The Medical Palm Review

Transitions

2007-11-04T17:00:00.000-05:00

Times change, needs evolve, and our computing devices need to keep up. Do they? And why do I keep writing about PDAs anyway?

Viva La Revolución

A long time ago in a hospital far away I was asked by a colleague why his housestaff kept whipping out pocket "calculators" when rounding in the morning. As it happened I didn't know much more than him about PDAs but had more spare time to explore the subject. I wrote back a few e-mails to him sharing what I learned and that little project mutated into the Medical Palm Review that you are reading now.

I discovered all the things that make PDAs worthwhile for a physician. In the beginning ortable medical reference texts, task management and appointment notebook functions were the "killer apps". Later, communications and Internet access, programmable databases. and (of course) game software became available to busy health care workers. In some respects our working day was transformed. We certainly carried around fewer books and papers.

Over the years the computing power, memory, and capabilities of portable computers have advanced greatly. My current Palm Treo 650 can shoot video or take digital snapshots as well as record and playback speech or music. It has a thousand times more memory (and gigabytes of external data storage) compared to the 64 kilobytes of memory on my first Palm IIIx.

Other PDA features have not changed as much. The size and weight of a typical PDA haven't changed in the past eight years. Screens are still small. Data entry can be awkward using one hand and you can't wear the PDA or attach it to your wrist, or speak commands to it. Wireless networking to patient or reference data is often not reliable or speedy.

Despite the defects, PDAs have captured the imagination of health care workers - many physicians and nurses use them every day at work. PDA functions are increasingly moving onto cellular telephones and thus entering the mainstream of working life for billions of people all over the globe. Palm itself, the brand I first started writing about, is being pushed to the sidelines as other firms take up the development of the mobile computing appliance.

You'd think that after eight years of observing and writing about this scene I would look back and be more impressed by the revolutionary changes in mobile medical computing. Instead I feel the changes have been incremental and frankly unsatisfactory. I don't want only faster performance, a brighter display, better data entry options, longer battery life and lighter weight. I don't only want to be able to do "on the go" what I can also do sitting down. I want to be able to do more with a PDA than with a desktop PC. The PDA should be an extension of me, not just a tool. Some have called it an ectopic brain, emphasising the organic nature of the interface that I'm after. Sure, I need integration with institutional patient care systems but those systems must have better interfaces than what I use at a desktop: I work differently at the bedside and my PDA must reflect that if I am to be effective. Where are the paradigm shifts in health care to go with the new tools? The great changes and innovations just haven't materialized.

The same can't be said about me. I'm older. I don't see as well and I don't think or move as fast as I used to. My work has shifted too and now involves more sitting down, administrative responsibilities and teaching. Along with that I goes fewer patient encounters in a busy emergency department. The deficiencies of PDAs are thus simultaneously more galling to me and less important because I can use a desktop PC much of the time.

So, after eight years reporting on the mobile medical and PDA scene, I think it's time to take a break. This is the last issue of The Medical Palm Review. No reports about software or hardware today. No more (sometimes snarky) opinions about things I don't like. I have but a few more comments to make.

First of all, I want to thank everyone who has ever taken the time and trouble to read the Review. It takes some nerve to impose one's opinions on unsuspecting readers. It's a bit like cornering people at a cocktail party and then talking their ears off. I plead guilty to this boorish behaviour but with the best of intentions. I have been motivated to share useful information and ideas. If at least some of the time you feel you benefited or had your horizons expanded then the Review served its purpose. I in turn have gained immeasurably from your feedback about my mistakes and misguided opinions.

Second, it would be remiss if I did not point out the terrific support I received from Dr. Stephen Lapinsky of the Technology Application Unit at Mount Sinai Hospital in Toronto. The TAU hosted the Review for most of its existence and provided invaluable programming support and web presence. My thanks to Dr. Lapinsky and to Randy Showalter, who programmed the Review's website. Our archived issues are still hosted there, although the Review migrated to Blogger this year.

Third, I want to thank Palm Computing (or PalmOne or whatever they are calling themselves this week). They didn't actually invent the PDA (Apple's Newton may deserve that distinction) but they certainly popularized it and spawned a host of competitors. The truly pocketable computer engaged my imagination and helped me to look afresh at my work, at computing in my workplace, and how to make a difference.

Which brings me to my last point. I challenge you all to take a good look at the portable computing device you are carrying about. Ask yourselves what it would take to make that Palm or smartphone or Blackberry just a little more useful. What would help you to see more patients or treat them more safely or get you home from the hospital a little earlier in the day so you could relax with your near and dear? If you think of something that would help, get out there and find it or build it. Then try it out, talk it up with colleagues and critically appraise the results. And keep building on that foundation.

