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    The Medical Palm Review

    February, 2003 (V4N2) - Convergence, Divergence

    Why is this issue so late? You might well ask. During the mid-February blues your correspondent contemplates broken hardware and ponders the dirty underbelly of the IT revolution.

    My Dog Ate My Homework

    Well, not exactly. But I have lots of other really good excuses for this issue being so slow to emerge from the starting gate. First, I spent a great deal of time fixing up the back issues of this newsletter for its new website (more on that later).

    Then my Handera PDA screen became wonky. That might not have been so bad, but wihout a reliable handheld computer, I couldn't test new software properly. Repeated phone calls and emails to the retailer got no response. Time to find that warranty card.

    Normally, I would fall back on the Palm Emulator (called POSE) which provides an effective test lab for programs. It runs on my desktop Windows PC and saves wear on the Palm batteries by avoiding long HotSyncs just to try out a new program that I might not want to keep permanently on my PDA. It's perfect for situations like this too.

    Then my desktop PC failed. "No panic", I thought, "there's the other PC on my home network and I have backup CDs with all my data". Unfortunately it was an older model: less memory, smaller hard drive, slower processor, and with none of the software that I usually use to write this newsletter. I wasted some time trying to whip the old brute into shape before breaking down and buying a new PC.

    It took a few days to get the new PC loaded with software and data files. As a result it has been quite a struggle to produce this issue of the newsletter. But you have to admit it makes a great yarn. By the way, the new PC cost about what I paid for my Handera 330 last year but has a gazillion times more memory and speed. Of course it also weighs fifteen kilos.

    Just to complete the Karmic Disaster, my cell phone packed it in too.

    This experience was educational, in its own way. Here are a few things I learned or was reminded of, in no particular order:

    • A second Palm handheld would be very useful, particularly if it used the same sort of external memory storage card as my "primary" device. In the event of failure, just pop out the card with all my data and backups (I did remember to back up regularly, no?) and slip it into the reserve machine. This would cost some dough, and many of us will outgrow our PDAs before we experience a failure. Upgrading then means discarding two handhelds instead of just one. Ouch. Why not just buy a new one if and when the old one packs it in? Only you can decide if your Palm is so critical to your work that you need a reserve machine on standby instead of buying when in need.
    • Purchasing clever toys from boutique manufacturers has risks: only one firm in Toronto sells or services the Handera I bought. Contrast this with all the places that sell or service Palm and Sony devices.
    • A second PC can be useful, but only if it is loaded with the software programs you need and if you have current backups of data files for it to work on.
    • It seems to me (warning: Dr. Arnold is going into "rant" mode here) that nothing works properly or reliably in this Brave New World of computers. I am constantly repairing, replacing, installing upgrades and otherwise frittering away time on this stuff instead of working on something productive (or remunerative). It wouldn't matter so much if PDAs were as cheap as a toaster or as easy to fix. But I can't fix what's inside a Palm computer. And the replacement costs for the better models run to hundreds of dollars.

    I suspect that some of my readers look to me for advice about Palm handheld computers and medical computing in general so let me make a clean breast of everything right now: I can't program my VCR. It's my wife Rose who looks after that - and a good thing too, or we'd never get to see those taped shows. VCRs are the final humiliation for the would-be technically competent.

    Now, with whatever shreds of credibility I still have, lets talk about more interesting stuff.

    Home Sweet Home

    The big news item this month is that the Medical Palm Review website is up and running. I owe a great debt to Dr. Stephen Lapinsky and Mr. Randy Showalter in the Medical Technology Assessment Unit at Mount Sinai Hospital for offering the newsletter an online home and for the website programming and development. Thanks, guys.

    You can see the website navigation menu to the left of this paragraph. We have archived all the old issues of the UHN Palm Newsletter. You can browse through the archives or use the search engine to look for specific topics. I encourage new readers to look through some back issues as many topics are not dependent on the most current hardware - you may find the answers to your questions there.

    We may expand the website to encompass other goals. Please drop either me or Randy a note with any suggestions or features you would like to see.

    Mr. Fix-it

    We might as well continue the theme of broken stuff and how to repair or compensate for it. Here's a pot-pourri of notes on common repair and operations issues.

    Sony makes great high-end PDAs. We all want a Peg-NZ90 with its camera and brilliant screen. Few of us would want to buy a second one as a backup -- too expensive. However, low-end Cliés have a great feature that recommends them as backups: for just US$120 you can get an SL10 with the same memory stick capacity as the NZ90. This makes the idea of having a second PDA not so outlandish. The downside of the cheap Sony PDAs is their rechargeable lithium ion battery packs. These tend to stop being rechargeable for various reasons but are not replaceable by the user. A backup that is not used for a few years may lose its ability to hold a charge. Newer model Palm brand PDAs also share this defect. PDAs which use alkaline batteries or use removeable lithium packs are more reliable. Older Palms with such batteries (such as Palm IIIxe, Handera 330, and some HandSprings) are still out there and available for as little as US$50 from mail order and "remainder" retailers. These might be your safest bet for battery life, but most of the older devices have no memory card slots. This makes it more complicated to migrate to them when your primary PDA croaks. Keeping a backup PDA around is not a straightforward decision.

