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    The Medical Palm Review

    June, 2005 (V6N5) - Everything Old is New Again

    Just when it seems that the hardware guys have glommed everything possible (except a durable battery) into one handheld device, then they start over again. The lines between product categories get fuzzier all the time.

    Nuts and Bolts:

    Hardware manufacturers are branching out. For example, you can now buy cell phones offering integrated FM radio, wireless networking, and a digital camera (Nokia 6230i) or video telephony and music playback (Ericsson's Z800i).

    Cell phone makers are also encroaching on traditional Palm PDA turf from two different directions. Some have signed up to offer Palm OS on some of their models (for example, Samsung). Meanwhile software once available only for PDAs, such as the iSilo document reader, is being ported to the Symbian OS used by certain smartphones.

    The need to reach out and connect wirelessly has finally convinced PalmOne to offer a WiFi card that that supports the Tungsten E2, T3, T5, and Zire Z72 models. However, there is still no PalmOne WiFi card that works with the Treo 650. Could it be that WiFi on Treo would cut into revenue for phone companies that want you to get your e-mail and do your browsing through billable minutes? [There is a software hack for the Palm SD WiFi card driver but some users have complained about it. Back up your Treo before trying this.]

    Device designers have been thinking outside the box. Once again, cell phone makers are leading the way. Nokia announced its model 770 Linux-based device. This appears to be an attempt to provide WiFi connectivity with a bigger screen. Halfway between a PDA and a tablet, it offers a bigger screen than a conventional PDA, wireless networking and a browser-style software interface. See review articles in Softpedia, InfoSync, and at Tom's Hardware.

    In the same vein, Bill Gates recently announced a handheld-size tablet computer running Windows XP. Bear in mind that, unlike everything else I described above, this tablet is still just a mockup. You can't find this in any shops. Its big advantage would be compatibility with most desktop PCs. I used to think it was sufficient for my PDA to share document files (e.g.. MS Word, MS Excel) with my PC and any Palm or PPC handheld can do this now. I can even bring a folding keyboard with me and modify those documents if I like. However, today I had to lug my laptop with me so that I could work on a web site in Dreamweaver (it doesn't run on a PDA). Oh, my aching back! Something lighter would be handy...

    PalmOne LifeDrive, illustration from has a different spin on file sharing. Their LifeDrive (see also a review at InfoSync) is new multipurpose PDA. With its substantial storage capacity it seems more of a PC hard drive replacement than a PDA. You take it with you wherever you go and, provided the right software is loaded, any desktop PC can access the files on the LifeDrive. It has WiFi, Bluetooth and a USB port to make connections. It accepts a variety of camera data cards so you can back up digital photos while on the road. You can store and play music files or even videos

    A bonus: the LifeDrive supports Apple's Mac PCs as well as it does Windows. Last year PalmSource announced that they would no longer support Macs directly so this is a welcome development. As PalmSource moves to support the SyncML standard with its HotSync software, integration of their PDAs with Mac and Linux PCs will be easier.

    On the downside, LifeDrive users will need to invest in a separate cell phone. The screen has decent resolution but is small -- do you really want to watch movies on it? Short instructional videos? Yes. Titanic? I think not.

    OK, so you have your whole life on the sucker, and someone steals it. I hope you made backups.

    Or maybe the battery dies. That won't matter so much if you own a Tungsten E2. Its 26 megabytes of Flash RAM protects data even if the battery has no juice. Read a review at the Boston Herald.

    To prevent the battery from fading in the first place it wouldn't hurt to have a few extra recharging cables. There is a new one for the Treo from Brando's Workshop which retracts into a spool - much tidier than carrying a scramble of wire in your pocket. It was reviewed recently in the Gadgeteer. Brando's is a good site to check for a broad range of accessories for PDAs.

    But let me get back to the integration and convergence issue for a moment. To reduce the number of gizmos I have to carry by folding my phone, PDA and MP3 player into one package seems reasonable. To take photos with a limited digital camera, or watch videos on the small screen is less practical. It's not just the screen size, although that is one of my pet peeves. The other issue is that battery life is simply not adequate to make viewing videos and then doing something else a reasonable plan. Convergence can be overdone.

