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    The Medical Palm Review

    July/August, 2004 (V05N07) - Smart or Dumb

    Some people might assume that I know a thing or two about PDAs. After all, I write this monthly newsletter about them. Well, I got taken down a peg this month.

    It's All in the Packaging

    In early June, one of my colleagues called me to help me fix a reset problem with his new Palm. He had been unable to find the solution online or from calling PalmOne's technical support. He half-jokingly called me a "guru". Well, I am bald - but not due to enlightenment, only from tearing my hair out with frustration.

    There is an upside to being thought an expert: people call me to help fix stuff (hmm, maybe that's really a downside). Seriously, I do get a charge when I can help someone resuscitate a PDA. In the case of my coworker's reset issue all I had to do was have him demonstrate the problem, familiarize myself with a new Palm Tungsten's button layout, read a few online manuals (thank you PalmOne) and do a Google search for a few support websites.

    The problem turned out to be nothing more than the user pushing buttons in the wrong sequence - it was different from his old PDA's setup. Easy as pie once I had read the manual. He was appreciative and I felt clever.

    Last week, I was cleaning up my home office, when I discovered my Handera 330 languishing in a desk drawer. It would have been two years old this past March but it had stopped working last year. Handera has stopped making or supporting Palm devices which is a pity because the HE330 was a pioneer PDA in its day. Longtime readers of the Review may recall several articles about it in past issues.

    I thought I'd give it one more try, maybe open the case (now long out of warranty) and try to revive it. I also looked in its retail packaging (I never throw packaging and manuals away) for leftover styli and other salvageable accessories.

    The HE330 would not light up despite various tricks and fresh batteries. But then I noticed a small piece of paper with a typed note, nestled in the bubble wrap. The note warned users that "sometimes" after replacing batteries you need to press the reset button to restart the PDA. Had I tried that last year? Apparently not, because it booted immediately after getting a set of triple A batteries and a soft reset. Oops! If I had been able to do that last year, I would never have got my Sony (and then the Kyocera). There's an oversight that cost a few hundred dollars.

    So how does my "retro" Handera stack up against today's gizmos? Although the screen is not colour and not very bright compared to my newer devices, the Handera supports wireless networking, has two expansion slots and the text on screen can be rotated to read in "landscape" or "portrait" mode. It has a voice dictation capability, although there is no built-in cell phone like my Kyocera. Best of all, the HE330 has been running for more than a week without recharging batteries even once - my newer PDAs can't go more than one or two days at best. In general the Handera is good enough that I would probably still be using it as my primary handheld computer if I hadn't mistakenly believed it had croaked.

    But I wouldn't go back now. I have become used to carrying one Kyocera instead of a cell phone and a separate PDA. My eyes appreciate the brighter colour screens of newer devices. Time marches on and although the HE330 evokes nostalgia, my needs (not to mention my eyesight) are different now.

    But the Handera won't go completely to waste. I have found some excellent math tutorial software online (MathTime), as well as some flash card quiz programs, like QuizWiz. My daughter will get to work on her multiplication tables and French vocabulary over the summer - even on car trips. I may even load a few games for her.

    And that will help to deflect questions as to why Dad the Computer Guru couldn't turn on a PDA - and didn't remember to consult the reference manual when it stopped working.

    Giveth and Taketh

    Well, I recovered the Handera, but there is something karmic about computers. My backup office desktop PC motherboard died about the same time. I got a replacement motherboard, thinking to just swap it in, reusing the hard drives, video card, etc. and thus not have to reinstall Windows. I used to do this sort of thing all the time. Piece of cake.

    Well, as John Campbell's Law of Everything has it "you can't do just one thing". It only took a half hour to swap out the old motherboard for the new one. It took a week for me to back up and reformat the drives, discard all the peripheral devices except monitor and keyboard install and troubleshoot application software, update hardware drivers, load Windows updates, etc. I finally got it all working but it was humiliating and frustrating. It would have been far simpler (and cheaper, if you add my time) to have just bought a new PC with Windows installed. Good thing my wife was out of town so she didn't get too annoyed by my frittering away my week.

    Want more proof that I am "losing" it?