Don't just use your mobile computer; help to shape where mobile computing is taking us.

In the eponymous movie, Ferris Bueller once said: "Life moves pretty fast. If you don't stop and look around once in a while, you could miss it". My Palm has facilitated not just work but also hobbies, travel, housework, looking after pets and much more. It frees me to get out of the hospital and into the rest of my life. Time for you to do the same.

Enjoy!

What "Portable" Means

2007-09-09T21:37:00.001-05:00

Everyone in my house uses computers to keep in touch with the world. But we all want to do it alone. What's up with that?

Work Is Where You Find It

Until recently we all shared a brace of PCs in the home office: my laptop and the desktop computer. Now suddenly everyone needs "space". My wife wants to teleconference with fewer distracting background noises. My daughter wants to do her homework (more likely MSN Chat) where it's "cooler". I think she means where the late afternoon sun doesn't conspire with the transformers from the computing machines to overheat the room. Then again, teenage girls don't think about "cool" the way dads do.... Mostly, however, what the women in my household seemed to want was to not do their computing in the same room as me.

I thought the solution to this would be simple. I ran some network wiring to jacks on the other floors of the house. I upgraded the router to one that provides wireless networking. I moved one PC to the finished basement for the overheated teenager. And was everyone happy?

Well, no.

Turns out what the kid really wanted was a notebook PC so she could do her computing stuff while lying on her back in the TV room. And the wife wanted to take over my office PC with its faster CPU and huge hard drive so she could share family photos and videos with her relatives overseas as well as organize the family albums.

Plan B then involved negotiating a schedule when the wife could take over the office. On those occasions I would leave the PC to her and take my laptop to another room in the house. I also bought a MacBook with a thirteen inch screen for my kid to share with me. Compared to my eight pound Dell with its fifteen inch screen, the MacBook is positively svelte (under five pounds). The screen is sharp enough. With a partitioned hard drive the MacBook provides me with Windows for my work (mostly experimenting with carrying a computer back and forth from the hospital to see how that impacts my writing and other tasks) and Mac OS for the daughter to do her thing (mostly school writing assignments with a large dollop of text messaging to classmates).

I hoped to find out what it's like to have a truly portable notebook PC but so far I am underwhelmed. The MacBook is still a little too heavy for tossing into my briefcase every day on the way to the hospital and I certainly can't carry it around with me when I see patients inside the hospital. I can't balance it in one hand while typing either.

Nope, I still like the pocket-size smart phone I use now for when I am on the go. The larger screen and keyboard of a notebook would be welcome for accessing the hospital lab or patient records but the overall weight and need for a flat work surface are a problem for laptops. Is there anything else out there I could try?

Palm Takes a Shot

Palm tried to stretch the envelope with the Foleo, a new machine (unveiled earlier this year) that would provide a bigger screen and keyboard than a PDA but which would rely upon a cell phone or smartphone for connectivity. Too small to have all the features of a notebook PC, but too large to have the portability and ease of use of a PDA, and lacking WiFi or cellular network access, the Foleo failed to capture the imagination of road warriors, students, business execs and geeks. This week Palm pulled the plug on the whole idea. I don't know it they ever actually presold a single Foleo and none ever shipped.

A business.ca columnist has an interesting comment on the Foleo, asserting that users have narrowed the focus of their mobile work. Some can get by with email, while others need to work on documents or get online to look up data. The former can make do with a smartphone, the latter need a laptop or notebook. According to this line of reasoning, the Foleo failed to provide enough laptop features to make smartphone users want to carry the extra gear to perform tasks they rarely would need to do anyway.

I think this is overly simplistic. Speaking strictly about health care workers in my hospital emergency department, work is increasingly complex and tools are ever more fragmented. Within the last twelve months we have deployed WiFi mobile phones for doctors, pagers for the nurse-in-charge for lab test result notifications, and, most recently, pagers for the doctors for yet other notifications of radiology results. We have simultaneously expanded the role of our electronic whiteboard. Used originally to show room occupancy and the status of investigations in progress or patient discharges, now it includes a toggle to indicate which rooms need to be cleaned by housekeeping. The whiteboard is only available on desktop workstations. Access to patient electronic records (for review or ordering tests) is still available only through desktop computers.

Thus, when I am on duty I carry a PDA, a WiFi phone, a pager, and still have to stop at the nursing station to check the whiteboard or to order a lab test. None of these technologies interconnect at the user interface (me). For example, if I want to update something on the whiteboard I have to go where it is, not use a mobile computing device.

