Handheld Technologies in Clinical Practice

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Handheld Technologies in Clinical Practice Powered By Docstoc
					                                Palm Reading
           Presented to the WAFP Annual Scientific Assembly
                             May 22, 2004

Carol Cordy, MD Swedish Family Medicine, Seattle. WA
ccordy@sfm.fammed.washington.edu
E. Chris Vincent, MD Swedish Family Medicine, Seattle. WA
cvincent@sfm.fammed.washington.edu

   Learning Objectives:
   1)    Become familiar with the types of Handheld Computer’s available on the
         market today.
   2)    Basic knowledge of the operating systems currently in use with the focus
         of this session being those products using the Palm OSTM.
   3)    Learn the basic operation of the Palm OSTM Handheld Computer.
   4)    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
   5)    Understand the ways the PDA can reduce medication errors and increase
         practice efficiency.

           ************************************************************************

                                    Lecture Outline

   I.    What are Palm Pilots and Pocket PCs?
         a. Handheld computing devices or PDAs (Personal Digital Assistants)
         b. Allow for data input and retrieval, either locally or remotely through
            various interfaces (connections)
         c. This workshop will focus on the Palm OS, which is available on several
            devices made by including the Palm One, SONY, Samsung, and
            Kyocera
         d. Usually all data is entered by a touch sensitive screen using a plastic
            stylus
         e. Keyboard options are also available
   II.   Connecting to the computer world
         a. “Cradles/Cables” – usually connect through the serial or USB port on
            the back of your PC and may allow further connectivity to the Internet
            or network systems



              Cordy & Vincent: Palm Reading          May 22, 2004   Page 1
          b. Infrared- allows for “beaming” of data or programs between Palm
             Pilot’s, printers or even PC’s
          c. Wireless (Cellular, Bluetooth, WiFi) – connectivity to the Internet or a
             network system by radio wave transmission
   III.   Basic Operation (Palm OS)
          a. Connecting to your PC and power issues
          b. Application screens and drop-down menus
          c. "Built-in" applications: calendar, addresses, task lists, memos, e-mail
          d. Sharing data and applications with others
   IV.    Overview of some useful medical software applications available today for
          the Palm OSTM Handheld Computer:
          a. Drug databases
                   I.      ePocrates
                   II.     Tarascon Pocket Pharmacopeia
                   III.    PDR
          b. Medical texts
                   I.      5 minute clinical consult – (www.handheldmed.com)
                   II.     PDxMD Handheld (www.pdxmd.com)
                   III.    Pepid Handheld (www.pepid.com)
          c. Medical Calculators
                   I.      Medical formulas and "rules"
                   II.     Anticoagulation indications and dose
                   III.    Pediatric norms
                   IV.     OB "wheel"
                   V.      Cardiac risk and cholesterol guidelines
          d. Practice management
                   I.      Track inpatient/outpatient data
                   II.     Billing/coding software
          e. Other database applications
                   I.      HanDBase
                   II.     JFile
          f. Viewers
                   I.      Graphics – Fireviewer, Pocket TV (Pocket PC movies)
                   II.     Documents
   V.     Understand the ways the PDA can reduce medication errors and increase
          practice efficiency - with PDA can do things at the “point of care”
          a. Look up drug interactions, side effects
          b. Write prescriptions, send to pharmacy
          c. Check latest treatment guidelines

REFERENCES:

Adatia F. Bedard PL. “Palm reading”: 1. Handheld hardware and operating systems.
Canadian Medical Association Journal. 2002; 167(7):775-80.
Adatia F. Bedard PL. "Palm reading": 2. Handheld software for physicians. Canadian
Medical Association Journal. 2003; 168(6):727-34.



               Cordy & Vincent: Palm Reading     May 22, 2004   Page 2
Chandrashekhar A. 10 quick tips for a more user-friendly PDA. Family Practice
Management. 2003;10(1):70, 73.
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
Nace GS, Willyard KE. PDA Basics. Oncology net guide 2002;3(4):5-10
www.mdnetguide.com
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
http://www.memag.com/.