    I downloaded and installed updates of PEPID and 5 Minute Emergency Consult, both useful emergency medicine reference texts. PEPID refused to load properly on my Kyocera unless I deleted the older version first but it took a few tries before I figured that out. But I had the same experience last time I updated and made a list of setup notes for this and other packages I use. Perhaps I should have remembered to look at those notes....

    5MEC's download site (Skyscape) registration process had me stumped until their support staff gently pointed out that I was misreading "DEA #" as "DEA *" and not filling in the online form properly. Hey, not only can I not execute instructions but apparently I can't read them either.

    I noticed today that the antenna on my Kyocera is broken. This means I use more power making cell phone calls and have to recharge more often. Time for more repairs. Whoever said that technology would make us "free" was mistaken.

    New Software

    Summer wouldn't be the same without new applications to experiment with on your Palm. Here is a smorgasbord of titles. Try some.

    • Medrules provides clinical prediction rules and guidelines to assist diagnosis. Handy but the author doesn't intend to update it.
    • A new version of Palm Reader has been released. You can create your own texts or download and peruse any of thousands of titles and documents in this proprietary format.
    • Another development tool set is PocketC and OrbForms Designer - they were used to build Pedi-Dose by the way...
    • Simulators for Palm OS (various versions) can be found at PalmSource and developers will find them useful. You need to register (free).
    • BlueFire silences BlueTooth and IR connections so it's hard for someone to take over your phone or PDA or to steal data.
    • The ePocrates Dx product combines the 5 Minute Clinical Consult medical text with a prescription drug reference. ePocrates, already provides a free medication reference called qRx. This is limited by its lack of Canadian medication brand names.
    • As I noted above, 5 Minute Emergency Consult is an emergency medicine reference text you can load onto your PDA. I wrote a few short chapters for it, but my only compensation was a free copy for my own use. Like PEPID, another emergency reference program for PDAs, periodic updates are provided for the duration of my subscription. Unlike PEPID, 5MEC will keep working after the subscription expires. This is far superior in my view, particularly since PEPID is also more expensive than 5MEC.
    • LauncherX is available for most Palm platforms and it is a great replacement for the standard Palm application launcher interface. It also provides a simpler way of deleting applications and support files. For those with Palm OS 4 or 5 devices who load programs onto memory cards, LauncherX provides tools that make it a cross between a launcher and a file manager. Check it out.
    • Pocket Tunes lets you play music files on your PDA. Multiple formats are supported.

    • FilePoint 3.0 can manage files on your Palm PDA and also files on attached network devices (wired or wireless link). The interface is a bit like Windows Explorer. With this program you could view or edit files on your PC from your PDA.

    This lot should keep you busy for a few weeks...

    Wide Open Spaces, as in "Holes"

    Security holes that is. How can you prevent others from snooping onto your wireless devices when you are in public? Without encryption or Virtual Private Networking (VPN), your data packets can be sniffed by a variety of techniques. This is a particularly sensitive subject for health care workers who use PDAs, and even more so if you are likely to use your Palm while on the road - paramedics or home-visiting nurses, say.

    You can also lock down your PDA by requiring passwords to access shared files and encrypting passwords and other sensitive data. pdaMD has an excellent introduction to the topic of protecting your files and records on a Palm device. TechRepublic also has an article about Palm security products. Documents To Go can lock selected Word and Excel files on your Palm. movianCrypt is another data protection software tool that is highly regarded. Any large Palm software Internet source will have many titles for you to consider (for example, Tucows' repository on Shaw Cable Systems)

    Remember to HotSync regularly so that your data will be safe if your PDA is lost or if you forget your password(s) and have to do a hard reset. And the backup files on your PC need to be protected from snoops who might try to get at your PDA data via that route. Passwords, file encryption, network router security all need to be addressed.

    Without access control measures, other computers can attempt to log onto the same network as your PDA. This can be blocked by measures which enable the security on the wireless routers that serve the network such as requiring passwords, limiting the devices that have access to specific computers and PDAs (using MAC ID codes), and encrypting data transmissions with WEP or WPA protocols. Look at these articles on arstechnica, and Home PC Firewall Guide to get started with home or small office networks. The Firewall Guide site has lots more on other aspects of computer security - check out their home page.

