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    The Medical Palm Review

    September, 2005 (V6N7) - Hit The Road (Jacked)

    Summer is holiday season in the Arnold household. And with Toronto steaming in the heat it was time to escape to cooler climes.

    Bag and Go

    When people travel, they usually have to consider what fraction of their worldly goods to bring along. For me, the weightier question is what part of the digital world I want to keep tabs on while I am away from home. What to wear versus what hardware? Ahem.

    If I want a cell phone, e-mail, Internet access, and the ability to type up another newsletter then my Kyocera smartphone has to come along. It's only six ounces so how tough a decision can that be?

    Well, I need the battery recharger if I plan to be gone more than one day. Outside North America the recharger needs a plug adapter for overseas electrical outlets. A folding keyboard is much easier for big typing projects than the Kyocera thumb pad.

    Before leaving the house, I need to check whether my cell phone service can "roam" in my destination. Alternatively I need to make sure I can link to the Internet with the WiFi card in my PDA. I need to back up my handheld in case I lose it and all its data. And that's just the beginning.

    Staying home would have been much simpler, but my wife made it clear that canceling our cruise to Alaska was not an option, so I got packing. Here are some of the highlights - think of them as ...

    The Good, The Bad, and The Ugly

    Actually, I decided not to do any work on the cruise. So I deliberately left the folding keyboard behind. The ship advertised its WiFi service, which they claimed could be used by "compatible devices". Information about that was impossible to come by but just for fun I decided to bring my Sony Clié with its wireless networking card.

    The same slot in the Sony that holds the WiFi card can be used to for a Compact Flash (CF) memory card instead. So I brought our Canon digital camera which uses CF to store its snapshots. That way I could transfer pictures to the Sony's memory, in case the camera were to be lost or to free camera memory to take more photos. The Sony's excellent large screen was also perfect for displaying photos, like a digital photo album. Sony provides software that can view JPEG photos files, but there are similar programs available for download from the Internet (for example JPGview, or myAlbum).

    The CF memory cards were so capacious that I even had room for a backup copy of critical data files that reside on my home office computer. I couldn't access them at sea but they were safe with me in case of a home burglary or fire. With my PDA backed up onto my desktop PC, and my PC backed up onto my PDA, you could say I was covered.

    At this point I had about fifteen pounds of clothes and shoes, and about ten pounds of PDAs, camera, camcorder, memory cards, rechargers (one for each device) and cases. Who said mobile computing would be painless or, at least, weightless? Almost all the gear fit into my camera bag and fanny pack which kept it simple at the airport for the security checks.

    The flight to Seattle was a breeze. When my daughter became bored I could flip open one of the PDAs for her to try a new game. To prevent her from playing them all in the first day I had used Filez to create extra folders on the memory cards. Palm's operating system (versions 4.x orScreenshot of Pyramid Solitaire 5.x) looks only in certain folders for executable programs and ignores other folders altogether. Thus I could "hide" some games until I wanted them. Then, using Filez again, I could copy one or two into main memory or the active folders of the cards. The games themselves I obtained from Internet download sites. Some of our favourites are Pyramid Solitaire, and Hearts. (Check out other game downloads at sites like Astraware).

    As I had hoped the Clié's large screen provided a focal point at dinner, as we shared each day's crop of snapshots.

    From this promising start, things proceeded downhill from a PDA perspective. The ship's vaunted WiFi network turned out to be accessible only to laptops running Windows XP, and only if they could be fitted with one of the ship's WiFi network cards with its proprietary software. My Sony Clié's WiFi card could find the shipboard wireless network but could not log on. When I showed my Clié to the geek-in-residence at the Internet lounge he turned pale and I don't think the seas were that rough.

    This is not smart marketing. Instead of just renting the cards so I can check my e-mail (the ship's satellite link is dreadfully slow), the ship should make it easy to log in with any sort of hardware but sell access to content on a local (shipboard) Internet server - e.g.. info and photos of destinations and local wildlife, music files for download, etc. I wonder how many passengers brought their own iPods? I wonder how many of them would have paid a dollar per tune for new downloads? I think that this would be a much bigger and more lucrative market than selling time to access e-mail, but I was happy not to check mine for ten days so maybe I am weird.

    I also found out that cell phone roaming was not always practical. Some smaller ports of call did not have a compatible network. On the ship itself, cell phones were useless once we left port. Many families used simple two way radios to keep tabs on the kids. But too many people were competing for the same handful of channels at the same time - thus chatting with other people's kids instead of their own. Cell phones would have been handy (and lucrative for the ship's owners) but I admit I don't know much about possible technical obstacles to this plan.

