The Handheld Computer and Medical Practice

Presented at Swedish Family Practice Day

March 15, 2002

E. Chris Vincent, MD, Swedish Family Medicine, Seattle. WA

Learning Objectives:

I. Become familiar with the types of Handheld Computer's available on the market today.

II. Basic knowledge of the operating systems currently in use with the focus of this session being those products using the Palm OSTM.

III. Learn the basic operation of the Palm OSTM Handheld Computer.

IV. Review some of the useful medical software applications available today for the Palm OSTM Handheld Computer:

A. Drug databases

B. Medical textbooks

C. Medical Calculators

D. Practice management

E. Prescription writers

F. Graphic and text viewers

V. Understand the ways the Handheld Computer can interface with larger information systems and gain an appreciation for the potential applications that will be available in the future.

I. What is a Palm Pilot?

a. Handheld computing device

b. Allows for data input and retrieve, either locally or remotely through various interfaces (connections).

c. This lecture will focus on the Palm OS, which is available on three devices-, the Palm Pilot, TRG-Pro/Handera 330, SONY CLIE, and the Handspring Visor.

d. Usually all data is entered by a touch sensitive screen using a plastic stylus.

e. Keyboard options also available.

II. Connecting to the computer world.

a. "Cradles" - usually connect through the serial or USB port on the back of your PC. May allow further connectivity to network systems.

b. Infrared- allows for "beaming" of data or programs between Palm Pilot's, printers or even PC's.

c. Modem - some devices have built in modems for Internet access

III. Basic Operation (Palm OS)

a. Power issues, screens, and startup.

b. Calendar, addresses, task lists, memos, e-mail

c. Connecting to your PC.

IV. Review some of the useful medical software applications available today for the Palm OSTM Handheld Computer:

a. Drug databases

I. ePocrates

II. Tarascon Pocket Pharmacopeia

b. Medical textbooks

c. Medical Calculators

I. Medical formulas

II. Pregnancy calculators

III. Cardiac risk

d. Practice management

I. Track inpatient/outpatient data- sign out friendly

II. Billing/coding software

e. Prescription writing- write in the room, print via IR print ports.

f. Viewers

I. Graphics

II. Documents

V. Understand the ways the Handheld Computer can interface with larger information systems and gain an appreciation for the potential applications that will be available in the future.

a. Integration of all of the medical applications with virtual server technology. Enter data into the Handheld Computer and when synched with server, data is distributed to database automatically.

b. Internet database connectivity.

c. Wireless technology - allow data transfer without cables/cradles

d. Voice transcription technology - allow direct data entry onto Handheld Computer.

Online resource: To link to some of the sites that are mentioned in this handout easily, go to this website: http://faculty.washington.edu/mtuggy/aafppalm.htm

REFERENCES:

DiLoreto S. Personal digital assistants: Make them work for you. Patient Care. 2001;5:38-53.

Ebell M, Rovner D. Information in the palm of your hand. J Fam Pract 2000; 49(3):243-51

OReilly M. Worshipping at the altar of the Palm Pilot. CMAJ 2000;163(8):1036

Pennachio L, Cohen M, Frankel A, Ogrod E. To err is human: How to prevent medical errors. Patient Care. 2001;11:95-104

Willyard KE. A Palm-Top Computer in Every Practice? Family Practice Management. 2000; 7(8):59-60

There are several articles on the medical uses of Handheld Computer's in the October 23, 2000 issue of Medical Economics, available on the Web at www.memag.com.

Palm Pilot Websites- compiled by Mike Tuggy, MD and Chris Vincent, MD
Our website: http://faculty.washington.edu/mtuggy/aafppalm.htm

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Palm OS devices:
3 Com Palm Pilot™ (IIIxe , IIIc, Vx, VIIx, m100, m105, m500, m505) www.palm.com

Handspring Visor™ (basic, deluxe, platinum, prism, edge): www.handspring.com

TRGpro™ and Handera 330: www.handera.com/

SONY CLIE™ (B&W and color) http://www.sonystyle.com/vaio/clie/index.shtml

Accessories: Palm Gear at http://www.palmgear.com/

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Software for Palm OS and Windows CE devices:

1) GENERAL INTEREST SOFTWARE: http://www.palmblvd.com, http://www.handango.com, http://www.tucows.com, http://www.palmgear.com/

2). MEDICAL SOFTWARE:

http://www.handheldmed.com

Palm OS software Sites:

1) GENERAL SITES AvantGo (news, sports, etc): http://avantgo.com/frontdoor/index.html

BackupBuddy Software (backup palm applications and data): http://www.backupbuddy.com

Documents To Go (convert MS Word, Excel, and Powerpoint files for Palm Pilot)
http://www.dataviz.com

Fire Viewer (graphics viewer): http://www.firepad.com

ISILO Software (document reader used by many medical texts) http://www.isilo.com/

Palm Emulator (run a palm pilot on your PC!): http://www.palmos.com/dev/tech/tools/emulator/

Tealpoint Software (document readers, printer software, etc): http://www.tealpoint.com

Vindigo (city specific info): http://www.vindigo.com

2) MEDICAL SITES

ePocrates, Inc. Rx (clinical drug database for the Palm): http://www.epocrates.com

Family Physician's Guide to Handheld Computers (The most complete site for Palm OS products I've seen!): http://www.fphandheld.com/