              Cordy & Vincent: Palm Reading   May 22, 2004   Page 3
Palm Pilot Websites- compiled by
Mike Tuggy, MD and Chris Vincent, MD

*************************

Palm OS devices (see also table at end of handout):

       Palm One™ (Tungsten, Zire, Treo) http://www.palmone.com/

       SONY CLIE™ http://www.sonystyle.com

       Samsung SPH-i500: http://www.samsungusa.com/cgi-
       bin/nabc/product/b2c_product_detail.jsp?prod_id=SPH-I500

       Kyocera Smartphone: http://www.kyocera-wireless.com

      Accessories: Palm Gear at http://www.palmgear.com/
*************************
Software for Palm OS 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, http://www.pdamd.com

Palm OS software Sites:
      1) GENERAL SITES

          AvantGo (news, sports, etc): http://avantgo.com/frontdoor/index.html
          BackupBuddy (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
          HanDBase (database manager): http://www.ddhsoftware.com/
          ISILO (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/



                Cordy & Vincent: Palm Reading         May 22, 2004   Page 4
   Tealpoint (document readers, printer software, etc): http://www.tealpoint.com
   Vindigo (city specific info): http://www.vindigo.com
2) MEDICAL SITES

   Anticoagulation Advisor: http://www.medical-data-solutions.com/
   Ectopic Brain (MedRules, Shots, and more! The best overall guide to Palm
    medical products): http://pbrain.hypermart.net/
   ePocrates, Inc. Rx (clinical drug database for the Palm):
    http://www.epocrates.com
   FPpda: http://www.fppda.com
   HandheldMed (medical texts, Patient Tracker): http://www.handheldmed.com/
   Healthy Palmpilot: http://www.healthypalmpilot.com/
   iScribe (prescription writing):
    https://physician.advancepcs.com/advpcs_phyres/index.html
   MedRules (Medical guidelines and clinical prediction rules):
    http://pbrain.hypermart.net/medrules.html
   MeisterMed (CodeMeister, AsthmaMeister, etc): http://www.meistermed.com
   MobilePDR: http://www.pdr.net/
   PatientKeeper: http://www.patientkeeper.com
   PDA MD: http://www.pdamd.com/
   Redi-Reference: http://redi-reference.com/
   Skyscape (medical texts): http://www.skyscape.com
   STAT E&M Coder and STAT Cardiac Risk calculator: http://www.statcoder.com
   Tarascon Pocket Pharmacopeia: http://www.tarascon.com/
   UW Health Sciences Library (Our second choice for links to Palm OS medical
    products): http://healthlinks.washington.edu/howto/pda/
   ZapMed (ZapCode, ZapICD, and ZapBill): http://www.zapmed.com




          Cordy & Vincent: Palm Reading          May 22, 2004   Page 5
                                   Medical Applications for Palm OS PDAs
                                                         Carol Cordy, MD
Title               Type                      URL                                        Price         Notes
ePocrates Rx        Drug database             www.epocrates.com                          free          Auto-update with formularies
ePocrates Rx Pro    Drug database and more    www.epocrates.com                          50/yr         Auto-update with formularies
Johns Hopkins       ID guide                  www.hopkins-abxguide.org                   free          Auto-update
Antibiotic Guide
TheraDoc            Antibiotic Guide          www.theradoc.com                           free
5 Minute Clinical   Medical Reference         www.skyscape.com                           65/yr         Limited use free trial
Consultant
MedCalc             Medical calculator        www.freewarepalm.com                       free
MedRules            Prediction rules tool     pbrain.hypermart.net                       free          Requires NSB Runtime
BreastCa            Risk prediction           www.freewarepalm.com                       free
Shots 2003          Immunization reference    www.immunizationed.org                     free
STAT Cholesterol    ATP III Guide             www.statcoder.com                          free
STAT HTN JNC 7      HTN Guide                 www.statcoder.com
Stat GrowthCharts   Growth charting tool      www.statcoder.com                          free
Stat E&M Coder      E & M coding              www.statcoder.com                          75            Multi-use free trial
Himando BMI         BMI tool                  www2s.biglobe.ne.jp/~kyanagi/palm/en/>     free
Calculator
DTree MMSE          Mini-Mental Status Exam   www.freewarepalm.com                       free
PregCalc Pro        Pregnancy Calculator      www.medicaltoolbox.com                     24.95         14 day free trial
PalmEKG             EKG help                  www.osflifeflight.net                      free
Redi-Reference      Literature review         www.redi-reference.com                     cost varies
Clinical Updates
CodeMeister         ICD9 codes hyperlinked    www.meistermed.com                         19.95         Requires iSilo
iSilo               Document reader           www.isilo.com                              19.95         30 day free trial
CSpotRun            Document reader           www.32768.com/bill/palmos/cspotrun         free
Palm Patient        Patient tracking          www.freewarepalm.com                       free
Patient Tracker     Patient tracking          www.handheldmed.com                        free
Patient Keeper      Patient tracking          www.patientkeeper.com                      35.00         21 day free trial
FireViewer          Really Cool Pictures      www.firepad.com                            29.95         15 day free trial