    Things got worse later in the sea voyage. I dropped the Kyocera on the deck in the rain and it appeared to stop working. After a scary minute or two, a hard reset revived it. The case looks a little more battered however. I realized that typical Alaskan tourist destinations (population about three thousand) were unlikely to have PDA service centres. Ships and salt water are not friendly environments for electronic devices so it's good that I had a second device and that the PDAs were not critical to any aspect of the journey.

    My biggest beef was that my cabin's auxiliary electrical outlets were not designed for Canadian appliance plugs. I could recharge only one gadget at a time with the bathroom electric razor outlet. With several PDAs, a digicam, and a camcorder there was no way to recharge everything overnight. I had not expected this problem on a cruise in North American waters, but the ship was in fact built in Europe. I solved this hitch with a multiple outlet adapter which enabled plugging in two rechargers at a time. Fortunately, I didn't cause a blackout in my corridor.

    Other Travel Goodies

    there are many software programs and accessories to make travel with your PDA easier. A quick look at the Travel Software section at PalmSource will get you started with some ideas. In no particular order, here is a selection of programs and resources I have heard about or tried.

    • Plug adapters for rechargers and other electric devices. has a nice discussion about how to plan and pack before you hit the road.
    • Power inverters let you recharge your toys from a car lighter socket, a nine volt battery or even using solar power.
    • GPS geolocation service is available in standalone devices or as plug-ins for your PDA.
    • Directions and maps of your destination can be downloaded from Mapquest, or Google Maps and brought with you on your PDA.
    • City guides are published by numerous companies these days. You can get phrase books, street maps, restaurant guides, links to geolocation software to guide you straight to your hotel, and more - all in one title. A quick Google search or a look at PalmSource, Handango or PalmBlvd will turn up masses of possibilities.
    • Worldmate screenshotWorldmate provides you with weather forecasts, flight information, international time clocks, even currency conversion. All these abilities are available in individual utility programs but Worldmate uses an update engine that can sync needed data to your PDA. Clever. You can find other multipurpose travel companion programs at PalmSource.
    • Currency conversion software includes the popular Currency Converter Deluxe and Euro.calc, but you can find numerous alternatives at PDATopSoft or PalmSource.
    • Internet access via satellite is being offered on ships and planes of ever more carriers. Some will even let you use your own laptop PC (e.g..Connexion). The two main drawbacks are that it is slow and comparatively expensive. You can get a performance boost if you stick with text-only e-mail or stripped down websites. Configuring your laptop browser to block images and scripts will also help somewhat. MobilePipeline has a recent article on the subject. Note that PDAs and smartphones are not explicitly supported - yet.
    • has PDA/phone-optimized web pages for facilitating car rental. This makes comparison shopping, reserving and modifying rentals using a handheld device much easier.
    • Win-Hand VPN Service gives users the ability to remotely control their PCs using handheld devices. What you get is a pretty speedy connection to the remote PC through a secure Internet connection. This has all sorts of possibilities for accessing data on the PC. If truly secure access is an issue, users still have to figure out where to put the PC that is up and running so that noone can snoop around it while the owner is away....
    • Wireless e-mail synchronization and messaging (like RIM Blackberries but for Palm devices) is now available through such companies as Consilient and Good Technology using cell phone networks. In fact Palm is presenting seminars promoting GoodLink with the Treo 650 as a business/enterprise solution. As you may have gathered, these systems require more than just installing some software on your handheld. Your IT department will have to get involved so it's not as easy as just checking your e-mail when you HotSync a PDA.
    • Before leaving for Alaska, I downloaded some articles and web sites with information about our destination and some of the wildlife we were hoping to see. I used iSiloX and its accompanying iSilo document reader. In the past I have also used a sketchpad or memo pad program to store directions to various destinations, or even written addresses in Chinese or Japanese to help me ask locals how to find my hotel.

    A friend told me how he traveled alone in China without knowing a word of Chinese. He would ask his hotel concierge to speak aloud the hotel address using the smartphone's dictation mode. He would also use the phone's camera to photograph the front of the hotel or the street it was on. Then he had several ways of asking locals to help him find his way back. He used Internet cafés to get maps from Mapquest. But he still had difficulty ordering food at restaurants.

