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    The Medical Palm Review

    January, 2004 (V5N) - My Dog Ate My Newsletter

    Well, the pup ate something that disagreed with him. And when he landed in the hospital, this New Year issue of the MPR went to the dogs.

    So, there we were in Montreal for the holidays, when our terrier puppy (see photo) stopped eating and began to mope. It was a slushy Friday one day after New Year's but we managed to find a vet clinic that wasn't closed. And you just know that I found a Palm PDA angle on the whole experience.

    Fortunately I had the pup's vaccination records in a Memo on my Kyocera. I was also able to call my regular vet long-distance to arrange follow-up appointments because I had her number on the PDA. The vet in Montreal appreciated getting my Toronto vet's fax number as well. I couldn't get a copy of the X-rays but I could have snapped a digital copy if I had not left my digicam in my suitcase. As we were leaving the clinic I used the alarm function in the Kyocera's Datebook to remind me when to administer medications.

    After returning to Toronto, the little guy got worse and we took him to an animal hospital. I loaded some eBooks and games (for my daughter) onto my Kyocera for those long vigils spent sitting in the vet's waiting room. I wish I could have downloaded my eMail but I didn't have all the settings on hand.

    Anyway, three days of IV fluids and much worrying later, our dog was out of danger and I had missed my deadline for pushing this issue of the Review out the door. How's that for an excuse? Nonetheless, once again, I found that a PDA made life a little better - if the groundwork was laid in advance. Had I not invested the time to store medical data about the dog, phone numbers and some reading material in memory then the PDA would have been irrelevant. "Fortune favours the prepared mind" as they say, and our New Year started off on a better note because my PDA was setup to help.

    More Cleaning Up

    Besides mopping up dog vomit (no, my PDA was not helpful with that activity) there is other tidying up I undertake at the beginning of each year. For example, I like to remove the previous year's appointments and completed ToDo items from my PDA's memory. That saves memory space and makes searches faster too.

    The easiest way to do that is with the Palm Desktop software that comes on a CD with all Palm PDAs and should be installed on your desktop computer. The handheld will delete purged items when you next perform a HotSync. You can delete items one-by-one or purge them by date (eg. everything older than one week ago).

    You can save the purged items in an archival file when you delete them from the handheld and desktop but watch out! Perhaps because I have been juggling two devices (a Clié and the Kyocera Palm-phone) the archival files failed to materialize on my PC. If the archives will be important to you, test the deletion/archival process on a subset of your data before deleting it all.

    An alternative is to use Time & Chaos as your desktop environment. This program organizes appointments, a ToDo list, and address book. It also has very sophisticated search and retrieval algorithms that permit you to delete and archive sets of data in a format that is easy to retrieve later if needed.

    DateBk5, among a wealth of enhancements to the Palm datebook, also has powerful purging and archive tools with the ability to recover from accidental deletions.

    You can also go low-tech. If you want a record but don't want to be able to search it on a computer, then simply print out the appointments and ToDo lists before purging them.

    You're going to have to clean house eventually or your Palm will have no free memory left. Choose your "broom" according to your needs.

    What's New?

    In no particular order, here are news about and improvements to many of the programs and websites that we have reviewed or discussed in recent issues. Nothing stands still in the handheld computing world as can be seen by the innovative new ideas and enhancements which grace these products and services.

    • SnapperMail is one of the most powerful eMail client programs for your Palm. Version 1.99 has lots of tweaks to take advantage of higher res colour screens on new PDAs.
    • We previously looked at, a web-based system for housestaff doctors. Since our review was published we have learned that procedure tracking has been enhanced, including customized lists, instructions for performing many diagnostic or therapeutic procedures, and procedure logs that can be checked online by the housestaff, their supervisors or by nurses wishing to verify credentials before letting a trainee loose on their wards. Also Palm and PocketPC support has been added.
    • POSE (the palm emulator for desktop PCs) has a companion program called the Simulator which sets more sophisticated conditions for testing and is OS5 compatible, unlike the emulator. Serious programmers take note.
    • The new version (v4.3) of PEPID has a snappier interface and lots of new features - but needs more RAM. There's even an equianalgesic calculator on the toolbar to help plan pain med dosing. Also, they've added a human dermatome map and ECG strips. Drugs have Canadian brand names. Diseases are integrated with drug info, medical calculators and pre-/posttest probability calculators. One drawback: the package is now big and diverse enough to require a fair amount of time to learn where everything is and how to employ it. The new interface helps make that process relatively painless. Annual subscription to this product is not cheap, but it replaces almost all the other medical reference tools that I once used on my Palm.
    • HanDBase has added new plug-ins to make it more useful. For example, now you can incorporate images as discrete fields in a database record or parse text fields to extract specific text. This is still one of the easiest and most flexible programs for building a standalone PDA database.
    • Progect continues to enjoy incremental improvements. It's now quite stable as a list manager and has some project management features. I use it as a memory aid for new multi-step tasks.

    Digging for Gold

    For some time, many medical reference texts have been offered in hard copy or electronic form. We are all growing accustomed to searching multiple resources for answers to questions about our patients.