Handheld Computers in Family Medicine (this site is a bit out of date but has some useful reviews and links): http://www.fammed.wisc.edu/education/res/PilotWeb.htm

HandheldMed (Medical Texts): http://www.handheldmed.com/

Healthy Palmpilot: http://www.healthypalmpilot.com/

KidDose, KidCard, KidNorm (pediatric calculators and reference): http://www.medical-data-solutions.com/

PatientKeeper (Palm EMR): http://www.patientkeeper.com

Riley Kidometer: (pediatric calculators and reference): http://www.kidometer.com/

Riverside Family Practice Peripheral Brain (MedRules, Shots, and more!): http://pbrain.hypermart.net/

Skyscape (Medical Texts): http://www.skyscape.com

STAT E&M coder and STAT Cardiac Risk calculator: http://www.statcoder.com

UW Health Sciences Library (My second choice for links to Palm OS medical products): http://healthlinks.washington.edu/primeanswers/palm/

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PDA's and Handheld Computers: Internet Resources
Compiled by Carrie Rose, MD

Information on Medical Palm computing
http://www.collectivemed.com
http://www.pdamd.com
http://www.medicalpiloteer.com
http://www.healinghand.com
http://www.fphandheld.com

Medical Reference Software
Clinical guidelines
http://redi-reference.com
http://www.handheldmed.com

Drug databases
http://www.skyscape.com
ePocrates qRx: http://www.epocrates.com

Reference Books
http://www.handheldmed.com
http://redi-reference.com

Patient Tracking Software
Patient Tracker:
http://www.handheldmed.com
PatientKeeper:
http://www.patientkeeper.com
PocketMD:
http://www.pdamd.com
Epatient:
http://www.iatrosoft.com

Prescription Writing Software
EPad: http://www.ephysician.com
Allscripts: http://www.allscripts.com
IScribe: http://www.iscribe.com

Billing and Coding Software
MD Coder: http://www.curontech.com
E&M Coder: http://www.ephysician.com
ZapCode and ZapBill: http://www.zapmed.com
Stat E&M Coder: http://www.statcoder.com

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To download free or demo versions of software applications (using a MS Windows PC) from the web to your Palm OS device just follow these 4 steps:

1- Select and download applications from any Palm™ related web site (e.g., www.palm.com). Save the file(s) to your hard drive (eg. C:\temp)

2-Using My Computer or Explorer go to the directory where you saved the software (eg. C:\temp). If the downloaded application is a Zip file, unzip its contents (use WinZip -free from www.winzip.com) and copy the files to the add-on folder in the Desktop Software directory (e.g., C:\palm\add-on). It's a good idea to read the readme.txt file if one is available.

3- Run the Install program by:

• Clicking on Start>Programs>Palm Desktop>Install Tool or
• Running Instapp.exe from the Desktop Software directory (e.g., C:\palm), or
• Opening the Palm Desktop software and clicking the Install button.

When the install window appears click Add. Select the applications you want to install. Click Open, and then Click Done.

4- Perform a HotSync® operation to transfer your new applications to your handheld.

Comparison features of Palm OS Devices

Notes on comparison of Palm OS devices:

In general, it is a good idea to purchase a device that has expansion capabilities. The most common expansion "module" adds additional memory, though other devices such as a digital camera, cell phone, GPS (global positioning system), MP3 audio player, books, games, etc are available for many of the Palm PDA's on the market today. Memory modules allow the user to store additional information on the Palm, with the caveat that not all software will run from the module. With this in mind, it is prudent to consider buying a device with 16 MB of INTERNAL memory (eg Palm m515, Handspring Visor Pro, or Sony CLIE PEG T615C). Prices for memory modules vary. CF and SD are generally less expensive than MMC, Visor Springboard, and SONY Memory Stick as CF and SD are not proprietary. The current Palm operating system cannot accesss more than 128MB of memory, so cards with more memory than this are a waste of money.

Most devices synchronize to computers (HotSync) via USB (Universal Serial Bus). This is much faster than Serial, but requires a Macintosh or a PC running Windows 98 or higher. If you are using Windows 95 you will have to purchase a Serial cradle. TRG Pro and Handera 330 HotSync via serial ports. A USB adapter is available, however the HotSync speed is the same as that for serial, which is to say it is noticeably slower.

A color screen is easier to read than a gray scale (B&W), but consumes more power decreasing the battery life considerably. All of the available color units use rechargeable Lithium Ion batteries. A full charge will last an average of 2 weeks. The battery life for most gray scale units is 2 months, hence most of these devices use Alkaline batteries. The Handra 330 can use either rechargeable Lithium Ion or Alkaline batteries.

All of the SONY units except the CLIE PEG S360 have high resolution screens (320X320 pixels compared to 160X160). They are superior to the Palm, Handspring, and Handera devices for viewing pictures or graphics. The Palm m105, m125, and m130 have screens that are about 25% smaller than other Palm OS devices. Before buying a device, try to compare the various Palm OS devices at a store that carries several models. Size and Screen brightness, resolution, and size varies considerably. Be sure to pick a unit that feels comfortable in your hand and that you can read. Try to find out how easy it is to see the screen in both low light (darkness) and high light (bright sunlight) conditions.

For an excellent review of Palm OS devices, go to http://www.fphandheld.com and look at the section on "Kind to Buy."