    Speaking the Lingo

    My friend would have benefited from a phrase book or dictionary on his trip. I always take a paperback phrase book with me when I venture abroad. But how useful is translation software on handheld computers? More importantly, are these programs helpful to health care providers dealing with non-English speaking patients?

    I think that a useful language tool must have several features. For example, no matter how marvelous and comprehensive a particular program is, it is almost certain that there will be nothing about proctology in its database. If you are a proctologist, you are sure to need to add terms or phrases that are unique to your field of work. This is true of virtually any health care field. An effective translation program has to be customizable.

    Indexing is another important feature. This is much more difficult (but much more important) to do well for a translating phrase book than for a simple translating dictionary. It speeds the flow of a patient encounter if the sentences you need flow sequentially from the screen or speaker than if you have to hunt for them. This leads back to the ability to customize the database and even the interface.

    Customizing the software requires you to think about what you need and to invest the time to tune it. Most of us probably don't have the time or energy to do much of this but, without adaptation, many existing products don't meet the needs of paramedics, emergency department nurses, and so on. If you do want to customize, or work with your desktop PC, you can get a good start with the resources listed at this multi-lingual dictionary site.

    On the hardware side, speaking phrase books presuppose that your PDA has a good enough sound chip and speaker to pump out words or phrases that are audible to the patient you are dealing with. In general, PDAs lack the power and memory needed for good quality text to speech processing. Anything you try will be awkward and need much faith and perseverance on the part of users.

    I tried using recorded Chinese phrases in the past. I stored them in no particular order as clips using my Handera 330's dictation software. On one occasion I had to hold the PDA up to one elderly man's ear for him to hear the question "Do you have any allergies?". At the sound of a Chinese-speaking voice, the poor chap became convinced the Handera was a cell phone and kept trying to speak to the the person at the other end of the line. After that false start it took quite a while to overcome his conviction that we were either devious or idiots.

    Despite that setback I think dictation software on your PDA or smartphone can be a useful tool. It's best if the speech clips can be saved to an external data card instead of main memory. Another advantage of an external card is that you can hand over dictation or recorded conversations to a transcriptionist for typing. It also facilitates recording speech clips on a desktop PC (where you may be able to obtain better quality sound) and then transfer the clips to your PDA for mobile use.

    Screenshot of ECTACO English-Chinese software, from the Lingvosoft web siteFor the masochistic there is text to speech software. Despite the best efforts of armies of programmers, these programs are all something of a struggle to use. Lingvosoft makes text to speech and speech recognition software for several language pairs for your Palm PDA (and a larger selection for your PC). Unfortunately, most of these programs can only create English speech.

    Lingvosoft also makes ECTACO translation software (for example, for Chinese) but most of those are unidirectional phrase "books" (speak in English from a selection of prerecorded messages) and run only on PocketPC. Beiks also makes talking phrase books for travelers.

    Ultralingua makes straightforward translation dictionaries and even has a French-English medical dictionary. DDHsoftware sells some language dictionary databases for the HanDBase database program. Both the HanDBase and Ultralingua databases can be modified or expanded. Of course, with HanDBase you can create your own dictionary from scratch if you choose.

    Smartphones bring the intriguing synergies of a voice-based communications tool merged with a pocket computer. As the power of such devices increases, I expect we will see better translation options.

    Medical "Doc" of the Month

    The Harriet Lane Handbook of pediatrics (published by Mosby) has been issued for PDAs by Skyscape. The December 2004 issue of the Annals of Emergency Medicine carried a review. The online version is only available to ACEP members. It may also be read in hard copy at your medical library.

    Medical Computing

    PDA Cortex recently summarized the results of a report from Forrester Research which described a survey of PDA ownership and usage trends among American physicians.

    It turns out that more than half of them use a handheld computer but mostly for personal information such as schedules and phone numbers. The most common clinical task requiring a PDA is to look up medications. Very few doctors surveyed use PDAs to perform activities such as looking up patient records or lab tests.

    The demographic mix was also interesting. Residents and family doctors use PDAs far more than surgeons or even other office-based doctors.

    The original report is available (for a fee) from Forrester Research.

    Nuts and Bolts

    Convergence of handheld computers with smartphones continues. Increasingly, software originally created for Palm or Pocket PC is being issued for smartphones or RIM Blackberries. Now iSilo is available for smartphones and RIM. The makers of QuickOffice recently announced that the latest version lets you manage your MS Office files on your PDA and smartphones too. This process, if it continues, will further erode the rationale for buying a PDA without cell phone capability.