    Now data-mining and reference software are starting to overlap as developers include search tools with texts and databases. Increasingly, reference texts for mobile computing come with the ability to make connections with real world resources, search engines and the Internet. Clearly this sort of integration is viewed as the wave of the future by vendors who hope to charge premium prices for this sort of tool. Here is a selection of products and sites you may find useful:

    • The Cogni-Q series of texts from Unbound Medicine are a case in point. Their first title is Unbound Surgery. The desktop and PDA software are integrated to provide access to Medline and web-based text for handhelds.
    • McGraw Hill offers many interesting services and products. They have a large library of PDA titles and an eMail notification service for news and new titles in selected disciplines. They also offer a free PDA-based differential diagnosis title - Diagnosaurus - another product powered by the Cogni-Q software I mentioned above. Although Diagnosaurus supports PCs and Palm or PocketPC there is no Mac support. Registration is required so expect unsolicited commercial eMails after you download this.
    • DiagnosisPro 5.0 is another differential diagnosis tool. This one had links to
      Harrison's online textbook of internal medicine and to Medline. Unfortunately, it's only for PocketPC and Windows PCs right now and is expensive at US$250.
    • UpToDate is a subscription based service with no advertising. The PDA (sorry, only PocketPC so far) client software links to Lexi-Comp medication databases and includes update services.
    • Ovid@Hand ties your PDA into an institution's Ovid subscription for Medline searches. Another product powered by software from Unbound Medicine.
    • ARTBeat from Skyscape is news service that can send medical information daily (eg. FDA, CDC) and can have custom channels (eg. to online medical journals) as well. ARTBeat integrates with other Skyscape software on your PDA. Imagine being able to automatically receive (wirelessly or when you HotSync) up-to-the-minute advice on managing a SARS outbreak or another medical disaster.
    • AvantGo is the grand-daddy of custom channel news distribution. If you pick medical journals and other websites that can be downloaded to your Palm, then you can get frequent updates and medical news on a variety of subjects.
    • MDConsult has begun offering custom news channels as well as reference and differential diagnosis tools (eg. FirstConsult, formerly PDxMD). MDConsult is also promoting a service that offers to pay honorariums to doctors who agree to verifiably view pharmaceutical promotional literature online.
    • ER Suite and other titles from Medical Wizards don't provide direct links to the internet but do include phone numbers for poison control centres and other real-time resources. The range of topics is limited (strongest coverage is in medications, IV drips, toxicology) but free trials are available.
    • The Medical Letter provides drug information, advice for travelers, medication recommendations for specific illnesses, drug interaction software and more. Their products are available online, in paper, and for your PDA. You can use your mouse like a stylus to navigate through the demo.
    • Micromedex offers medical references and some acute care guidelines with their PDA products.
    • FPnotebook is a wide-ranging reference website for family medicine practitioners. It is also available for PocketPC, but not for Palm devices. However, you could capture and convert parts of it for your Palm with iSilo, Plucker or AvantGo.
    • InfoPoems is a subscription-based service to provide evidence-based medical info to clinicians. It runs on most desktop and handheld computers.
    • TRIP is another online evidence-based medicine resource but it has no direct support for PDAs. The results of searches can be captured and downloaded onto your Palm.
    • Drugmagnet is a web- or wireless palm-based drug prescription program which checks for medication interactions before it prints out your prescription. Good if your handwriting is as poor as mine.
    • PubMed and ClinicalTrials are both available for wireless computing.
    • Members of the AMA can register at MerckMedicus When they perform topic searches they can earn CME credits at the same time.

    Hardware news and reviews

    What would a new year be without new toys, er, hardware. Two trends that are emerging in accessories. One is to combine as many functions as possible onto a single external data card. Another development is the effort to put wireless networking capability into every possible PDA or phone.

    PDA Backup from Mobile Digital Media is a great idea for handhelds with a Secure Digital slot. This 64 megabyte SD memory card comes with software already installed for backing up your Palm's memory to the external card. Just plug and play (no need for PC to install the backup app). One stylus tap executes a backup or restore operation and data encryption, compression, and password protection are built-in to the card - excellent for privacy. This is a convenient and simple solution but pricey if you already have all the SD cards you need. There's a short news item about it at InfoSync World.

    By the way, if you own a Palm Tungsten T3, SD external memory cards may not record data reliably - get a patch at PalmOne.

    Combining Wireless networks (WiFi) with PDAs has great potential: telephone applications, eMail, web-browsing, custom applications like medical charting all become possible. Many newer Palm models incorporate WiFi. Look at a detailed review of the Treo phone-PDA. Older models need an external WiFi card (eg. the Sony NZ90 Clié uses a Compact Flash WiFi card). Sandisk makes a WiFi card in the SD format. Now they have announced a new SD card that combines WiFi and memory storage - reviewed at InfoSync World.

    Think Outside is renowned for it's plug-in keyboards for Palms. Now they have a wireless one (reviewed at InfoSyncWorld). This device uses infrared instead of the HotSync socket so it will work with any number of portable devices. This versatility is important when you consider that your next PDA may well use a connector that's not compatible with the old one, making a plug-in keyboard useless.

    Medical "Doc" of the Month

    WebhelpDoctors. The purpose of this site is to help MDs (and others) pick a PDA and it does cover most of the important decision factors. The same folk are writing a series for the journal of the College of Family Practice of Canada. First article appeared in the Nov 03 issue. Not everything they write can be accepted without challenge (eg. Pocket PCs are "more convenient" and "more versatile") but it's grist for the mill.

    The University of Connecticut medical school library has an excellent site with advice about selecting PDAs, and lots of good software title recommendations. I highly recommend checking this out if you are a beginner or looking to upgrade hardware and also if you are still developing ideas about how to use your PDA in health care.

    Medical Computing

    More RNs use PDAs for ref at work than MDs do, according to a report by Forrester Research and discussed at length on PDA Cortex. What do MDs use? The internet apparently. Does this mean nurses are on the go more than doctors?

    Penn State is using wireless PDAs instead of paper charting for a variety of tasks. IT students are developing the system to bring patient information to clinicians' portable wireless computers.

    In Times to Come

    Sooner or later I should set up the web browser on my Kyocera. Maybe now that the dog is better I will have more time..?

    Until next month, enjoy your PDAs and your pets!

    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.