Medical Images – www.images.google.com, www.hon.ch/Media/anatomy.html, www.mic.ki.se/Medimages.html
Other good web sites – www.pdaMD.com, www.aafp.org/fpnet, www.handango.com, www.tucows.com, www.fppda.com, www.zdnet.com,
www.palmgear.com, www.palmpilotarchives.com, www.palmspot.com



                                     Cordy & Vincent: Palm Reading        May 22, 2004     Page 6
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.,
http://www.handango.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:
•Opening the Palm Desktop software and clicking the Install button or
•Clicking on Start>Programs>Palm Desktop>Install Tool or
•Running Instapp.exe from the Desktop Software directory (e.g., C:\palm) or
•Opening Windows Explorer or My Computer and double clicking on the application.

When the Install Tool 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.

Note: If you have an expansion card you can elect to install the software onto the
card by clicking on the “Change Destination” button on the Install Tool window. Be
aware that many programs will not run from an expansion card, and some
applications (such as texts and eBooks) may require that the “reader” be installed on
the Handheld while the text my reside on the card. Applications installed on the card
are stored in the /Palm/Launcher folder. Data and text files installed on the card will
not be “visible” without the appropriate corresponding reader.




                Cordy & Vincent: Palm Reading     May 22, 2004   Page 7
                               Comparison features of Palm OS Devices (as of 5/6/2004)
                             MSRP1     Memory2      Screen   Expansion3    OS vers       CPU      Other
Kyocera 7135 Smartphone      ~$500     16           Color    MMC & SD      4.1           33 M     cell phone, MP3 player
Palm One Treo 600            $449      32 (24)      Color    MMC & SD      5.2.1H        144 M    cell phone, camera,
                                                                                                  MP3, keyboard
Palm One Zire 21             $99       8 (7.2)      B&W      None          5.2.1         126 M
Palm One Zire 31             $149      16 (14)2     Color    MMC & SD      5.2.8         200 M    MP3
Palm One Zire 72             $299      32 (24)      Color    MMC & SD      5.2.1         312 M    Bluetooth, video
                                                                                                  camera, MP3, voice
                                                                                                  recorder
Palm One Tungsten E          $199      32 (28.3)    Color    MMC & SD      5.2.1         126 M    MP3
Palm One Tungsten T3         $399      64 (52)      Color    MMC & SD      5.2.1         400 M    Bluetooth, MP3, voice
                                                                                                  recorder
Palm One Tungsten C          $399      64 (51)      Color    MMC & SD      5.2.1         400 M    WiFi, keyboard
Samsung SPH i500             ~$600     16           Color    None          4.1           N/A      cell phone
Sony CLIE PEG TJ27           $200      32 (23)      Color    Sony MS       5.2.1S        200 M    camera
Sony CLIE PEG TJ37           $300      32 (23)      Color    Sony MS       5.2.1S        200 M    WiFi, MP3, camera
Sony CLIE PEG TH55           $400      32           Color    Sony MS       5.2.1S        123 M    WiFi, MP3, camera,
                                                                                                  voice recorder
Sony CLIE PEG UX50           $600      104          Color    Sony MS       5.2.1S        N/A      MP3, WiFi, Bluetooth,
                                       (16/16/29)                                                 voice recorder, video
                                                                                                  camera, keyboard
1. Manufacturer’s suggested retail price form web site
2. RAM Memory in MB, with total followed by actual available in parentheses if applicable
3. Abbreviations for Expansion: MMC=MultiMedia Card, MS=Memory Stick, and SD=Secure Digital
                               See notes on next pages for explanation of features, recommendations, etc.