How did we get to this state of affairs? It all arose from our quest to improve patient turnover times. We looked hard at our work flows and bottlenecks. Many meetings were held. A management consultancy came in to study the problems. Individually, each of the quality improvement measures we have implemented seems unobjectionable. Together, they have made my working hours a boggy mess of different colour-coded on-screen tables and buzzing gizmos dangling from my waist. There are far too many different signals and signalling devices to integrate into what is already a complicated working environment. The Foleo, if I had one, would not have made this situation any easier.

UMPCs At The Gate

What about the new Ultra-mobile PCs (UMPCs) being touted by some online sources? Machines like the Fujitsu U1010 (pictured to the right), Sony VAIO VGN-UX38GN, Kojinsha SA1F00, Samsung Q1, Gigabyte U60, Raon Digital Vega and ASUS R2H, (to mention just a few)? All these devices have some mix of light weight, bigger keyboards and screens than a PDA and the ability to run the Windows operating system. Only some can operate in tablet mode with a stylus and battery life is a major issue for them nor can they make cell phone calls. Virtually all of them are sold only in the Far East and are not easily acquired by a North American resident.

But the UMPCs have one other important feature: momentum. The idea of a laptop PC that fits in one hand has got all the major device manufacturers hopping and many small players jumping in with novel ideas. The ferment and creativity are reminiscent of when PDAs were a new idea. Palm itself may have something cooking in this arena but so far they are not giving any hints. People in the field are asking the right questions, as this column on Pocketables reveals, so I think the future is bright for a device of this type eventually making it big.

So, while I can't use one of these at work yet, I am betting that in a few years my laptop will be the same size as my PDA and my battery pack will fill the rest of my briefcase. The right feature set will emerge about the time I am ready to retire....

Parting Shots

PortableApps is a website where you can get software configured to run off a USB memory keystick. With this suite of applications you can go to the nearest PC, and run your favourite software regardless of what is previously installed on the PC. If I could install those apps on the memory card in my PDA, and plug the PDA into a PC, then I could take my computing environment with me to work without the extra memory stick. What's missing is a standard USB connector on my PDA instead of a proprietary one, so I wouldn't have to lug the HotSync cable around with me everywhere I go. This would allow me to carry fewer gizmos but would not solve the problem of staying within reach of a desktop PC in order to access the hospital systems. But it's a start.

And look for a more capable iPhone, Apple just dropped the price (to the ire of people who bought the very first ones only ten weeks ago) and will almost certainly continue to expand its capability. There is little to stop Apple from adding more and more PDA-like features to their smart phone. Contrast this story to the demise of the Foleo and weep, Palm fans.

Mobile Medical Multimedia

Last month I wrote about Podcasting for PDAs. I mentioned EMRAP.TV and EmedHome but failed to mention CMEDownload, the Society of Critical Care Medicine, and Project Disaster among many other sources of excellent podcasts with an Emergency or Critical Care Medicine emphasis.

Software for acquiring, converting and displaying podcasts on your Palm PDA is widely available. Check out:

Podcast how-to information from PalmFocus
Juice, a free program that does other media files too
mOcean, which does music and video files in addition to podcasts
Quick News, which manages RSS newsfeeds and podcast content for PDAs

I think podcasts, whether video or plain audio, are one more great tool on a PDA or smartphone. And, since I ride public transit to and from work, I can actually pay attention to the material without endangering other commuters.

Staying synchronised is not only a matter of HotSyncing your PDA to your PC these days. Online content and schedules may also need to be coordinated with your personal PC and PDA. The tools are out there. More about that next month....

Until then, enjoy!

Convergence, Divergence and Emergencies

2007-07-16T21:17:00.000-05:00

Put too many toys in one PDA and you might not know whether you're coming or going. No fear of featuritis in Palm smartphones - they only change incrementally from one model to the next, it seems.

iThink iPhones are iTrendy Now

Yes, the po-faced little devices were everywhere as crowds lined up to purchase them at the beginning of July. The iPhone is a cellular phone, camera, web browser and media player. Reviews popped up on eWeek, MSNBC, and others.

And the reviews were mixed. Some commentators criticized the lack of productivity applications. For example, there is no Task Manager. Apparently, there is also no synchronisation to Microsoft Outlook. You can synch with iTunes but an eWeek article points out that in a corporate environment, hosting illegal copies of copyrighted music and films on company servers could be asking for trouble. The iPhone, despite its gigabytes of memory, cannot be used to store or transfer files. It lacks a file management application or a way to mount it as a memory stick on a PC USB port. There is no way to add applications to the device: it's Apple upgrades or nothing. Seems a little unreasonable to me but it fits the image the company has cultivated for controlling all aspects of the user experience.

Everyone loved the sleek button-free look but the virtual keyboard took some getting used to. Others experienced hardware failures or overheating during recharging. The WiFi system is welcome but there is no VOIP support.

