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    The Medical Palm Review

    September, 2004 (V5N8) - Back to School Again

    We're back, reluctantly, from summer and its distractions. And what distractions they were. I took my PDAs on the road across Canada and found they make good traveling companions.

    On Being Versatile

    It was a long, long road. All the way from Toronto to Charlottetown in PEI. The whole family, even the dog, piled into a Honda Civic and drove East until we had caught up with all our friends and relatives along the way. We made stops in Quebec, New Brunswick and PEI.

    I brought along two PDAs to help make the trip. My Kyocera provided a cell phone and Palm combined.

    My Sony NZ90 Clié came along too. Besides its big colour screen (good for maps), it has a decent two megapixel camera that can share a Compact Flash card with my Canon digital camera. It also supports WiFi so I could browse the web at hot spots (wireless networking access points).

    Thus equipped (with the equivalent of two cameras, two PDAs, one cell phone) I felt there was enough capability and redundancy to cope with the expected breakdowns and technical glitches that accompany any high tech enterprise.

    And just what did all these gizmos do for me?

    Data. I had lots of friends' names and phone numbers, along with instructions to find their homes in the PDA Phone Book. Having a second PDA meant not worrying about loss or breakdown. Before leaving home, I downloaded some websites about New Brunswick destinations, using iSiloX to convert them into a form I could look at on my Palm devices.

    Directions. Since I had never driven these routes before, I needed to take along some maps. The Canadian Automobile Association (CAA) creates excellent maps and directions which you can download to a PDA with AvantGo or print onto paper. Incidentally, I found their route maps better than Mapquest or Maporama, but that might reflect less familiarity with Canadian destinations in those online sites.

    The advantage of paper printouts, of course, is that you can look at the big picture more easily than on a small PDA screen. And the big advantage of the PDA over a laptop is portability, although the laptop has a bigger screen for looking at websites and maps.

    Communications. Thanks to Bell Canada's roaming agreements I could make long distance calls at about the same rate I would pay using my regular phone at home. Local calls were free. The dial-up data link capability of my Kyocera meant that I could check e-mail if I wanted.

    Web browsing. The WiFi card in the Sony let me access the Internet from the waterfront in Fredericton and a few other places, but that was less useful than it sounds because most websites are not optimized for the slow data rate and small screen of a PDA. Finding hot spots was facilitated by the Jiwire website which lets you search by country, province, or area code.

    Snapshots. With two digicams, one built into a PDA, I could swap data cards into the Sony and review pictures whenever I liked.

    Keeping my electronic gizmos recharged was easy. Every night, whether we were staying in hotel or a private home, I plugged the PDA cradle into the wall and recharged it. Had I been camping, I could have used a power inverter, available from any Canadian Tire store, to draw juice from the car's cigarette lighter socket.

    Despite, or because of, my precautions nothing broke down and everything went smoothly. I even downloaded a map of downtown St. John so that I could use it to take a walking tour of the older parts of the city, making Memos as I went. The cell phone made coordination easy, even in unfamiliar towns. So my wife could go shopping while I walked the dog.

    But, I don't know if I would do this again in the same way. Every hotel and friend's home offered free computer and Internet access so I could obtain most of what I needed without a handheld PC. Most tourist websites were not usable on a PDA due to screen size. Cell phones with extra capabilities (eg. Symbian phones) are poised to eclipse PDAs in a variety of roles (SMS, text messaging and web browsing, and digital cameras mare all available in cell phones now). I also felt a little nervous taking my PDA for a hike in the woods or on the beach. What if I had dropped it on a rock? Or in the water? In future, one multi-role and cheap cell phone will be a better bet for traveling.

    Still, traveling with PDAs is a similar paradigm to taking them along in an ambulance or on a house call. Reliability, rechargeability, communications, and appropriate software are all relevant issues. But in an ambulance there are no jellyfish to step on.