    Speaking as a doctor who wants to use a mobile device for patient management, there are more important issues. Small screens, poor battery life, device weight and awkward interfaces are all obstacles to finding a new way to work. Back to the drawing board, folks.

    Software mutations

    Software developers too are trying to enter as many markets as possible. Just take a look at the Beiks home page. Once known primarily for their language dictionary software for PDAs, the company offers a variety of translation dictionaries, but now also has several medical products. Recently they added Stedman's Medical Dictionary for the Blackberry and several medical handbooks.

    But there is another trend as well. Increasingly, your software tries to be all things - reference text and pharmacopoeia, with access to EBM resources and guidelines. These products increasingly take advantage of wireless networking (if your PDA has it) to make real-time connections to resources like MEDLINE.

    Screen shot from Nurse's ToolBox, Nurse's Toolbox is an example of the traditional approach to a "suite" of reference modules covering a range of subjects from ICU nursing to pediatrics. Basically, each module is a separate program. The only significant integration is the front end menu that lets you select the task you want to use.

    The 5 Minute Clinical Consult is an example of the next level. The internal medicine text is integrated with other Skyscape titles (e.g. a pharmacopoeia), so that drug names in 5MCC are highlighted: click on the highlight and you see the relevant article in the pharmacopoeia.

    Contrast the above with Unbound Medicine's new Anesthesia Central. It provides a series of software tools including an anaesthesia manual, an ICU medicine manual, and a drug guide. It also offers subscription-based access to medical references and journal search/tracking. The online access can be wirelessly from your PDA or via your desktop PC's web service. One year costs USD150. This product doesn't so much link texts as it does connect the user with the entire world of medical publications.

    Other publications now offer wireless access, including Merckmedicus (available wirelessly for RIM Blackberries, PDAs, or smartphones) and Harrison's.

    Integration has its pitfalls. PEPID offers a manual of laboratory medicine as part of its suite. It is accessed easily from the navigation bar on the PEPID screen. I tried the 30-day trial but didn't choose to buy a subscription. After expiry of the trial, the lab manual icon persisted on the navigation bar, popping up irritating error messages if I accidentally tapped on it, or on the link in the Table of Contents. [ed. note: PEPID developers advised me that they are working to fix these annoyances].

    Hands Off My Stuff

    Losing your PDA has several implications. First there is the disruption of not having your "external brain" available. Then there is the cost of replacing it. If the data was not archived somewhere safe, there is the inconvenience of reconstructing the lost material. Finally, there is the potential for misuse of sensitive or confidential information (data files? bank card PIN numbers?) stored on the handheld.

    Small gizmos that fit in your pocket or purse are easy to carry, hence less likely to be put down than a laptop bag. But if they are lost or stolen you may be able to get them back. Companies like StuffBak, Trackitback and SmartProtec provide labels and serial numbers for your hardware as well as a registry. Some offer a reward for safe return of your gear. Obviously, the reward is funded out of subscription premiums. Brigadoon Software has a system for devices that connect to the Internet.

    Can you insure your PDA to recover the cost of a replacement? Adding a rider to a household insurance plan can be more expensive than a cheap cellular phone you are trying to insure. High end PDAs can cost about C$4 per hundred dollars cost of the device. Safeware's web site offers insurance for your high tech gear. Alternatively, your cell phone service provider may have insurance available for a smartphone or PDAphone.

    I checked with a few home home insurance brokers in Toronto, Ontario, Canada. Coverage for a C$500 PDA would be C$20 to C$50 per year with a C$100 deductible. Safeware wanted a comparable amount of money but offered a US$50 deductible. Well, now I know I have some choices.

    Data protection is a perennial concern of mine. I back up my PDAphone to its data card in case of a crash and reset. I back it up to my desktop PC every time I HotSync. The backups are available to me when I am at home but would be no help if I was on the road when disaster struck my PDA.