Apple is also taking a fair amount of stick for its efforts to restrict the type of service plans vendors could offer with the phone. I don't know: AT&T's US$70 per month for 450 minutes of talking and unlimited data seems pretty attractive to a power user. On the other hand, if you want the iPod mostly for its phone features then a cheaper plan would be nice.

Yup, sounds like a PDA rollout to me. It's new and clever but it doesn't have every conceivable feature. Palm device developers certainly went through similar teething problems and lots of carping from the sidelines with every new new PDA but they still made functional devices. Most of the complaints could be dealt with by software upgrades and third-party applications. And then there was always next year's model. Similarly the iPhone can be readily improved by innovative software developers - if Apple permits it. On balance, the iPhone merits the hype and future models will almost certainly look even better.

So when can we expect to see this much excitement over a new Palm OS device? Maybe never. After all, there are only a few features in the iPhone that can't already be found in other PDAs. The interface and style are responsible for most of the enthusiasm last week. A new Palm smartphone is unlikely to offer another revolutionary style.

Anyway, though the Palm interface and physical appearance may be old-fashioned, that is not compelling reason for me to abandon all the third party software and links to my PC provided by the Treo 650. I have made effective use of this family of devices for years and won't give up for a pretty face.

Who says only Apple users are fanatical?

Less Revolution, More Evolution

So, if anyone were to ask me for my smartphone wish list, what would I say? Glad you asked!

More memory. Lots more. UpToDate, to give one example, requires a two gigabyte data card. But I could also transfer more files between devices, play more media files.
USB connectivity. A really short USB data cable would do, but a wireless solution would be OK too.
WiFi. Why can't I have WiFi and cellular phone service in one device?

Notice I didn't mention fancy user interfaces. I know how to use what I use and don't want to relearn the basics without good cause.

Medical Computing

Recently I received an invitation to refer patients to participate in a study of tele-management of hypertension in diabetics. The research is being conducted in Toronto by Drs Alexander Logan and Warren McIsaac. The study seeks to compare patients who monitor their blood pressure at home and receive usual care from their doctors with those whose home blood pressure measurements are transmitted by cellular phone to a central computer. Patients and physicians can receive feedback and reminders from the central server about progress towards target blood pressure goals. Will this help achieve better pressure control for the test group of patients? Readers are encouraged to contact study coordinator Jeffrey Tong for more information or to inquire about patient enrolment.

This idea is not entirely new, of course. For example, the June 2007 American Heart Journal published an article by Bosworth et al entitled Hypertension Intervention Nurse Telemedicine Study (HINTS) which describes home blood pressure tele-monitoring using devices that connected to subject patients' telephone lines. Study nurses would follow-up on blood pressure reports by calling back with recommendations. Outlier readings and monthly reports can be sent to family doctors by fax. (Not email because most Toronto doctors who were asked apparently weren't ready to use PCs for anything beyond billing. What a great idea. Telemetry for the masses, reduced numbers of doctor visits, flagging of bad numbers (or failure to perform daily readings at all), etc, etc. And not even using a Treo - just a cell phone. The future is here and it uses a phone, folks.

The use of mobile computers has interesting potential beyond simple telemetry. The key features are the ability to transmit important information to health care facilities (and back) and programs on the PDA itself that know how to take action upon receiving critical telemetry data. Imagine getting automated reminders to take your medications, with the smartphone downloading instructions from the doctor's office. Imagine an automatic implanted cardiac defibrillator automatically calling the nearest hospital after it was triggered. Ambulatory cardiac rhythm monitoring would also be transformed. All this would be supplemented by the ability to carry one's medical records around in an eminently portable form.

Telemanagement of hypertension is just the beginning.

Mobile Computing

Not content with putting closed circuit TV cameras in every public space, some Britlish communities are putting them in the headgear of law enforcement officers. Apparently Manchester parking enforcement and transport police officers have head-mounted video cameras now. Wireless links to police, motor vehicle licence databases, and other enforcement agencies will surely come next. The current targets of this high-tech offensive? Littering, flyposting and doggie doo. I think there would be more benefit from putting such cameras on the helmets of paramedics, firemen, urban search-and-rescue, and police (ie. serious crimes) officers. Well, maybe next year....

Natara Comet is a better call log for your Treo smartphone. Use it to take notes on calls, schedule call backs, look at call history for a phone listing. If you work extensively with your mobile phone, this may be a powerful tool.

Mobile Medical Multimedia

When I started out in medicine we used to play medical audiotapes in the car stereo. It was hard to concentrate on driving and learning from a panel discussion on diabetes management simultaneously but many felt this helped them save time and stay current.