    Wireless News and Reviews

    Yes, wireless devices are spreading fast and providing most of the buzz in handheld medical computing lately. Here are some stories that accumulated over the summer:

    • Bell now offers the Palm Treo 600 Smartphone for voice and data services.
    • Palm.Net and Web-Clipping (PQAs) will be discontinued after August 31 - undone by G3 phone apps and true wireless PDAs, the pager-based PQA idea was too slow and not popular enough to survive. Unfortunately, nothing else is in prospect that can compress the web data stream the way the Web Clipping system did it, leaving us with the tediously slow PDA web browsing experience using plain old TCP IP over wireless (see also this editorial from InfoSync World)
    • PalmSource EuroDevCon will be held at the end of September for developers. This year there will be a particular focus on wireless networking and communication issues as the Palm community seeks to avoid being swallowed up by improved cell phone data services.
    • There will also be a medical computing online conference "in" Australia in October.
    • Shades of things to come: A PPC Trojan has been developed. As with desktop PCs before them, handheld devices and phones will increasingly be targeted by viruses and Trojan horse programs. There are also rumours of attempts to target Bluetooth devices such as cell phones. Ouch.
    • The Ascent of Wireless Networks is an article describing the burgeoning growth of wireless data networks at hospitals south of the border.
    • There are a variety of ways to connect PDAs to the Web. If your device doesn't have built-in wireless networking, or a phone, you can link to something that does. For example, Corsoft has a Plug2Net which enable linking to a suitable phone or PC.
    • Some facilities have eschewed wireless computing and instead are using SMS (Simple Messaging Service) to connect health care staff to each other or their patients. For example, Ealing Hospital in west London uses SMS to remind patients to show up for outpatient appointments.

    Medical "Doc" of the Month

    The Agency for Healthcare Research and Quality (AHRQ) has developed PDA software for helping clinicians and patients to choose preventive services during the clinical encounter.

    Take These To Work

    Here are a few medical tools you can use.

    • Skyscape's 5 Minute Clinical Consult is an internal medicine reference. Recently, the publisher has added dynamic updates (ie. your PC checks their website during HotSync and downloads relevant upgraded bits). As usual with these arrangements you have little control over size or duration of your HotSync when you do this - not great IMHO but OK if you schedule your HotSync at an appropriate time.
    • Medical Letter now offers their drug evaluations and treatment guidelines for PDA. The Medical Letter is a nonprofit which obtains and publishes without advertising or pharmaceutical firm sponsorship. Worth looking at and not expensive. The snap shown here is from their website, and shows part of an article on Influenza management.
    • PEPID is a medical reference text you can put on your Palm. Available in several flavours, for housestaff, emergency physicians, nurses, and paramedics, it is now also available online. Recently I received an e-mail from the company advising that the online version of PEPID is now available to subscribers to any PDA version of PEPID. Their letter states that if my PDA breaks I can log on at the company website and access the online version using my existing account ID and PW. Thus, I need never be without PEPID while at work. This works for me because one of my pet peeves about licensed medical software is that I can't load it onto two PDAs and keep one at each hospital where I work. This would be handy during the next SARS outbreak when I wouldn't want to remove hardware from the hospital and transport it across town.
    • HandEchart is a patient charting or student tracking application based on HanDBase, a database program. The program comes in two versions: one for students, the other for directors. Like all DDHsoftware products, this one benefits from the active user forum and the large library of databases on the company's website.

    Medical Computing

    PDA Cortex reports on an innovation at Northeast Medical Center in North Carolina. Paramedics can transmit ECGs directly to a cardiologist on his HP iPaq. Suitable patients bypass the ER and go straight to the cath lab (assuming they are stable). This has cut access time for angioplasty from 93 minutes to 33 at this hospital.

    The under-used 3G telephone networks in Europe have been touted for applications as diverse as videophony and movies-on-demand. Now Vitaphone GmbH plans to use the cell phone grid and souped-up cell phones to transmit 3 lead ECGs to doctors. The phones also employ GPS to send patient position information. Other applications built into the phone handsets remind patients to take their medications. This article from Merginet has more.

    Hack of the Month

    PalmOne has patches for the PhoneBook/ToDo/Appointment software on the Tungsten E and T3 as well as the Zire 31 and 72 models. The patches are free and supposedly fix some minor unspecified problems. If you own these models you should check if out at PalmOne.

    In Times to Come

    In October we will take another look at how to access files and data remotely. Also, I'll have a description of the process I use to add changes and updates to my personal database of medical tips and cheat notes.

    Until then, 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

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