    By the way, if you already have a wired router and then add a wireless one to support WiFi networking for your PDA, consider using the wired one for day-to-day indoor computing and switch on the WiFi one only when you need to be mobile. This will reduce your exposure to data snoops. There may even be a health pay off if all those long-term studies finally do show subtle health effects from low power radio transmissions (there's lots of reading material from, say, New York City, the FDA, and the Japanese Government and more).

    If you work in a large corporate or institutional setting, there are broader issues and more places for human factors and social engineering security problems. For example, staff turnover is probably higher at your hospital than in your home (at least I hope so...). Someone needs to address these non-technical issues also if patient data is to be adequately secured.

    Read more at ExtremeTech (which generally takes the view that basic measures are enough for most users) and SecurityFocus which takes a more alarmist viewpoint, at least for corporate environments.

    Medical "Doc" of the Month

    BMJ's Clinical Evidence site has teamed up with Unbound Med to offer portable Evidence-Based Medical reference capability using CogniQ (a system that links websites, handhelds and wireless devices). This has some overlap with AvantGo, which offers access to a broad range of websites and news services but is not particularly focussed on medical needs. Still, one can use AvantGo or iSiloX to capture updates from online medical resources to a PDA if one is prepared to do the preparatory work.

    Speaking of AvantGo, we have changed our setup slightly. If you use it to download new issues of the Review, I encourage you to update your AvantGo channel using the newly programmed Get MPR for AvantGo button. Thanks to Randy Showalter, our web guru for fixing this. Unlike me, Randy really does know what he's doing!!

    News and Reviews

    Bozidar Benc died recently. He was one of the pioneers in the development of Palm shareware and freeware. He created programs used by millions of people worldwide from his small home business in Croatia - and this during very unsettled times in that part of the world. As is often the case with creative types, Mr. Benc was something of a polymath, and he also dabbled in ham radio and astronomy. Browse an interview with him or check out some of his work at Benc Software Production. Bozidar Benc was also the lead developer of the LauncherX application which I mentioned above.

    The PocketGoddess website is a place to find news and reviews about all things PDA. Worth adding to your list of sites to check out periodically.

    Are you thinking of creating Palm OS software for the health care field? PalmSource will host a developer conference in Europe this autumn. Start planning now to take time off to attend.

    Medical Computing

    Radio-Frequency ID systems for tagging and tracking patients and staff are being deployed in some medical centres.

    PDAs are being used to send ECG data from ambulances to the ER. The goal is to shorten "door to needle time" for those who might require thrombolytic therapy.

    How about wearable vital sign monitors? The WEALTHY project is attempting to create fabrics and sensors for remote monitoring of BP, heart rate and rhythm. Here is an overview and a detailed paper which was presented in Cancun in 2003.

    Some facilities have eschewed wireless patient data transmission and settled for data transfer stations where doctors can update their patient data onto their PDAs. This isn't real time but it's mobile. For example, there's MData.

    Spyglass Consulting has released a report entitled Mobile Computing in Nursing which discusses the current state of mobile computing in nursing. Spyglass, a health care consultancy, claims that more than 90% of nurses won't use Tablet PCs for bedside nursing due to their large size, weight, and fragility as well as inadequate battery endurance between charges. Nurses are also not impressed with larger PCs on wheeled carts (so-called Computers on Wheels, or COWs) because they are heavy and hard to move, or hard to find when needed. By contrast, about 85% of nurses interviewed used a PDA, most commonly a Palm. The study asserts that nurses are more efficient and less likely to make medication and other errors when they use a PDA. The study is a little light on info about what software nurses are using to achieve these effects or which programs and devices might be better than others. The nursing site PDA Cortex has a brief discussion of the Spyglass white paper.

    In Times to Come

    Well, that's it for the Review until September: as is our custom, we make the July issue stretch to cover August too. I hope we have given you enough to digest for the whole time, and that you have a good summer. As for me, I have a few computer manuals to read...

    Meanwhile, enjoy!

    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 of on paper. To subscribe, comment, or complain, contact the author

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