Now we have access to podcasts on a range of topics. EMRAP.TV provides streaming video, MOV files for your PC, and podcasts. Topics range over injury diagnosis and treatment, procedure demonstrations, and more. EMRAP.TV podcasts can also be downloaded from iTunes. Search there for EMRAP/Resuscitation.

Emedhome also provides podcasts on topics relevant to Emergency Medicine.

Nex

Tips and Tricks - Task and Project Management Revisited

Over the years I have tried out many different software tools for keeping track of projects on my Palm handheld. In previous issues of the review I have written about Progect (free but flawed) and Bonsai (powerful and works well with built-in applets on your PDA). There are numerous other commercial products that I never had the time or budget to play with.

The fact is, however, that the built-in Contact Management, ToDo Task List and Appointment Calendar applets cover most of my (simple) needs quite well. The secret to successful use of these tools is to create and use categories for different projects and to use the same categories for appointments, contacts and tasks. When I want to review the status of a project I need only select the appropriate category to review upcoming appointments, tasks not yet completed, or find the person I need to speak with in my contact list. This strategy won't give me timelines and synchronise alarms with task due dates, etc, but it is quite functional and requires no additional software beyond what came with the PDA right out of the box.

All that's needed is to give some thought to the category names. Change your mind about the names later? The beauty of the system is that you can rename the categories any time you choose, without losing your notes and lists. This makes it easy to subcategorize when one project turns into two follow-up assignments. Watch out if you delete a category, however: this will cause all tasks or appointments in that category to become members of the Unfiled set: too much housecleaning at once might mix several unrelated items together in that pot.

Of course, true planning and project management tools have more bells and whistles but you can get by with the basics and a bit of, well, planning.

I'm still waiting for new Palm PDAs for specialized or niche medical workers. Still waiting... until next time at least. Enjoy your summer!

Spring Has Sprung

2007-05-31T13:50:00.000-05:00

And new gizmos are on the wing.

Nuts And Bolts

Palm has just announced the Foleo, a two pound extension of the Treo smartphone. The Foleo uses Bluetooth to access the Web or eMail via the Treo's phone service. It also is the first Palm device based upon Linux rather than Palm's own proprietary operating system.

This is not the first attempt to find a niche midway between PDA and laptop. oQo offers the model O2 which has built-in wireless networking. And various companies have played around with subnotebooks, tablet PCs, and so forth.

Will Foleo make much of a splash? It seems to me that it will be underpowered - only five hours of battery life for example. It needs Bluetooth to connect to a Treo for eMail or the Web although it will have wifi also. I question just who is the target customer for this machine. And I wonder how one will use it: with the Foleo in one hand and a Treo in the other, keyboard or stylus use will be a challenge.

Calling Home

There is still no native wifi for Treo smartphones, although there is a wireless card that can be plugged into the SD slot. The new Treo 755p has support for EVDO (means faster connection to the web or email) but it's still a cellular service-based feature. The whole idea of wifi on your mobile phone cuts to the heart of cellular company revenue models. Now that Palm's better models are all smartphones, it's an open question whether we will ever see robust wifi for Palm OS devices.

Web-based services and applications, and voice-over-internet phone (VOIP) capability would be very useful in a hospital or large office building. This would also help in a crisis when cellular service failed. Emergency teams could bring wireless routers and satellite uplink antennas to the scene and establish (or re-establish) web-based services quickly.

Why bother with VOIP if one has access to cell service? I like the idea of operational flexibility with a familiar interface. When you need to improvise communications, it's better not to have to carry multiple phones and radios, and not to have to learn how to use unfamiliar equipment that is only brought out when you are stressed and in crisis. The ability of a smartphone to use cellular or VOIP, as the need arose, would make life simpler.

With clinical reference info and some hospital or community agency phone numbers inside, a smartphone becomes an important tool in a crisis. Add GPS, the ability to take and upload photos, and a bar code reader to really expand the scope of tasks. Who says there are no new challenges for mobile medical computing hardware?

Software and services to take advantage of these new abilities will emerge. Two examples that give a taste of what is possible. Google Maps will work with GPS to provide location-specific info such as where to find the nearest hospital, and give directions to find it, complete with voice cues. Shout Postcard lets you send multimedia messages to multiple recipients. Include pictures, audio, text to provide a detailed report to dispatchers or base hospital staff.

Heed the Call

Cell phones and computerized call lists make a powerful combo for emergency call back systems. A public health agency or hospital could theoretically activate a disaster plan and notify off-duty staff with just one mouse click. Palm and AT&T recently began to promote AT&T's Send Word Now service. Now that Palm is focusing on its smartphone products, it's not surprising that they have partnered with telephone service providers. Codespear, Voiceshot, Amcomsoft are just a few of the many other players in this field. The recent mass killing at an American college has resulted in much tasteless marketing but these services do have considerable potential to improve emergency alerting and staff recall.