    If you do need to recharge your lithium ion battery pack but are not at home, there are several new hardware solutions on the market:

    • The Data Power Package features a recharger with adapters and cables for many models. This provides the ability to recharge your PDA while in a car, plane or from a wall socket. You can even recharge from a 9V battery in a pinch. Additional USB cables facilitate transferring data too.
    • Belkin has released the USB Sync Charger - a USB cable that syncs and recharges your PDA simultaneously.
    • The Sony Battery Adapter recharges your PDA from a set of alkaline batteries

    I still hear about people who bought m500 series Palm PDAs who have trouble HotSync-ing intermittently and maybe have to reset the Palm (losing data on the handheld but not the desktop PC). The mysterious problem is static electrical discharge - and is worse in the winter. If you are having this problem and your cradle is not one of the newer "E" or "H" series, then help may be at hand. Check out this helpful Palm site. And remember: most of the data is not lost - it's still in your backup directory. Just reset the PDA to clear its memory, then set HotSync to "Desktop Overrides Handheld" to restore data from your PC. Similarly, when you sync to a new, backup or repaired PDA, make sure it's one way (PC to PDA) or you might lose your backups too!!

    Another way to protect your data is to spread it around to other computing devices. Fun Communications makes software tools to port your Palm phonebook to new cell phones. This is much faster than the manual system of laboriously adding phone listings one by one.

    Share and Share Alike

    One reader recently asked me how he could arrange to share phone book and schedule data with multiple other Palm users in his hospital. There are a few things to consider before answering this question.

    First think about what sort of data you are sharing. My correspondent mentioned Schedules and Address listings, ie. for built-in Palm PDA software. What about other files such as reference texts, lecture notes, or journal articles that require third-party software?

    How many users are involved? Are they all using Palm devices or will some users need to have a different way of obtaining the information? Do you want to email the data to each user? For a small number of people you see every day, you could even beam the info to them.

    Will all the users be physically in the same space at one time or another? Can they all obtain updates by HotSync-ing to the same PC? Do their Palms have the same type of connector to permit that one PC to connect with all devices?

    Then consider the source of the data that will be shared. Does one person prepare all the schedules on one desktop PC? Do multiple users modify the schedule data that all must share? Do you use a particular program to prepare the schedules or are you prepared to invest time and effort to learn to use something new?

    There is a lot to consider.

    One of the simplest solutions is Chapura's PocketMirror program which allows you to synchronize Microsoft Outlook files onto multiple Palm PDAs. If you prepare a schedule on Outlook you can "distribute" it by having all the users HotSync on that desktop PC. Chapura will also share Memo files, and ToDo lists with Outlook's Tasks and Notes. You have the ability to define public and private folders and to limit which one will be shared.

    In a more limited way, the Palm Desktop software will let you sync only Address Books and MemoPads using the File Link feature (on version 4 or better of the desktop software). File Link doesn't support other built-in Schedule data or any other sort of file. FileLink will let you synchronize the selected file(s) with multiple users sharing one PC and cradle but is not a "distribution" system that can take advantage of email or wireless networking. Look at the manual that came with your Palm or search the Palm website.

    Palm has a great online service called WeSync for this exact purpose (Schedule and Address book sharing) but it is not available to new users any more. You can look for alternatives (some are listed at the WeSync Support page). One of them is DualDate, a Palm freebie that lets two users share schedules but it isn't designed for multiple users. After combining schedules, your Palm's appointment book screen might look like the screenshot shown to the right. Other web-based file-sharing solutions exist:

    • Visto primarily targets corporate email but also handles other data formats. Visto is primarily concerned with wireless sharing but can be used with HotSync cradles also.
    • FusionOne provides online data sharing services. For example, paramedics who need to look up the database of which hospitals are on "time consideration", or doctors who want to look up lab data would access the information using wireless networking or cell phones. It can also kick in when users HotSync.
    • Intellisync is a very popular system for sharing a wide range of data files between PCs and mobile computers.
    • Yahoo uses Intellisync software to provide linkage to its services as well as anywhere-anytime retrieval of your contact list and schedule to your PDA. You can sign up for this free service at the Yahoo site.
    • Synchrologic has a free demo of their online service. This is easy to set up but does require you to register for the trial period.

    Time & Chaos is a program that, among many other things, will share schedule and address book data across a network (for multiple desktops) and HotSync to a Palm PDA. You can also create exportable sets of data which can be distributed to multiple users to add to their desktop PCs and sync to their Palms. The trick is to send only the data you want to the Palm users. Using its own software (called ChaosSync) for syncing to the Palm you can force T&C to perform unidirectional updating (eg. of only schedules or address books and not ToDo lists). But it is a bit fiddly.