    Online backups through free e-mail service providers make your files available wherever you can access the Internet. HotMail, Yahoo, Lycos and Gmail offer up to two Gigabytes of e-mail storage, using saved messages which can each include attached files of up to ten Megabytes. A little planning and you can send yourself some messages with key data files for safekeeping. You can even configure Gmail as a remote server using Windows XP.

    Yahoo Briefcase offers a dedicated online file storage option. There are commercial solutions in this space as well. Streamload, IBackup, Xdrive are a few examples.

    These are all certainly options for PDAs with wired or wireless Internet access, but they are not necessarily optimized for that purpose. You can also place files from the PDA backup folder online, using your desktop PC. Remember that online storage brings its own risks, as some HotMail users discovered last year when a HotMail "system failure" erased all their data files.

    Trust Digital has a neat wrinkle on data security. They sell software to encrypt data, lock devices, and remotely wipe memory. Their focus is strictly to protect data - there is no attempt to recover the hardware.

    On my PDA, sensitive data is kept in encrypted memo files using CryptoPad. Really sensitive stuff is not on the PDA at all. No bank card PIN numbers. Bank account numbers can be partially xx'd out to make life harder for thieves (but I have to remember more of the number myself). The Palm's built-in password security is not very robust but there are alternatives that are harder to crack such as TealLock.

    Theft or loss of your PDA is a problem which benefits greatly from a little forethought. Think about what you put on the PDA and how you encrypt it. Make your PDA ownership info easy to locate. Back up data files to save hassle. Be alert and careful when using your gear in a public place. If PDAs cost only fifty dollars, and all your important files were backed up online then you wouldn't care so much. But we're not there yet.

    Medical "Doc" of the Month

    The Online Textbook of Emergency Medicine is a way cool idea. It is available through the same folk who brought us the Wiki encyclopedia. A Table of Contents has been developed. Anyone can contribute a new topic or edit an existing one. All that's needed is interested contributors. Because the work is not copyrighted to one person or firm, it can be freely used, copied and modified. You can log on from anywhere or you could snag the site and convert it to an iSilo document (although it would need a lot of formatting). The text is not comprehensive enough to replace a conventional published manual - yet. This project is just subversive enough to threaten existing textbook publishers.

    Medical Computing

    eMedic used to be called PalmEMS. Then it became known as MobileEMS. Whatever they are calling it this week, it is actually quite useful for any health care worker, not just paramedics.

    Recently I came across yet another site which offers suggestions to potential PDA buyers (aimed at teachers and neophytes) as to what to look for. Although it hasn't been updated in a year EduPalm is still surprisingly topical. Why? Because our perceived needs haven't changed as fast as the gizmos. That is probably not a bad thing....


    Cell phones and smart phone hardware:

    • Nokia 6230i:
    • Ericcson's Z800i:
    • Samsung:
    • iSilo for Symbian phones:
    • Nokia 770 tablet:
    • Nokia 770 tablet:
    • Nokia 770 tablet:
    • Treo 650 WiFi hack:

    Brando's Workshop Treo Recharging Cables:


    Windows XP mini-tablet:

    PalmOne LifeDrive:


    Palm and SyncML:

    Tungsten E2 review:


    • Beik's dictionary and language software:
    • Stedman's Medical Dictionary for PDA and Blackberry:
    • Nurse's Toolbox:
    • Anaesthesia Central:
    • Merck Medicus:
    • Harrison's Textbook of Internal Medicine:
    • PEPID laboratory medicine manual:

    Hardware and Data Backup and Security:

    • Stuffbak:
    • Trackitback:
    • SmartProtec:
    • Brigadoon:
    • Safeware insurance:
    • Online e-mail data file backup:
    • Gmail as online file server:
    • Yahoo Briefcase:
    • Streamload:
    • Ibackup:
    • Xdrive:
    • HotMail data file loss:
    • Trust Digital data protection:
    • CryptoPad:
    • TealLock:

    Other web sites:

    • Online Textbook of Emergency Medicine (Wiki Books):
    • eMedic EMS website:
    • EduPalm:

    In Times to Come

    Getting the word out - software or content - to potential users. How do they do it? What new tools and tricks can you use for your students, patients, coworkers? Look for it in the July/August issue.

    Until then, enjoy!

    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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