16 July, 2007

Convergence, Divergence and Emergencies

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.


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!

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