|The Medical Palm Review |
April/May, 2005 (V6N4) - Deadlines
No man is an island. Getting this newsletter out on time might appear to be (mostly) a one man show but it wouldn't exist without readers. And the programmer who built the web site. And all the news services, researchers, and software publishers who create and talk up new products. And the doctors and nurses, students and schools, hospitals and health care agencies who dream up new ways to use the technology to get work done. It's actually getting a little crowded in here....
The Dog Ate My Blog
Well, no, I won't claim that lame excuse. But my DSL Internet service stopped working reliably about a month ago -- around the time I discovered that my terrier had been using the RJ11 telephone wire as dental floss.
Unfortunately, replacing the wire did not improve the service. Replacing the terrier was vetoed by my wife and daughter.
Meanwhile, I found it impossible to maintain a live link to the Net. I was cut off from e-mail, web browsing, and researching with the university's online medical library. The timing could not possibly have been worse either. I had four book chapters to update (I contribute to the 5 Minute Clinical Consult - Emergency Medicine reference book). I had a lecture to prepare. I was in the middle of last minute e-mail discussions/preparations for a disaster training exercise that was only days away. I was consulting on a web project. I was trying to book a holiday and a conference online. And, of course, I was late finishing up the April issue of the Review.
I had arranged for three weeks off to tackle this mountainous agenda. And then my Net access was lost. Many days of aggravation followed. While negotiating daily with service reps on the phone, I was forced to reorganize tasks. This mostly consisted of jettisoning or deferring as much as possible, like a balloonist heaving gear out of the gondola to gain altitude so that he won't collide with a mountain.
The current labour dispute between my DSL provider and their field service representatives didn't help either. The DSL service folk blamed the phone lines. The phone company blamed the DSL provider. Might I add that they are two parts of the same corporation? And there was nobody to come take a look in case the problem was a yet-undiscovered dog-induced line failure. For a few days I wandered around the house with a laptop in one hand and a broadband modem in the other. I crawled under furniture to test phone jack outlets, but to no avail. There is no problem as frustrating as an intermittent one. After each test or tweak the DSL link would fail after anything from five to thirty minutes - or maybe not. When can one say that things work reliably? At what point can one be sure they won't fail again? Finally I concluded that the problem could not be blamed on the dog. Somehow, my DSL service had simply stopped working.
I reluctantly decided to postpone the April Review. I spent some time lurking at the university's physical medical library. I rediscovered that eight pounds of laptop and some accessories may be "portable" but is not really "mobile". I relearned that being over-programmed with tasks risks a meltdown. I discovered that it can take about a week to order and install cable broadband service. And that means now I have to change all my e-mail addresses.
Somehow, most of the assignments got done. This debacle underlines how dependent I am on the Web for many activities, and communicating with collaborators and colleagues. Web-based activities have extended to traditionally off-line stuff like medical reading, publication, and correspondence, but also includes new activities that wouldn't even exist if the Web was not around - like this Review.
The most important thing I learned is that if my family has to choose between the dog or the computers around here, it won't be the dog that is shown the door. Hey, now I know my place....
This one was on purpose. The HUSAR exercise tested multiple elements of disaster response. Special search and rescue teams worked to free simulated patients who were trapped in the rubble of a collapsed building. Paramedics rehearsed scooping and ferrying large numbers of students made up as casualties. Doctors and nurses in a simulated hospital at Centennial College prepared to deal with the throngs of injured, and their agitated relatives.
The interesting sidebar to the exercise was how much the whole exercise depended upon information systems. Webcams at the disaster site allowed hospital administrators to see what was going on. Paramedics preregistered casualties with tablet PCs, and the information gathered automatically updated a web site. This too helped health care workers. Updates on arriving patients and live video feeds were fed to "situation board" - a web site that hospital managers could monitor for news as the disaster unfolded.
Behind the scenes we used a wireless network to carry the web cam signals and to post updates to the situation board. Voice-over-Internet phones replaced the regular switchboard and supplemented handheld radios. I even used my Clié with wireless card to subtly sabotage a few things here and there (couldn't make it too easy for them, after all).
