04 November, 2007


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 RevoluciĆ³n

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.


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