Say It Again

The Palm 755 offers voice control of many functions. You can make phone calls, browse the web, and much more. But what if you want voice control without having to buy a new PDA? Start by taking a look at the list of voice control software at Pocket PC Central. Short list. Google didn't help much either. It seems that there are only a few programs, aimed at the Palm OS device market and only the newest models at that. If Palm continues to include voice command capability in future models there is not likely to be a stampede of third party software vendors into such a small market space.

Error Correction Mode

Reader Guylhem Aznar wrote to correct the impression left by my post on 20 April that push email was not available to users without the Treo 700w PDA, which has Versamail 3.5 installed in the factory.

In fact VersaMail 3.5 is also available as an upgrade and provides users of Treo 650, T|X and LifeDrive with a Blackberry-like email experience. Guylhem must have a flat rate data plan with his cell phone company which allows him to get email on the Treo 650 without being charged airtime for each upload!

The principal downside of the VersaMail upgrade is that it installs to RAM on the PDA (VersaMail 2.5 is already installed into ROM but it can't be upgraded there). Guylhem, a talented fellow, has inserted a ROM upgrade chip into his Treo, but this is not a surgical intervention for the casual hobbyist. Perhaps Guylhem will post instructions onto his website one of these days (hint, hint).

Websites of Interest

Palm has created two sites to support customers. The MyPalm site offers tips and software discounts to Treo users. Specify your model and cellular service provider when you log in. If you don't see your provider listed, pick the "unlocked" model but be careful before installing software upgrades as they may not match. Naturally, there is no specific support for Bell, Rogers or other Canadian phoneco customers. I will probably stick with the more traditional support channels to avoid trashing my handheld.

If you want to read another source of info, the Official Palm Blog is a new site with articles about hardware, software, and news. Not restricted to Treo users and worth checking when you have no new Medical Palm Review issue to read (grin).

Easy Come, Easy Go

Two weeks ago something happened to the Review archives and the search engine broke. The programmer who put the website together has moved on to bigger and better things so it was very gracious of Randy Showalter to take the time to fix things up for us. Apologies to anyone who was frustrated by the glitch.

If this ever happens again, you can still search our archives using Google. Try a search term prefaced by "Medical Palm Review" (hint: include the parentheses). This misses a fair number of articles and references in past issues but will catch some, usually the more recent ones.

The fact is, however, that much of the archival material is no longer topical anyway. Hardware reviews are particularly time-sensitive. It's unlikely that anyone is going to try to buy a Sony PDA, now that they have stopped making new ones, to give just one example.

Whether through lack of creative juice or because of recurring questions from colleagues and friends, certain themes do recur in articles about software and troubleshooting, however. Maybe I can mine the archives for some ideas to revisit, before the server dies or something else turns out the lights on the website forever.

Sic Transit Another Month

The summer issue will come out in July. Until then, enjoy!

Green As You Wanna Be

2007-04-20T13:29:00.000-05:00

No not green as in eco-friendly. That's green as in envious. My daughter wants an iPod like her classmates - one with more memory to play her expanding list of pop tunes. My suggestion that she use the MP3 player in her cellphone or use a PDA was met with scorn. iPods look cool as well as play music (and even videos). Too bad for her that lame-o dad thinks Palm PDAs look cool too.... It may not interest my kid, but I think it would be great to be able to play podcasts and music purchased from iTunes on a PDA. Turns out I can. I have Real Player on my Treo 650, but it can't handle the iTunes proprietary format. There are commercial multimedia players such as mOcean, and Pocket Tunes v4.0 which can handle iTunes music. Alternatively, you can convert iTunes melodies to MP3 files and use any music player at all, including free ones like Kinoma Player or the Real Player I already own. This process is moderately tedious as it involves burning the music to CD then ripping the CD back to the hard drive. The resultant MP3s can then be transferred to a PDA or its memory card.

There is a useful little article on PalmFocus which discusses how to get podcasts onto a PDA. For example, RSS news feed managers like Quick News can also handle podcasts. Listening to podcasts and music does make the subway commute to work more stimulating, but the earphones are probably bad for my hearing. At least I will have an excuse not to pay attention to a certain adolescent's demands for a new iPod.

Green as in Saving the World

I am on a mission to reduce power consumption in my house. I have about a dozen small transformers plugged into the wall in my office. These enable my PC, my PDA rechargers, my internet modem, and a variety of other devices. I was recently tidying up around them and noticed just how much heat they continuously emit. Individually they consume only a few watts but it does add up.

