The Medical Palm Review
May, 2004 (V5N05) - Airborne
It seems this is the year for wireless everything. This past month I have been trying out a whole spectrum of mobile computing devices and ideas. Yes, I also spent more money...
Look Ma, No Wires
At the end of April I participated in a big disaster training exercise with large numbers of simulated casualties who presented to an improvised hospital emergency department. We were primarily interested in exposing emergency medical residents and paramedics to multicasualty situations. But we also wanted to explore whether specific hospital protocols and systems were up to the task of managing a surge of about eighty patients in two hours. Could we get them all registered and assigned to different parts of the emergency department? Would our hospital patient database cope? How could we share patient information between paramedics, public health authorities, front-line emergency staff, and discharge planning workers? Could we function effectively if the main hospital network was down or if chemical contamination forced us to relocate the emergency department to a local gymnasium (for example)?
Last year I built a website to support a similar project. It had some background materials and hosted a post-exercise message area and photos. This year we used WebCT to build a much more ambitious and professional site (sorry, the specific site is for participants only, but you can check out WebCT itself here). Among other things, we collected many web documents and sites with reference material. Participants could log on to review materials or read/leave messages in the different discussion areas. None of this was formatted for small screen portable computers. I did use my Kyocera PDA to wirelessly link to the Internet and access the site but it was not easy to read. We did convert some of the reference material into Palm or AvantGo documents for those who wanted to have something handy during the actual event. Participants could download those files onto their handheld computers. You can find the National Center for Environmental Health's guidelines for initial management of chemical weapon exposures online or download/convert our cleaned up version.
But we also went one step further and created a temporary wireless network using wireless routers by Rajant. At the beginning of the simulation, a half dozen "Breadcrumb" battery-powered wireless networking routers were scattered around the simulated hospital (a gymnasium and its adjacent parking lot). One of the little blue boxes was connected to the Internet via a broadband link, but we could have as easily used a truck with a satellite dish.
Within minutes of plugging everything in we could link to the Internet with any number of systems. Laptop PCs with wireless networking cards could "tunnel" to the hospital patient database and could link to Internet sites with useful medical reference material. Our handheld computers could link also if they had wireless capability. I tested a Sony NZ90 with a wireless adapter (that's where I spent a few hundred dollars). Using Firepad's Picture Viewer software I could get live video feeds from webcams dotted around the site and see what was happening at the triage desk or the patient waiting area (check it out). Other folk successfully linked Palm Tungstens or iPaqs. Not all the software worked consistently or well. Cutting edge stuff sometimes needs sharpening, but the possibilities are manifest.
Things we didn't do but will try out next year include:
- Voice-over-Internet phones. With a wireless network and the right wireless phones, or with software such as Skype on our PDAs, we can provide a local telephone network in case the local telephone service or cell phone service is knocked out. The Internet connection means you can hook up to other telephones or computers anywhere. They also make great "walkie-talkies" for working an event like this. Currently Skype is available for PocketPC handhelds but I am hoping a Palm version comes out soon.
- Tracking. The wireless network can be used to track patients and staff who have wireless-capable handheld devices, or by using little radio transmitter tags that you clip onto clothing. Currently this technology is in use at amusement parks. Well, that's where all the leading edge stuff happens....
- More Tracking. Wireless technology can also provide radio frequency ID tags (RFID) that can be built into patient arm bands or adhesive patches. We hope to try this for rapid registration and tracking of patients in next year's exercise.
- Sharing patient data. If paramedics could enter patient data into handheld computers during the run to the hospital, and if the hospital could access that data, it would save time and duplication of effort once the patient arrived at the emergency department. Systems with this capability are being studied in Toronto and may be available in time to test during next year's exercise.
- Webcams with wireless transmitters. Positioned in strategic locations, these will make it easier for paramedic crews, hospital administrators, security personnel and public health coordinators to keep tabs on the situation.
All these technologies and ideas have potential for day-to-day operations, not just during disasters. The wireless network in extreme situations points the way towards more mundane use in future. I would love to have a wireless phone in my pocket so I could call or be called during an emergency department shift. And wireless access to the patient database would let me order and review tests and patient charts at the bedside or on the move..