    The new Palm LifeDrive received an encouraging review in the October printed issue Consumer Reports. CR liked the built-in Bluetooth and WiFi networking, the large memory storage and the big screen. The LifeDrive can also be plugged into a PC USB port to share data files. But they lamented the absence of a cell phone (they suggest you use Bluetooth to connect via a cell phone). They also noted that the battery can't be replaced once it can no longer be recharged.

    An alternative gizmo to the LifeDrive has been announced. A one gigabyte hard drive in its own case with fingerprint access control by Upek that plugs into a USB port. Would this be a better way to carry around confidential data? It is still in beta testing but it lacks the PDA and wireless networking features of the LifeDrive.

    PalmOne changed its name back to Palm again in July. This means that there are still two companies: Palm makes the PDAs and PalmSource is for the software and operating system used by, well, Palm and a dwindling list of other manufacturers of the hardware.

    Are you confused by the name changes? Read a treatise on the history of PDAs. Hope that helps...

    Hack of the Month

    I received exactly two e-mails about the summer issue. One was from Dr. Andrew Schechtman, founder of MeisterMed. I quote from the letter as follows:

    "Thank you for your mention of MeisterMed's recent release "Splinting Manual for PDA" in the July/August 2005 issue of the Medical Palm Review. Unfortunately, your description of this reference as crippleware is inaccurate. The Splinting Manual is freeware. The full contents are available for download free of charge."

    Well, he owns the company and ought to know. So, why couldn't I access the contents? Very likely the problem was at my end but what was it? I dashed off an apologetic reply to Dr. Schechtman and set aside an hour to tinker.

    The Splinting Manual is an iSilo file. I reloaded it on my Kyocera and found it still didn't display properly. The reason? I was inadvertently using an older version of iSilo which would not run the Splinting manual PDB file properly but wouldn't crash either. Unfortunately, iSilo has no way of informing me that I had an outdated version of the software so I guess you could say that it failed gracefully but unhelpfully. Thus I never got a hint of the trouble.

    The MeisterMed web site does point out that the splinting manual requires the most recent version of iSilo to run correctly. When I installed it I probably didn't pay enough attention to the instructions on the site. Once I updated iSilo (only US$10 for registered users) the splinting manual worked just fine. Its illustrations of various splint types were easy to see on a colour screen. I would recommend the file to medical students who need a guide to applying the common types of rigid plaster splints to upper or lower extremities.

    Once again, my apologies to Dr. Schechtman and the staff at MeisterMed for my misinterpretation. But it all serves to keep me humble and gives me something to write about in this column.

    In general, every six months or so I go online to check for new versions of the software I use. I then download the ones that need updating. After making a backup of each PDA, I install the new files and then test for problems.

    Apparently, I will also have to start paying attention to software versions when installing document files as well.

    In other words, this month's tip is a social hack not a software utility: always read the installation instructions and tip files for new software, and always check applications when newly installed data files don't work. One day I'll get good at this computer stuff....



    • JPGview,
    • myAlbum,
    • Astraware game software,
    • Filz file manager,
    • Pyramid Solitaire,
    • Handango,
    • PalmBlvd,
    • Hearts,
    • PDATopSoft,
    • iSilo,
    • iSilox,
    • QuickOffice,

    Travel Gear

    • TravelProducts,
    • Sedio rechargers,
    • iSun solar inverter,
    • Kensington car inverter,
    • Garmin GPS handhelds,
    • CanadaGPS plug-in modules,
    • PalmSource Travel Software,
    • MapQuest,
    • Google Maps,
    • Worldmate,
    • Euro.calc,
    • Currency Converter Deluxe,
    • Conexion airborne internet,
    • Mobilepipeline about airborne internet,
    • Win-Hand VPN Service,*

    Wireless E-mail Synchronisation

    • Consilient,
    • Good Technology,
    • GoodLink,

    Translation Software and Dictionaries

    • Mulit-lingual dictionary resource web site,
    • Lingvosoft,
    • Lingvosoft Chinese translator,
    • Beiks speaking phrasebooks,
    • Ultralingua,
    • DDHSoftware,

    Harriet Lane Pediatric Handbook,

    Physician PDA Usage Survey

    • PDA Cortex,
    • Forrester Research,

    Consumer Reports Online,

    Upek Fingerprint Security Systems,

    Review of the history of PDAs,


    In Times to Come

    Next month we have a smorgasbord of wireless and mobile computing items for your delectation. Are WiFi and VOIP a boon for health care workers or is it all hype?

    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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