The exercise exposed hundreds of paramedics, police, fire, hospital health care workers and students to a realistic crisis. It forced us to take a hard look at what strategies and tools would work under pressure and what wouldn't. We discovered that "real time" updating of web sites can vary by more than fifteen minutes depending on the software configuration. We found that RFID tags for logging patients at the scene and when they arrived at the hospital work just just as well as for shipping cases at an airport. We discovered that tablets are heavy to lug around when your paramedics have alot of other gear, but that PDA screens are too small to enter much detailed info.
While preparing for this I noticed there are many ideas that could synergistically create useful tools for crisis managers and health care workers. Why not RFID tag all patients at a disaster scene before transport or at the emergency department door? Hospital staff, visitors and equipment can all be tracked in the same way. Why not equip all senior hospital administrators and department managers with RIM Blackberries so that they can share e-mail messages to a common discussion area on a web site? A smartphone might work even better - not only for e-mail but for voice contact, paging, and for browsing the web. And disaster protocols or medical references could be stored on the PDA or on an accessible web site. GSM Smartphones also permit emergency messages to get through even if voice circuits are jammed with traffic, by taking advantage of SMS messaging. Cameraphones can also be used to register casualties using a combination of text messaging and digital photography (see The Economist, 10 March 2005).
There are lots of ways mobile computing can enhance disaster medicine. Now come the hard part: making choices, implementing, and training. There is much to do....
He Said, She Said
At the review we generally receive one or two e-mail messages per month. This is not a vigorous response rate, but it does keep us in touch with one of our two faithful readers (thanks, Rob and Matt). The past two months, however, have seen a flurry of feedback, not all of it positive. Whether praise or brickbats, it has all contributed to the learning experience for this journeyman writer.
It all started when I got my wires crossed trying to write about some work by Dennis Christopher. He developed a robust system for crews in the University of Toronto's Facilities and Services Department. I had a chance to visit the Department and see how the crews used Palm PDAs and a shared desktop PC to track their time and assignments. Afterwards, everybody involved wanted to see what was written before it was published (see the February 2005 issue). That led to quite a flurry of postings. It was a novel request for me. I never submit my prose for scrutiny prior to publication. And noone had mentioned this condition prior to my site visit. Rightly or wrongly, I try to keep some distance from software companies and publishers whose work I discuss but I guess I could have handled it more diplomatically. Sorry, Dennis. Next time I will make a point of clarifying that issue before making site visits or conducting interviews.
Then I got my facts wrong on the editorial independence of the Internal Medicine reference work by PocketMedicine (see also the February issue). The publisher rightly took me to task there. Maybe I should get my work prescreened after all....
Then there was actually some positive feedback about recent mini-reviews of medical reference software. I also had a flurry of requests for advice about hardware (what model of Palm or PPC handheld would I recommend?) and software (could I recommend medical translation software for English-to-French?). These queries, and other, led to some lively exchanges which I enjoyed. I learned about what people need and use - and for that insight I am genuinely grateful.
Others wrote with helpful suggestions for the Review. More than one advised me to solicit advertising in order to obtain funding. I was given the very interesting idea of including a bibliographic list of the URLs and links mentioned in each issue (thanks, Dale-Ann). This, I was told, would help people who print the Review to read off-line. When we first started out, all URLs were imbedded in the text. Later we did away with that in favour of the current style (underlined links). Here we were, so proud of our modern and streamlined format that we had completely missed the perspective of people who used the Review differently. For a publication which prides itself on its perspective (not to say eccentricity) this was a telling reminder that noone can encompass every point of view. Thus, towards the end of this issue you will find a new section which presents a list of links. Let me know what you think of the change.
It was thrilling to have so much interaction with readers of the Review, even if we didn't agree on everything. But there was one request which I really couldn't oblige. I received several inquiries for lists of my favourite products or of the programs I keep on my own Palm PDA. The problem: I test and discard software more often than I change my socks (hmmm, that doesn't sound good). From one month to the next there is too much turnover for me to pretend that I have screened out the dross and kept only the best. For a diverse group of users, such as health care workers, just what constitutes the "best" anyway?