                                       Cordy & Vincent: Palm Reading      May 22, 2004   Page 8
         Notes on table on previous page comparing Palm OS devices:


MSRP: In general, the price quoted on the manufacturer’s web site is similar to that
advertised in major electronic stores. An Internet search may yield some savings
(about 10% to 20% off MSRP) from mail order companies, however shipping
charges will negate some of the savings, and mail order companies may be less
reliable. Models change rapidly. It is not unusual for a model to be on the market
for 12 months or less. Prices and model numbers in the table above are current as
of 5/6/04.


Memory: The total memory (MB or Mega Bytes RAM) listed in the PDA may differ
from actual available memory for software. Much of the total RAM may already be
used by the manufacturer’s proprietary software that is “added on” to the operating
system software. Read the fine print before buying, as you may be getting
substantially less memory than is advertised. The Sony Clie PEG UX50 has only 16
MB (of its total 104 MB) available for software. Another 16 is reserved for backup,
and 29 MB for video memory.


Screen: A color screen is easier to read than a gray scale (B&W), but consumes
more power decreasing the battery life considerably. With a full charge, a color unit
will last an average of 1 - 2 weeks, while the battery life for most gray scale units is 1
- 2 months. All currently manufactured devices use rechargeable batteries.


Most color units support high resolution (320 X 320 pixels), and some offer even
higher resolution (320 X 480 pixels), which is better for viewing digital photographs.
Before buying a device, try to compare the various Palm OS devices at a store that
carries several models. Screen size and brightness, resolution, and device
size/weight 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.




                Cordy & Vincent: Palm Reading       May 22, 2004    Page 9
Expansion: In general, it is a good idea to purchase a device that has expansion
capabilities. All models on the market today have expansion slots except the
following: Palm One Zire 21, and Samsung's SPH-i500. The most common
expansion “module” adds additional memory, though other devices such as, books,
games, wireless adaptors (Bluetooth), 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 at least 16 MB of available
INTERNAL memory (RAM). Prices for memory modules vary by type of card and
manufacturer. Secure Digital (SD) cards are generally a bit less expensive than the
proprietary MultiMedia Cards (MMC), and SONY Memory Sticks.


OS Version: The most current Palm PDA Operating System (OS) is 5.2. In general,
the higher version OS’s offer more features and fewer “bugs.” If you currently use a
Palm PDA, you may have to install a newer version of the Palm Desktop (PC or
Macintosh) software to take advantage of these features.


CPU: Numbers listed in table are Central Processing Unit (CPU) speeds in MHz. In
general, the higher the number the faster the processor. This can make a big
difference when running applications from expansion cards. In my own experience,
upgrading form a Sony with a 33 MHz and Palm OS 4.1 to one with a 200 MHz CPU
and Palm OS 5.2 reduced the time needed to load a program from the expansion
card from 20 seconds to about 1 second. Applications running from the main internal
memory (RAM) are less affected by processor speed.


Other: All current 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.




               Cordy & Vincent: Palm Reading      May 22, 2004   Page 10
Before purchasing a Palm OS PDA, ask your self “how will I use it?” Features to
consider in this decision are: do you want an integrated cell phone? MP3 player?
Camera? Keyboard? The notes below may help making this decision.


Palm One’s TREO 600communicator, Kyocera's smartphone, and Samsung's SPH-
i500 are Palm OS devices with integrated cell phones. Purchase may require
cellular service activation, and therefore price may vary by contract. The Treo
communicator has an integrated (tiny) QWERTY keyboards (“thumb-boards”).
Kyocera's smartphone and Samsung's SPH-i500 use the Palm OS Graffiti, but
Kyocera's smartphone has a flip-up screen and integrated telephone keypad. Palm
One’s Treo 600 and Kyocera's smartphone have expansion capabilities. All PDA
cell phones have integrated microphones and speakers.


Palm One’s Tungsten C, Treo 600, and Sony’s CLIE PEG UX50 have integrated
(tiny) QWERTY keyboards (“thumb-boards”). These may be easier to use if you are
entering lots of data or are an experienced typist. Of these devices also allow the
ueser to enter data via “Grafitti” (handwriting recognition).


