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    The Medical Palm Review

    April, 2003 (V4N4) - Ring in the Changes. Again

    Well, I did it again. Spent alot of money, that is. That ringing you hear? It's the sound of a cash register at the Sony Store.

    Once More Into The Breach

    My poor old Handera 330 is kaput. One day at the end of March I turned it on and the screen didn't light up. No point in calling the company support line: they announced on April 16 that the firm was retreating from the Palm business. I needed to buy a whole new device.

    This was quite bad. I didn't lose any data because I keep backups on my desktop PC. No, the real damage was to the gestalt I had created for working with my Palm PDA at the hospital. I had come to depend on some of the Handera's unique features:

    • oversize screen. The Handera screen was 240 X 160 pixels because the Graffiti area could drop out of the way. I could view much more text on the big screen. Not only that, but text could be rotated sideways (so the long axis was horizontal) making it easier to view tabular data.
    • voice dictation capability. This was handy for quick memos - I am just not that proficient at jotting notes with Graffiti
    • memory card. The Handera had both a Compact Flash slot and a Secure Digital slot for memory cards or other add-ons. Two slots gave it great flexibility. My camera uses Compact Flash too, so I only needed to keep one type of memory card around. And, with 128 Mb on the CF card I never ran out of space for medical reference texts.
    • external keyboard. I was just starting to get more mileage out of this. Unfortunately, it is designed to plug into older model Palm PDAs. New ones don't fit.
    • software bundle. The Handera came with a free version of QuickOffice (word processing, spreadsheet, presentation software) as well as a modest collection of truly useful utilities: on-screen keyboard, battery monitor, etc.

    Could I find a new PDA with all the advantages of my defunct Handera with none of the disadvantages? Of course not. There's a tradeoff for everything, and the "perfect PDA" has yet to see daylight. I opted to drop a bundle of cash on a Sony Clié NZ-90 and got a mix of (for me) good and not-so-good:

    • oversize screen. The Sony has a gorgeous colour screen, with a 320 X 480 resolution. Unfortunately, most software cannot run in sideways mode.
    • voice dictation capability. Not only can it record but the NZ-90 plays MP3 music files. Not something I need - yet.
    • memory card. The Sony uses proprietary Memory Sticks. Speed and capacity are adequate but I can't share the Sticks with my camera (wants Compact Flash).
    • built-in camera. This is more than adequate for snaps of my patient's cellulitic arm, for comparison on his return visit tomorrow. But it takes 5-10 seconds to turn on the camera. The patient had better sit still....
    • built-in thumb-button keyboard. Too small for touch typing. But it might be easier and faster than Graffiti.
    • faster. The NZ-90 runs a faster CPU chip and also uses Palm's newest operating system (version 5). The result is that this is a snappy beast. Searches and image recall are much quicker than with my Handera.
    • wireless communication. BlueTooth, and support for longer range WiFi networking are available for the NZ-90 but peripherals and services that employ these abilities are lacking at present in my work environment.
    • software bundle. Good alarm clock and very good viewer for PDF, Word doc, Excel spreadsheet, and web page files. Not much else in the bundled software which interests me. Nothing to replace Quick Office.

    There are more features (this thing is covered with buttons) but it is ironic to compare the NZ-90 with the Compaq iPaq which I reviewed more than a year ago. The iPaq had a great screen but several serious failings which I thought made it unacceptable:

    • weight. iPaq PDAs weighed nearly twice as much as Palms at that time. The NZ-90 weighs even more than the iPaq.
    • battery life. The great colour screen and superior sound quality suck the life out of batteries in a few hours. Ditto for the Sony I just bought.
    • recharge and HotSync cradle. Fast (it uses USB) but fiddly to insert the PDA into. The Sony doesn't even have a HotSync button: I have to launch the HotSync from software.

    Ironically the Clié 9Z-90 shares all the defects of the iPaq but one: it runs the Palm OS which, for my money, is still vastly superior to the Pocket PC software system for handheld computers.

    So, am I happy with the new PDA? It has lots of cool features, and a much better screen, but I will have to change the way I work. No more week-long excursions without dragging the battery charger. No more turning it sideways to read tables across the screen. And it's too big to slip comfortably into a shirt pocket. I'm using the Clié, but only time will tell whether I really like it. And who knows if it will keep working long enough for me to understand all those buttons. My Handera packed it in after only a year....