Still, maybe that's a suggestion I can work into future issues.
Everybody Needs a Friend
Where do you turn to get help? A Google search is always a good place to start but I have found more specific resources ready and waiting. One of the most consistently helpful has been Randy Showalter, the webmaster for the Review site. Here are a few web sites which also came up with the goods when I needed it.
- Palm. Try to get over the annoying split into two corporate parts. Now there's PalmOne for hardware and technical support. And PalmSource is the place for software and operating system support. For example, PalmSource is where I got the emulator software that allows me to check out software on my desktop PC without loading it onto my handheld.
- ClieSource was a gold mine for Clié owners with discussion forums and news. Too bad Sony has stopped manufacturing PDAs. But the discussion forums are still available and the archives are full of useful tips and tricks.
- Jim Thompson's Palm Pages. A few years ago, when I first took an interest in PDAs, I learned a great deal about what made Palm devices useful to a working doctor at this site. It's still good for insights into Palm use.
- Dr. Oh's Palm site is a little dated on the hardware side of things. It is very good for beginners in the handheld medical computing field and works through the key questions that help one choose a device, software and supporting tools.
- InfoSyncWorld is an excellent source for news about mobile computing devices. Frequently items I read here lead to articles in the Review.
- PalmZone has news and reviews and "how-to's". You can even download it to your Palm and read it while commuting to work.
- PalmLoyal is a nice addition to the Palm scene. There is freeware to download, software reviews, tips on using handhelds, and other resources. Small but with nuggets of good stuff.
- Handheldmed is one of the major online vendors of PDAs and medical software.
- McGill Emergency Medicine links has a wealth of resources
- pdaMD has news and discussion forums. The Learning Center has tutorial videos on basic Palm PDA use.
- Dr. Hunter's Medical Web Page is packed with online resources for health care workers. The PDA material is limited in scope but well-rounded.
- engadget is always good for news about a broad range of toys and gizmos.
- The Gadgeteer is great for plainspoken reviews and news. One of Julie's or Judie's detailed reports on one gizmo is usually longer than a whole issue of the Medical Palm Review.
- Memoware is the place for downloadable PDA documents on any subject you can imagine.
- Palm Boulevard is another Palm hardware and software site that I monitor for news.
- PalmGear sells software for Palm PDAs.
- Tucows has a vast library of downloadable Palm software titles.
If you plan to write your own software, the PalmSource US DevCon 2005 is the place to be. First of all, it is being held in San Jose, California. The program runs from May 23-26 2005. Developers of mobile, wireless, educational and medical applications will find tools they can use here.
Recently, PalmSource also announced the launch of the official Palm OS User Group (PUG) web site. PUGs help users build their own networks of supporters, developers and hobbyists. There is even a directory of PUGs for locating one near you.
This should be enough to get you started.
Medical "Doc" of the Month
The WISER system helps field health workers to identify and manage hazardous materials. It's a free download for various types of PDAs from the NIHJ in the United States.
My book review of Chris Heliopoulos' The Medical Professional's Guide to Handheld Computing appeared in Geriatrics and Aging last month. Read it to see what the other pundits are writing about these days.
Skyscape has a new Ident-A-Drug reference for PDA. You can use it to identify pills and capsules by their ID codes and descriptions of shape, colour. Unfortunately, they aren't using photos as in the hardcopy CPS.
UTS Software has released their UTS blood pressure tracking software for patients to record their periodic home measurements. Increasingly, medical software for Palm PDAs is also being released for smart phones or Blackberries and this package follows that trend. The utility of monitoring software like this is enhanced by the ability to e-mail a report to your doctor from the handheld device. Speaking as a doctor, I think it would be great if all my patients could just dial in their BP readings from home. I could look at a summary chart and see who needed follow up, instead of fielding multiple visits or individual phone calls to screen for problems. Of course, this begs the question of whether my patients were taking accurate BP readings at home.
