portable printing solutions that didn’t make it into the summer edition of the newsletter. - Monarch 6015 Handheld Printer
- Adobe PDF files can now be stored and viewed on a PDA. Adobe suggests that you could keep forms on your Palm and print them on demand, using your IR port and pointing straight at a printer. Is this going to be faster than keeping preprinted forms around?? I think not....
Hack of the Month  This month, instead of a hack, I suggest you look at ICUmath. This handy program was dreamed up by a doctor called Terry Fagan. It includes a number of useful calculations and reference sections. Its one major drawback is that it needs a fair chunk of RAM on your Palm, weighing in at 315 Kb. I have enclosed ICUMATH.ZIP in the email with this newsletter or you can find it at Freeware Palm.
Medical Computing Are you trying to decide what is the best way to link your PC and your Palm for sharing Word, Excel and PowerPoint documents? Read this review of some of the most popular “office suites” for the Palm OS including Documents2Go, IambicOffice and QuickOffice. The Stanford medical students’ guide to what’s out there for your Palm. Definitely worth a look. PEPID RN will be demonstrated on pre-loaded hand-helds at the e-Strategies for Informatics conference in Grand Rapids, Michigan on October 8. Other nursing tasks will also be presented. Find out more about the conference at PDA Cortex.
“Doc” of the Month
The Canadian Medical Association has news, clinical guidelines and CME monographs available online. Now they have converted much of this material for AvantGo users to put on their Palms. You need to be registered on the site to access this material.
In Times to Come There is one compensation to the end of summer: I’m definitely ready to tackle some new projects. You have, no doubt, noticed the appearance of this newsletter. The new look is an experiment. This format is more compact in your mailbox. Is it more readable? Is it more attractive? Or am I messing up something that worked just fine before? Let me know how you feel about it. Unless somebody stops me, I’ll be back with more next month.
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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