    Other People's Toys

    Not everyone is shelling out for a Sony Clié. But the competition for our dollars is quite intense. Palm is discounting the price of its latest model Tungsten T. In fact, they are selling it with a coupon good for a free Veo camera that plugs into the SD slot (see the February 2003 issue of the MPR) and a 50% discount on their Ultra Thin Keyboard. This offer ends late in April or after 15 May, 2003, depending on where you buy, apparently. Here in Toronto, Batteries Plus is offering it until 15 May. The Ultra Thin Keyboard, by the way, is a clever update on the folding full-size keyboard idea. It locks open so you can use it on your lap or other uneven surfaces, yet it is thin enough when closed to fit in a pocket. Suitable for newer handhelds with Palm Universal Connectors.

    Palm has also rolled out its Tungsten W model. This is an interesting package with a built-in thumb keyboard, wireless networking and cell phone, and a good colour screen (see illustration at right). You can read some early reviews at InfoSync and PDAbuzz.

    Interested in alternative keyboards? Halfkeyboard features a one-hand touch-typing keyboard for PDA or desktop use. Clever. Prefer one of those virtual keyboards that project an image of the keys onto the table so you can type away? Here's a discussion piece with more than you ever wanted to know about the companies developing these products.

    If, like me, you have recently switched brands of PDAs or digital cameras, you may wonder how to access the extended memory card(s) you used with the old handheld. Multi-card readers add the ability to read various formats to your PDA. Another idea is to get a reader that plugs into your desktop PC: you can use old memory cards as portable backups for important data files.

    Software can also enhance PDAs to keep them competitive with newer models for just a bit longer. For example, there are now several MP3 players for Palm's Tungsten T (RealOnePlayer, free; AeroPlayer, USD9; Pocket Tunes, also not free). All need the audio update patch from Palm or sound is very poor quality.

    If you don't have a phone built into your PDA, at least you can share your phonebook data more easily. Fun Communications makes software tools to port your Palm phonebook to new cell phones - easier than using the T9 data entry system which most phones employ for laboriously keying in phone numbers one at a time.

    Graffiti coming and going

    Do you hate Graffiti? Have you been struggling to get skillful at it? Well, now there's another reason to be pissed off: Palm is dropping it and replacing it with Jot, a rival handwriting system. Among other things, the new system will include support for writing over the entire screen instead of a dedicated box at the bottom of the screen. According to PalmSource, the Palm software development company, the new system, called Graffiti 2, is easier to learn than the the current version of Graffiti. Unless you have already learned the old system, in which case Graffiti 2 is allegedly harder to learn. Gee, thanks, Palm.

    Why is Palm doing this? You don't suppose a pending lawsuit by Xerox over the original Graffiti software could be a factor? Read more about replacing Graffiti with Jot at InfoSync, PDAcortex and still more at PDAcortex.

    Not all Palm OS users are wild about the move to Graffiti 2 and its Jot character set. TealScript supports Palm OS 5 and lets users customize many features without going to a whole new character set. Read more at InfoSync. For a review of several alternative text entry software packages see this Palm Infocenter article.

    The difficulties of using a stylus and Graffiti to enter data quickly and accurately has convinced me that the future of handheld patient charting and data entry lies with database software which uses structured templates and forms. I don't believe Jot will change the equation enough to make handwritten patient notes more attractive to busy health care workers any time soon.

    Medical "Doc" of the Month

    The high quality Sony screen and Memory Stick makes it practical for me to keep sample ECGs and rhythm strips on the Clié to demonstrate to students. There are several free or almost free packages out there or you can scan some and load them up.

    PalmEKG is a freebie which used to be available from the PalmEMS website. Unfortunately, the site appears to be off-line now. So I have attached my copy of the program to give you an idea of what rhythm strip tracings look like on the Palm PDA screen.

    Hack of the Month

    OS 5 messed up the underpinnings used by many software Hacks. None of the Hacks I used to use seem to work on the new Sony. Fortunately McPhling, the hack I use most, has been rewritten for OS 5. McPhling gives you a shortcut menu to launch applications. I find it very handy on the Sony to launch HotSync which has no hardware button on the cradle.

    Medical Computing

    Last year the journal Canadian Family Physician published a series of articles on using "hand-held" computers in medicine. The four-part series is still topical and the choices of software they discuss are highly pertinent. The entire series is available online at the following links:

    This year there will be several conferences of interest to health care workers. IMICH will be held on June 14 in Halifax. The focus is primarily on nursing applications of handheld computers but hospital managers and paramedics will also find much to engage their interest.

    The PalmSource Developers Conference will take place during May 6-7 in San Francisco. This is the biggest event in the Palm programmers' annual calendar. It is aimed primarily at industrial strength software developers but if you are interested in wireless networking to health care computers you will get alot out of your trip to San Francisco.

    In Times to Come

    Next month we will look at using a scanner and conversion software to put images, photos, and charts on your Palm PDA. I will also be struggling to figure out my new gizmo and to reload all my applications -- or find replacement software if the old ones don't work.

    Until then, enjoy!

    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.