Many hospital-based doctors use patient tracking software (basically, glorified databases) to help manage their inpatients. DoctorsGadgets has a good list. Some, like PatientKeeper, are able to integrate with electronic patient records and lab systems. Others, like WardWatch are designed for standalone use or for integration with a desktop PC. The ambitious can always write their own patient management software using a database program like HanDBase. None of these products have the native ability to e-mail or HotSync reports from doctor to patient. Of course, one can program this is but I suppose far more doctors than patients use PDAs and e-mail - for now.
Bluefish Rx sends prescriptions from your PDA to a pharmacy, taking advantage of wireless networking, integration with EpocratesRx pharmacopoeia software, and patient medical records. There are other software packages that link doctors to pharmacies (e.g.. DrFirst Rcopia) and they all attempt to address.
Nuts and Bolts
Sandisk's Cruzer Profile provides secure USB storage. Data is only accessible if you swipe your fingerprint on the device. This has interesting potential for portable patient files. I like the idea of patients carrying copies of their ECGs, medications, discharge summaries and x-rays. But is this really better than having access to a secure web site with the same information?
Hack of the Month
Eudora e-mail and web browser software on my Kyocera stopped working. In fact they would crash the PDA whenever I opened them. The only clue was a cryptic error message: "Fatal Alert - DataMgr.c, Line:7386, DmWrite: DmWriteCheck failed". I went online and did a Google Search on a combo of that phrase and "Eudora" Within five minutes I had discovered several clues at web sites like PDAPhone.
The solution: delete the Eudora scratchpad file. If that didn't work I learned that it might help to clean out all the Eudora preference and bookmark files. Such files are labeled with a "Creator ID" of QCwb.
To do this I needed a file manager that could identify file Creator IDs. Filez is a good free product that lets me look at files in main memory and on external memory cards. I can sort by name, creator, size. Files can be copied or deleted.
Using Filez and these tips allowed me to fix the problem without uninstalling and reinstalling or potentially doing a hard reset on the PDA which would have meant alot more work.
Bucket o' Links
This month, as part of ongoing efforts to improve the Review's appearance and compliance with usability standards, we are incorporating a suggestion by one of our readers. Because some of the embedded links in the text can be a little obscure, we will try posting a list of them at the end of the issue. If this seems to be useful, - mostly for those who print each issue and then can't figure out the URLs, we will continue the practice in future issues.
RFID tracking, messaging and cameraphones at hospitals:
- Tennessee Regional Medical Centre using RFID
- Alexandra Hospital, Singapore, uses RFID during SARS outbreak
- 5MCC available for smartphones
- SMS messaging in disaster, from New Scientist
Support and downloads for Palm:
- PalmSource - software support
- PalmOne - hardware support
- Palm User Groups Directory
- Clie forums at 1src
- Jim Thompson's palm page
- Dr. Oh's Palm page
- The Gadgeteer
- Palm Boulevard
- Tucows' PDA site
- Dr. Hunter's medical web page
- McGill Emergency Medicine web site
- Memoware medical documents source
PalmSource US DevCon (www.palmsource.com/events/devcon2005/)
Medical Computing and software:
- WISER hazmat information software from NIH
- Skyscape's Ident-A-Drug
Patient tracking software:
- List of available patient tracking programs from DoctorsGadgets
- UTS BP tracking software
Wireless prescribing software:
- Sandisk Cruzer Profile secure memory device
Hacks and Tips:
- Eudora e-mail and web browser software
- Filez file manager software
- PDAphone discussion forums
In Times to Come
I haven't really mapped out the next issue yet. I have a few ideas but mostly I hope to not write about any of my dog's new hobbies or pica.
Now, if you will excuse me, it's suspiciously quiet in the house and I don't see the dog around so I need to go find him. Quickly.
This is one of a continuing series of newsletters about Palm handheld computers, prepared for doctors, nurses, IT professionals, educators and other people who need tools that work. The Review is published monthly on our web site. Subscription is free; the principal benefit is receiving e-mail notification of new issues.
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