    I use T&C but I don't have to sync multiple users. I know that a number of surgeons and other docs at the university have been using T&C but can't comment on their experience with multiple users either. You can find out more at The T&C home page.

    For Macs there is Personal Organizer which supports multiple users. I don't know much about the details as I don't use a Mac any more.

    Last, but not least, do you really need to use the Address Book or Schedule to display the data you want to share? Could you get the same functionality from a text file or Memo? It's easy to share text files or email attachments that other users would then cut and paste into their memopad. Or you could use AvantGo or iSilo to create viewable files based on web pages - whether the "website" is really online or just on your desktop PC.

    After writing the foregoing I learned that GroupSync is back on the market. It allows you to share data with multiple users and has extensive filtering features. The filters let you select which appointments, phone book listings or To-Do items are shared. I have not tested it but it sounds perfect for a scheduling coordinator to share specific sets of shift data with various groups of students, clinicians, etc. Each group would get only the relevant info when it synchronised with the "base" PC or PDA.

    I also forgot to mention RecoX which allows two Palm users to beam updates of memos, appointments, contact lists and todo lists to each other.

    Next month we will consider a few other hardware, software and organizational issues involved in supporting data sharing with handheld computers.

    Nuts and Bolts

    Not everyone is thrilled with the new Sony NZ90. It can take pictures and video, play MP3s and has a keyboard as well as an excellent colour screen. Unfortunately it also seems to be bigger and heavier than almost anything else out there except an iPaq with a sled. Read some ambivalent reviews at tpug and If you want a basic colour Sony PDA that runs Palm OS software and has a colour screen, check out the SJ33.

    For the opposite experience, you could get a Palm wristwatch. It straps to your wrist and holds a subset of your Palm data. But if you thought the screen on your Clie is small, you'll be appalled at this. Strictly for those who want to have their Palm RIGHT THERE, without fetching out of a pocket or case. Of course, you wouldn't be able to call it a handheld any more....

    The Veo Photo Traveller is a camera that plugs into the Secure Digital card slot of your PDA. It takes snapshot quality photos (about 1megapixel). This might be handy for accident scene photography, recording the extent of inflammation of a leg with cellulitis, etc. The advantage of this over the Sony PDAs with built-in cameras is that it can be attached to a different PDA when necessary. It's also much cheaper than the Sony devices. Notable disadvantages include lack of a flash system and low resolution (Sony's newest PDAs feature two megapixel resolution which is much sharper). Most serious, in my view, is the limited storage capacity for photos. Unless your PDA has a second storage slot, the Veo relies upon available system memory which is just not good enough even for average photo sizes of 50 kilobytes.

    Hack of the Month

    Linker allows you to link apps to selected text in the primary built-in Palm apps. Works with some other apps as well. A bit like having hyperlinks in a text document, but instead of linking to text in another text file you can also link to an Address, phone number, database file record, etc. Lots of interesting possibilities - eg. you have some diagrams of a procedure, a text file describing how to perform it, and an AvanGo file with a converted journal article. You can link to all three of these files from one article in the MemoPad - not easy to do otherwise.

    Medical Computing

    Would you like to see your health care facility provide wireless networking for handheld computers? It's been tried: secure WLAN implementation at a hospital using iPaqs and tablet PCs. As noted, there are lots of issues to consider (reliability, data security, authentication of users). Here are two more articles on relevant topics:

    • Xyloc This infrared-based token system locks your PC when you aren't nearby. It may also provide a good approach to securing data on PDAs from attackers who are inside the firewall or the four walls. Concepts like this also solve the problem of multiple access and authentication sign-ins which can be very annoying if your hospital makes you log-in separately for each software application you use. Some interesting features of this feature, known as Zero Interaction Authentication, are discussed in this paper.
    • WideRay can be quickly set up as wireless server for mobile computers. Designed to make the job simple and painless, WideRay devices allow you to link mobile health care workers to each other and hospital databases. It even has potential for "quick and dirty" deployment by emergency services personnel at the scene. That way, even if phone or cellular phone services are knocked out, you can create a wireless communication network from scratch.

    In Times to Come

    Next month I'll be out of town for a few days. I am working on a few articles and lectures and don't want to interrupt that writing. I plan to take my Handera 330 with me (assuming it is still working) so I can continue to make notes and jot down ideas. I will report back to you on my "road warrior" experience.

    We will also, as mentioned above, consider a few more issues regarding data sharing for handheld computers.

    Until then, enjoy the snow!

    This is one of a continuing series of newsletters on Palm handheld computers, prepared for doctors, nurses, IT professionals, educators and gadget lovers everywhere. 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.