This week's New York Times has a special online section about wireless computing and there is one article in particular about medical applications. Chicago's Central DuPage Hospital is also going this route. It has been reported that their staff will soon have wireless phone and patient care software using Treo 600 PDA/smartphones. The Treos and wireless networking will also allow their hospital staff to communicate with each other "walkie-talkie" style. The hospital plans to cover part of the cost for this project by providing access to the wireless grid for phone and web use by patients and visitors. And how long will it take before some bored teenager with his leg in traction hacks his way into the hospital's financial documents?
Other Cool Stuff
If you have wireless access to e-mail, and frequently receive or send Microsoft Word or Excel attachments, you should look into Inbox To Go Wireless by DataViz. The program can even manage picture attachments in several formats. Along with Documents to Go by the same company you get the ability to read, edit, send and receive Microsoft Office files wirelessly.
Navman SmartST GPS is a handheld GPS receiver and Palm PDA. Now if they could just add a cell phone, wireless e-mail, and a camera....
PalmSource has a few new PDA models. Here are some early impressions of the Zire 72 and the Zire 31. They both feature better screens and numerous other improvements.
Medical "Doc" of the Month
The National Library of Medicine (US) has published several reviews of Palm software titles. In keeping with this month's theme of chemical gas weapon toxic exposure, here is the latest review, featuring software titles in toxicology and environmental health. Previous issues are also archived here.
Hack of the Month
My laptop computer has a wireless networking card built-in. So does my Sony Clié. But I don't have a wireless router to enable the PDA to access the Internet directly. Hmm. Can I link to the Internet by networking the Clié via the laptop? Turns out I can using what Microsoft Windows calls ad hoc wiLAN. Of course it took two days of tinkering and a few phone calls to Sony's support service before my PDA's web browser could display a Google search page or two. I learned a few things which I will share with you now (see how nice I am? I spend all my evenings doing this obscure stuff so your spouse won't feel as neglected as mine does...)
- First of all, the instruction manuals that came with my SONY wireless networking card were mostly right but had too many omissions to let me set up from scratch.
- Dell (they made my laptop PC) phone support staff were happy to verify that my PC was working but could not and would not try to debug the wireless networking issues that prevented me from linking to the Sony PDA. Their position was that it was a Windows or Palm problem. Of course, if I cared to purchase a Dell Axim PDA that would be another story...
- The SONY Clié support website is worth monitoring regularly for updates and patches for the whole range of Clié devices.
- Then there are the SONY helpdesk people. I spoke with two. One did not know how to manage networking issues and referred me to another. He knew how to set up wireless HotSync for the Clié but insisted I could not link to the laptop for web browsing without a wireless router (incorrect).
- ClieSource, the online support group for Clié owners is a gold mine. There are numerous discussion fora where almost any conceivable question can be answered - if it isn't already in their archives. For example, I learned to set up the wireless connection one way for HotSyncing, and to have a different profile for wireless linking (via my home broadband Internet connection) to the Web.
Those who want details on how I set up the wireless connections can read my detailed notes. These notes really only apply to certain Cliés as newer PalmSource devices have rather different configuration software. But there are a few pointers and links you may find useful.
I don't plan to take my Sony to Starbuck's to check my e-mail over a latte. So why bother with wireless networking of the PDA? Well, for one thing, wireless HotSync solves the problem of HotSyncing with multiple Palm devices when they all have incompatible cradles. You can't plug multiple cradles into one PC (usually) without straining its brain and swapping cradles all the time would be a pain. Wireless allows me to HotSync my Sony Clié without a cradle at all. That way my Kyocera can sync in the old-fashioned way.
If I were running a clinic, I could use the Sony for wireless electronic charting. But I am not ready to open a clinic just to test that concept.
Why not get a wireless router for the latter functions? Actually that's a good idea and maybe I'll try that next month. But it's going to need some significant changes to the setup profiles on the Clié and maybe my PC too. Oy.
Here is an interesting article about security issues for corporate PDAs. The same problems might well apply to mobile health care providers or hospitals.
The Johns Hopkins University School of Medicine's First Annual Conference on Information Technologies at the Point of Care (full brochure can be found here), will be held during June 17 and 18 this year.
In Times to Come
Last month I discussed all the pros and cons of my new laptop. I forgot to mention one: noise. The laptop is almost completely silent. This is so much better than the multiple fans whining on my desktop that the latter device will be banished to the server closet Real Soon Now. To reduce the noise still further, maybe I can use the Sony and wireless networking to control my PC remotely.
Hey, I'm having fun with this!