Several Palm OS PDA’s have built-in MP3 audio players and/or voice recorders for
playing MP3 songs or for recording short voice memos (see table above). Some
PDA’s also have integrated digital cameras (see table above). Camera resolution is
limited to 310,000 pixels (0.3 mega-pixel) except for the Palmone Zire 72, which is
1.2 mega-pixel. The lower resolution may be adequate for viewing on a computer
screen or printing a 5” X 7” photos. The Sony CLIE PEG UX50and Palmone Zire 72
can record and play videos.


Several Palm OS PDA’s have built-in WiFi or Bluetooth wireless
transmitters/receivers. See table above for devices and
http://www.palmone.com/us/wireless/ProvidingFluidConnectivity.pdf for more details
about Bluetooth and WiFi. In general, if you want to use a PDA to connect to the
Internet, you will want one with WiFi. Bluetooth is used to create a “Personal Area



                Cordy & Vincent: Palm Reading       May 22, 2004   Page 11
Network” (PAN) and is handy if you have several other Bluetooth enabled devices
such as a printer or cell phone.


                      Hardware Comparison Web Sites:
Palm One:
http://www.palmone.com/us/products/compare/
SONY (decision guide):
http://st.adiho.com/cu/clients/sonyelec/hp_decisionguide_clie.html

                 PDA (Personal Digital Assistant) Glossary
802.11b: A wireless (radio wave) technology (See WiFi below).
Application: A software program that performs one of the important tasks for which
the PDA is used.
Beaming: Transferring data or an application from one Palm OS PDA to another via
the infrared port. PDA's must be within 4 feet of each other.
Commercial Software: Software that must be purchased before use. There is
usually no "trial" period available before the customer must spend money for the
product. Commonly done with electronic medical textbooks.
Bluetooth: A wireless (radio wave) technology that allows several devices (eg PDA,
cell phone, printer) to transmit or receive data within a short range (about 30 feet).
See http://www.palmone.com/us/wireless/ProvidingFluidConnectivity.pdf for more
details.
Cradle: The device in which a handheld is placed to synchronize data with a
desktop computer. The cradle connects to the desktop computer via a cable and
plugs into the serial or USB (Universal Serial Bus) port.
Expansion Module: PDA hardware "accessory" that increases the handheld's
functionality. Common expansion modules include memory cards, games, and
textbooks. Module plugs into an expansion slot in the PDA.
Expansion Slot: A nook or hole in the PDA that accepts expansion modules.
Freeware: Software application distributed free of charge. Caveat - may not be
thoroughly tested and may not work on all PDA's.
Handheld Computer: See PDA
HotSync: The process in which data is transferred and synchronized between a
Palm OS device and a desktop computer. "HotSyncing" also installs applications
onto the PDA.
Memory Card: A small rectangular "card" that is inserted into an expansion slot in
the PDA to increase the devices total storage capacity. Common memory cards are
Secure Digital (SD), MultiMedia Card (MMC), and SONY memory stick. See also
"Expansion Card."
Operating System/OS: (eg. the Palm OS) Software that enables a PDA to create
an environment to run applications.



               Cordy & Vincent: Palm Reading      May 22, 2004   Page 12
Palm OS: The operating system used on Palm Pilots, TREO's, SONY CLIE's, and
others.
PDA: Personal Digital Assistant - a wide variety of handheld and palm-size
computers, electronic organizers, and sophisticated pagers and cell phones.
Platform: The collective group of hardware, software, and accessories that relate to
a particular operating system.
RAM: Random Access Memory. Temporary storage for computer applications
(typically user-installed programs and data). Data is lost when battery power is
removed.
ROM: Read Only Memory. Used for static information on computing devices,
typically built-in applications and the operating system. Data is preserved even
when battery power is removed.
Shareware: "Try before you buy" software. Usually either a time-limited demo or a
"crippled" version of the product. In both cases, the customer must register (pay for)
the product in order to utilize all of its features for an unlimited time.
WiFi: Also refered to as 802.11b. A wireless (radio wave) technology that allows a
PDA to transmit or receive data within a range of about 300 feet. Often used to
connect to the Internet via a WiFi “Hot Spot.” See
http://www.palmone.com/us/wireless/ProvidingFluidConnectivity.pdf for more details.

Glossary adapted from: Nace GS, Willyard KE. PDA Basics. Oncology net guide
2002;3(4):5-10 www.mdnetguide.com




               Cordy & Vincent: Palm Reading     May 22, 2004   Page 13

				
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