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    The Medical Palm Review

    October, 2003 (V4N10) - Fun, Fun, Fun

    It was bound to happen. After all these years of serious, sober Palm computing, I finally got bored and looked for ways to amuse myself. No I don't mean recovering from data loss, hardware failures and defective software. I mean serious, er, real fun.

    Don't Fence Me In

    Okay, I didn't just play games this month. I spent a good part of September tinkering with my Clié's external memory storage cards. It's all the fault of one of my colleagues. He pointed me to a website with downloadable Compact Flash (CF) drivers for Sony handhelds, like my NZ90, with a CF WiFi slot. These software patches let you use the CF slot in ways that Sony never intended: for a modem, say, or a memory card instead of just a WiFi networking card. This Cliésource article describes in great detail how to make it all work, and where to find the free software you need. Unfortunately for my other plans for the month, the software hack works.

    Sony hates this, of course. They want everyone to use their proprietary and more expensive Memory Sticks, which fit into a different slot in the side of the Clié case (my PDA has better ventilation than most convertible autos). Until recently Memory Sticks could hold, at best, 128 Mb of data. Enough for a fair number of texts and music files. Not enough for a movie video, which is a pity because the NZ90 has great movie-player software.

    Well, the cat is out of the bag now. Now I can load up programs and reference reading on the Memory Stick (128 Mb) and still have lots of room on a Compact Flash card. My card has another 128 Mb, but I can buy a heftier one with 500 Mb if I develop the overpowering urge to watch a movie while on a subway train sometime. And imagine the number of MP3 music files I could listen to (did I mention that the NZ90 has a good sound chip?). I even tried out some game software thereby wasting memory on my PDA and alot of time. I don't need to tell you where to look for games do I? I thought not.

    Even if I restrict myself to work-related data, this gives me tons of room. Even Stedman's Medical Dictionary needs less than 30 Mb. I have a huge teaching library of images (skin rashes, ECG tracings, etc.). I wonder how they'd look on that small but high res screen?

    If the prospect of all that tinkering with your Sony's programs leaves you uneasy, you can buy a commercial product from Eruware that will do at least as good a job with less work.

    If you don't own an expensive Clié but you do have a slot for an external memory card, you can still make more room on your PDA's internal memory by shifting applications and data to that card - even ones that wouldn't normally work there. It's one thing to put photos of skin rashes on the data card, but unless you use a PDA with Palm operating system 5 or newer, the actual viewer program usually has to reside in the internal memory of your Palm handheld. TealAlias tackles that problem. It lets you put apps and data on VFS memory cards which normally wouldn't like that. There's a brief news item about TealAlias on InfoSync also.

    If your PDA is not capable of mounting an external memory card, there are still some potential solutions for you. In previous issues of the Review I noted data cards that would plug into the HotSync port of older Palms. Some HandSpring models allow you to plug in extra modules. There are even firms out there that will open your PDA and insert more memory, but this is not cost-effective now that a new Zire 71 from Palm will set you back only CD450 and has 16 Mb of memory and an external data card slot.

    Even more important, you can be creative about what you load up so as to preserve as much memory as possible. For example, further down in this issue I discuss medical calculators you can put on your handheld. Some are big (Archimedes weighs in at 660 Kb or so). Some are small (MedMath needs less than 40 Kb). Which one will fit on your PDA?

    Another example: there are many text and document reader programs for the Palm. Try to convert all your material to one format so you can use just one reader for all your documents. For example, iSilo converts web pages and text documents into a single proprietary format, eliminating the need for a different reader for each type.

    And finally, take a hard look at data files, documents, recreational software and games on your PDA. Perhaps many of them could be removed and archived on your PC. If you are discriminating, you can probably clear some space. But, if you remove all the games, MP3s and family photos, you'll be back to the sober, perhaps boring, PDA that I started out with in September.

    I Can't Believe I Ate the Whole Thing

    After the fiddling, I had tons of memory to install applications. Every medical application I own has been copied onto one or other of these memory cards and there is still tons of room. In fact, I never filled up even one of the two cards.... I had to find some way to justify the time I spent on getting extra memory cards to work (Rose was starting to ask some pointed questions about my time management). So I just loaded a smorgasbord of programs: games, study organizers, graphic applications and more. I have been meaning to test some of these for a while. Here are some of the goodies I found. Where possible, I have tried to find a medical or educational purpose for these things. Honest.