Yet I use them perhaps a few hours per day on average. The solution: a switched power bar. When I need to compute, I turn on the whole shebang. The rest of the day, they are switched off and staying cool. This actually has additional benefits in terms of security. Switched off, my wireless router is not accessible to being hacked. And each time I turn the internet modem back on, it acquires a new "address", helping to defeat certain types of web attackers.

My PDA and a USB memory stick are also useaful against global warming. They let me bring work on the road without my laptop. If I can't get by with the PDA, the memory stick lets me use a local PC. Privacy for the mobile road warrior can be tricky, but I found some great ideas at PortableApps.

There are much more power-hungry machines in my home. But I also vacuumed the fridge heat exchanger coils, installed a programmable thermostat and started hanging clothes to dry in the basement instead of using the dryer (yes that's why I favour the rumpled, professorial look).

Taken to the Cleaners

While I am on the subject of cleaning, let me mention the springtime ritual of cleaning up a PDA. This is a good time to try to recover memory by removing unneeded applications. I also have duplicate documents on my SD memory card that could go. There are medical articles and miscellaneous notes that are out of date. And my appointments or completed ToDo tasks from 2006 can be archived or simpley expunged. Getting back about two megabytes of system RAM
this way feels good and allows me to consider loading up new stuff for testing.

I do all this work manually, but Palm offers a toolkit called the NeatFreak Pack which makes it considerably less tedious. Depending on which sort of clean up you are interested in, there are many other software tools available.

Busy Bees

Palm and other wireless product/service providers have been very active this past month. I have received numerous eMails about products and information events of interest:

The Palm web store has a raft of sales and special pricing for PDAs and accessories.
Palm also held an online webinar about mobile security. For Treo smartphone users who need to access data on a central server, there were a few interesting ideas.
Palm is also promoting a series of webinars dedicated to the push eMail solution offered by their Treo 700w series PDAs (which use Microsoft's PocketPC system), and cellular service provider Verizon. OK, many of us can't use this but I hope someone offers comparable capabilities to the Palm OS smartphone users in Canada.
Emory University Medical Centre deployed a wireless network to enable all sorts of innovations for their doctors and nurses. HealthCare IT News has the story if you are willing to register and give them your eMail address.

Nuts and Bolts

No, not new Palm hardware, but lots of other intriguing solutions for mobile workers:

Medical applications for the Blackberry series are starting to pop up. QxMD offers a calculator for nephrology problems. I expect we will see more and more applications for this platform. The QxMD site itself links to LexiComp and the concise Oxford Medical Dictionary.
The Garmin Mobile 10 enables Bluetooth-equipped smartphones and PDAs to access GPS localization services. The best part is that one GPS receiver can be used with any computer, PDA, phone that has Bluetooth wireless networking. I like that flexibility.
Sony offers UX micro PCs running Windows Vista. This being Sony, the price is steep, but just think how compatible the UX would be with your desktop PC. I know someone who couldn't find the Sony micro he wanted in Canada. His solution? Buy from Dynamism,
an American company which imports SONY devices from Japan, then strips out the Japanese operating system and replaces it with English Windows OS. Sounds adventurous
to me....
A portable device with a keyboard makes for a lightweight text input solution. The K-Jam
from i-mate runs Windows PocketPC and has everything you could ask for: wifi card, camera, 3G cellular capability, you name it.
I have never been very enthusiastic about Windows tablet PCs. The trade-offs of weight, screen size, battery life and fragility never seemed worth it. Motion Computing's new C5 Mobile Clinical Assistant has addressed some of my biggest peeves. The thing has a great big handle so it's hard to drop. It has no keyboard so it is easy to wipe down and decontaminate. Its integrated camera, RFID reader and barcode reader make it perfect for rapid patient or object identification. And the screen is big enough to make using Windows less painful than on a PDA. The brochure doesn't state this, but the C5 may be light enough to hang on a belt clip or in an oversize pocket in order to free up both hands for clinical work. Because it runs Windows and has wifi, it can probably run your hospital's electronic patient record software and connect to the main data repository. In short, this concept takes a good shot at providing what is needed by the emergency department staff or field medics.
By contrast, Symbol got it almost right with their latest Windows Pocket PC device, the WT
4000. It can be strapped to wrist or thigh and is intended for use by warehouse staff who need to hold a barcode scanner (or they can strap that to their hand, too). Unfortunately, the WT 4000 has no touch screen and relies on a cellphone-like keyboard which makes it less functional for workers who need more than a scanner to enter data. Nonetheless, this is on the right track for freeing up both hands.