    • Imagiworks has created a range of software and sensors they have dubbed "probeware". The idea is for kids to use the sensors to learn about some part of the world around them, with the help of lessons embedded in the software which also makes the sensors work on the students' Palm PDAs. These have lots of possibilities for adult learners too and are really neat.
    • GoKnow develops software tools for teachers and students. Their projects include a student assessment program and an organizer for kids to plan their class and study time. Both these programs could be deployed in adult learning environments. HandySheets (worksheet and quiz developer), Sketchy (sketching and animation development) and PiCoMap (outliner and visual representation - you can do simple algorithms with it) are simple but effective. I tried them and they don't conflict with other software on my handheld. Cooties is my favourite as it simulates viral disease spread (eg. using IR beaming to mimic disease transmission). This is a publicly funded project and the software is all free.
    • Progect is a scheduler and project manager which is still under development but is already usable and appears to have become much more stable in recent releases. While you are visiting SourceForge (Progect's home page) check out some of the over four hundred applications and programming tools being developed for Palm users and developers. And remember that these are all free or almost free. These folks rock....
    • SourceForge is also the home of Vexed, a cool puzzle game that will interfere with your social life. Work life too if you aren't careful.
    • In contrast, Bejeweled is commercial software but really addictive.
    • AcidFreecell is a Palm version of the game that ships with most editions of Windows
    • Finally, here's one I downloaded but didn't get to test yet. You can speed up Sony Cliés with LightSpeed from CliéVideo. The reviews aren't bad. But the product instructions warn you that overclocking your Sony can mess up software, corrupt data, decrease battery endurance between charges. Hmm. This sounds like the sort of "fun" I have had far too much of in the past. Maybe I won't run this one....

    Back to Work

    Study and lesson organizer software is a popular area of development and everybody has gotten in on the act. There are some medically-oriented ones out there but they are often more expensive without being more useful than the ones aimed at high school users. Here are a few candidates

    • 4.0Student is a class and study plan organizer with an online component and a Palm component.
    • LessonPlan is for teachers.
    • Thought Manager outliner runs on your PC and your PDA.
    • BrainForest is another outliner and list maker which has recently been upgraded to make better use of colour and high resolution screens.
    • And don't forget MindMapper which was reviewed in the in July/Aug 2003 issue of the Review.
    • Not satisfied yet? Palmspot has a ton of outliner and organizer software titles.
    • Still undecided? Do a Google search on "outline software Palm" but you had better eat lunch before you start because you'll be sitting there for a while.

    Hit Me Again, Barkeep

    Whenever I'm having too much fun, I start thinking of new toys to buy. Here are some gizmos that made the news lately:

    • Sony has produced yet another new Palm device, so far shipping only in Japan (?). The UX-50 has a clamshell configuration and many clever features. One of the cleverest is that it is smaller than my NZ90. Read more about it here and here.
    • The Palm Tungsten W has had a facelift and software update. The Tungsten is barely a year old and already getting eclipsed by newer models from various competitors. I suppose the question is whether to go for something new or whether the fixes (and a price drop) would make the Tungsten attractive. It certainly would be alot smaller than the Sony NZ90 I lug around. There's a brief article on InforSync about the Tungsten improements.
    • The Treo 600 wireless phone also does eMail and web-browsing using Palm SW. There have been numerous enthusiastic reviews from people who don't want to carry a phone and a PDA, or who don't want to fiddle when it's time to connect the two to get eMail or surf the Web. Read a review from the Wall Street Journal.
    • Garmin has finally shipped its iQue 3600 which is Palm PDA with a built-in GPS navigation system. It has received widespread reviews. Many are enthusiastic about the sophistication of its GPS functionality although some claim it will not work under a fibreglass or metal car top (or inside buildings) because of loss of line-of-sight to the satellites. Another concern is battery endurance. Apparently the GPS system will drain the iQue's battery within 2-3 hours. Even I would be hard-pressed to get lost on a trip that short, so the optional AC adapter for your car's cigarette lighter would appear to not be optional.

    Medical Calculators

    I am still looking for the "perfect" medical calculator. Most have too many formulas I never use and don't let me organize them the way I want. Some don't do SI units but only Imperial. Others don't let you add new formulas. So I was interested to see a few news items about Archimedes, a program that previously was only available for PocketPC devices. I downloaded it and gave it a try.

    Archimedes is available from SkyScape. It's a decent calculator and looks very pretty on a colour screen. Like many of its brethren it has lots of functions I wouldn't use in Emergency Medicine. Fortunately it allows the creation of shortcuts to the ones I would use more often (calculated osmolality, anion gap, etc.). While you can add notes to the program, it is not set up to add new formulas manually. As you might infer from the screenshot seen here, Skyscape links this program to its library of other medical tools. If you have some of them on your PDA you can quickly switch between them. The handsome appearance and broad utility are reduced by the need for more than 660 Kb of RAM, although you can install Archimedes onto an external data card if your PDA supports one. Part of the installation is an extremely annoying HotSync conduit that wants to register your copy of Archimedes and send you updates. Just how often do I need to update a calculator anyway and why should it be an automatic update? Furthermore, when I'm just evaluating a program why should I want to be reminded to register or be forced to link to their website every time I perform a HotSync? That's waaay too intrusive for me, folks. Call me old-fashioned, but when I buy a book at the University of Toronto bookstore, I don't expect the sales staff to follow me home or call me on the phone to see if I want the next edition.

    So I deleted the application. But that was only the beginning of the fun. Unloading Archimedes from my PDA did not remove the SmartSync (misnamed!) registration and updating software from my PC or my PDA. I finally tracked down and manually removed the files from the Clié but the conduit is still installed on my PC. Perhaps if I had looked hard enough I could have found a way to install the program without the SmartSync nonsense in the first place - but why should I have to look hard for that? That should have been a refusable option and not surreptitious and unavoidable for casual first-time installations.

    Next time I will install new software on the Palm Emulator that runs on my PC before testing on my PDA. That way, if anything goes wrong, I might be able to delete all trace of it without leftovers on my handheld computer. Alternatively, I could backup the Clié before installing a new program. Then I could simply restore the backup to eliminate annoying programs. Nothing's perfect: these strategies would not have purged the SmartSync conduit from my desktop PC.

    Anyway, there are alternatives to Archimedes and I'll use one of them. Mathpad, MathCalc, MedMath and others besides. Search previous issues in the Medical Palm Review archives. Look at Canadian Family Physician's online September 2003 issue for a recent "second opinion". Pepid has an extensive calculator capability built in but takes a bit of getting used to because it's embedded within a large reference text of emergency medicine/nursing.

    Medical "Doc" of the Month

    If you need to proselytize about healthcare and handheld computers, Palm (henceforth known as PalmOne) has posted a PowerPoint presentation of a recent online conference for developers. Warning: this is a multi-megabyte download. It's long on sizzle and short on steak, but it does provide a quick overview of where this trend may be heading. In a nutshell: we will all be using wirelessly-connected handheld devices to do charting, lab test ordering and result fetching, as well as prescription entry, and reference text lookup.

    Mohammad Al-Ubaydli has written a book for medical handheld computer users or would-be users. It's aimed at helping people get started (why, choose hardware, etc.) but then goes beyond that to look at using PDAs collaboratively for team handover rounds and so forth. There are many effective solutions to problems we face that can be implemented incrementally and at the grassroots level. The text is easy to read and replete with worthwhile ideas. Some sample applications can be downloaded (they are used with HanDBase). Check out some parts of the book which have been posted online, or show the website to your boss when it's time to ask for more funding.

    Medical Computing

    As predicted in the publications noted in the preceding section, wireless handheld computing is spreading out of hospitals and into the field.

    First responders are using Palms for a range of tasks. Palm highlights some of them.

    Looking for more help in choosing a new PDA? The handheld computing website of the medical school at Dalhousie University in Nova Scotia is a useful place for those looking to evaluate what handheld to get and what to use it for. It's also chock full of software reviews and links to other useful sites. Stewart Cameron tends the site and has been writing about PDAs for some years. He also wrote the review of PDA medical calculators in Canadian Family Physician which I mentioned earlier in this issue.

    In Times to Come

    I still don't know my way around all the software on my Clié. I'm running Palm OS 5.0 and already newer versions are emerging. For example, Palm OS 5.3 is being previewed with Chinese language support, support for QVGA screens (i.e.. 320 X 480 pixels) and other goodies. Palm OS 6.0 has also been touted. It's hard to keep up with it all, but we'll take another crack at it next month.

    This is one of a continuing series of newsletters on Palm handheld computers, prepared for doctors, nurses, IT professionals, educators and other people who need tools that work. Feel free to pass copies around electronically or on paper. To subscribe, or complain, contact the author at the following address:

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