Mobile Medical References

I have been using PEPID for some years now. This provides me with background on many medical conditions, a prescription drug database, a drug interaction checker, critical care algorithms, medical calculators, and much more. PEPID runs on my Palm PDA but can also be
accessed from the Internet. Recently I have been looking at another medical reference package called UpToDate.This is also available on my PC, the Internet, and my PDA. It has far more extensive information on medical conditions but lacks some of the other tools that PEPID provides. UpToDate requires a relatively new PDA to run, and (on my Treo 650) will only install onto a memory card due to its need for 1.5 gigabytes of room. This could be awkward for users with huge databases on their SD card already, because older Treos can't handle SD cards larger than two gigabytes in total. Newer Treo models can handle cards with up to 4 gigabyte capacity. I am getting an inkling of what my next PDA upgrade will be and why. The database seems comprehensive (I haven't stumped it with any questions yet) but it isn't cheap. If you like
it you should try to find a job at a teaching hospital with a site licence (grin).

I'm still waiting for new Palm PDAs for specialized or niche medical workers. Still waiting... until next month at least.

Time for a Change

2007-02-28T14:01:00.000-05:00

Welcome to the new MPR blog site!

This is the eighth year of publication of the Medical Palm Review. It has gone through several changes in format and delivery. Starting to feel a little stale so I decided to try delivering it as a blog.

Blogs have some advantages over the website format I have been using until now. With a blog I can log on from anywhere to add content when I feel like it, instead of aggregating news and commentary in monthly chunks. It's also easier for readers to offer comments and feedback. I can also break up each issue into multiple short articles, so that comments can be directed to selected topics. Up until now, almost all the mail I have ever received at the contact address listed in every issue has been spam. Now I can retire that address and rely upon readers to click on the comment links at the end of every post instead.

Disadvantages include the possibility of even more spam, which might also clutter up the blog site if I am not careful. And there is the risk that readers might not like the change in style that the new format entails. Many of the features for visually challenged users which I added to the MPR will not work the same on a blog and will need to be relearned.

I am still learning and experimenting. Let me know how you like it. Your comments can influence how we continue. Meanwhile, I am hedging my bets by continuing the MPR site. You can continue to access the archive of back issues there.

Change, for a Time

Daylight Savings Time in North America is fast approaching. In fact, due to recent legislation, DST will arrive several weeks earlier than usual. If you have a Palm, you should get the DST update from the Palm website.

Be aware that the DST patch gets zapped if you perform a hard reset on your PDA. The problem is discussed in more detail in a Brighthand forum.

While you are at it, you should go to the website of your desktop PC operating system to get whatever update you need to maintain correct time there as well. Otherwise the Palm Desktop software may not stay in sync with your handheld.

More Hacking

Another fix or two that may need your attention...

Treo smart phones can still be accessed when password locked. How? By using the built-in Find feature. The Smart pda site covers this problem in some detail. Palm has not done anything to correct this problem yet.

Microsoft also comes in for some stick because the latest version of Office XP. Outlook repeatedly pops up warning messages when Palm Desktop (and some other, older applications) attempt to access the Outlook email address database. This gets old very quickly, so you may want to look at Mapilab's Advanced Security for Outlook software, which reportedly tames the beast.

Medical Computing

Ontario Physicians who want to have an up-to-date listing of Limited Use Codes for prescription medications need look no further than Lawrence's Download Page for the latest version.
You will need a database program for your PDA but the owner of this website thoughtfully offers the database in several popular formats.

Hardware

Palm pulled the plug on the LifeDrive in February. This was in many ways a flagship product. Big screen, hard drive, wireless networking - the LifeDrive had it all. What it didn't have was big sales apparently. Once again we are forcefully reminded that PDAs are being eclipsed by other handheld devices with more emphasis on telecommunications. The Guardian had a perceptive article on the quest by cellular telephone operators to add more features. Palm and other PDA manufacturers are going to have to trot down the same road: GPS, location-based advertisisng, video on demand, uploading photos to websites like Flickr or MySpace.

Although I like my Treo, I was astounded to learn all the tricks an ordinary cell phone can perform with the help of a few online services and downloads. Larry Magid's article is called Plain Cellphones Can Overachieve, With a Little Help in the 25 January 2007 New York Times (proprietary content that you can't link to without a free registration, folks). The article describes how to get RSS news feeds (Flurry), web search (Google, Yahoo), email (Google, Yahoo Go). You can link to Outlook and other applications on your PC with Soonr. That's pretty good for a cell phone.

As a doctor, I can see many useful things in a connected PDA. But I would much prefer something with a screen larger than that of a typical cell phone. And I don't want a great big tablet PC either. Recently I even contemplated jumping ship to try a Dell Axim with a head-mounted display which projects an image onto one eye. iCuiti makes some great ones (the picture on the right shows their M920 model plugged into an iPaq). Unfortunately their website indicates that they are out of stock on the displays. So I will have to wait a while longer before experimenting with that technology.

That's enough for a first effort. More to come in March and April....

Until then, enjoy!