Recommendations for Handheld Hardware and Software Dalhousie

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Recommendations for Handheld Hardware and Software Dalhousie Powered By Docstoc
					      Recommendations for Handheld Hardware and Software
   Dalhousie University Faculty of Medicine – March 2002, 2nd edition
            1. Rationale ......................................................................................... 1
            2. PalmOS vs. PocketPC ............................................................. 2
            3. Recommended Hardware................................................................ 3
            4. Recommended Software................................................................. 4
                    Medical Textbook........................................................................ 5
                    Drug Reference ........................................................................... 6
                    Infectious Disease Reference ......................................................... 7
                    Evidence-Based Medicine Reference........................................................ 7
                    Medical Calculators ..................................................................... 8
                    Document Reader ........................................................................ 8
                    Image Viewer ............................................................................. 9
                    Database Program........................................................................ 9
                    Security Program ....................................................................... 10
                    Web Browser ............................................................................ 10
                    Utilities ................................................................................... 11
                    Patient Tracking ........................................................................ 11
                    What’s Not On The List .............................................................. 11
            5. Optional Software......................................................................... 12
            6. Bundle Pricing Summary.............................................................. 12
            7. Synchronization Issues ................................................................. 13
            8. Network & Wireless Connectivity................................................ 13
            9. Suppliers and Support................................................................... 14
           10. Selected Web Links ...................................................................... 14
           11. Disclaimer and Copyright ............................................................. 15
           12. Members of the Palm Committee ................................................. 15
           13. Contacts ........................................................................................ 16

1. Rationale

Handheld computers are becoming an increasingly useful tool in medical education and practice.
Often known generically as “Palm Pilots” (although in fact that refers only to early units running
the Palm operating system, or PalmOS ), they are best known for their built-in scheduling, to-do
list and address book features. They are also, however, capable of running a huge variety of
medical software, from drug references and textbooks to medical calculators and image viewers.

In contrast to desktop or even laptop computers, handhelds are very small and light, offer the
convenience of “instant-on” and a relatively long battery life, and are much more rugged (no
moving parts). These features make them well-suited for the demanding healthcare environment.
Recent models now even offer features such as voice recording, high-resolution screens, memory
expansion slots and wireless modems—more computing power than flew on Apollo 11!


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In recognition of their capabilities, of the fact that many of the students, faculty and staff of the
Dalhousie University Faculty of Medicine are already using them, and of the exponential growth
of their use in other medical schools and healthcare institutions, a committee was formed in
January 2001 for the purpose of putting together this recommendation document. Our primary
goal is to provide recommendations for the use of handhelds in medical education. In addition,
we will work with the Personal Computer Purchase Centre and Medical Society of Nova Scotia to
promote the program, obtain discounts on hardware and software, and provide training and
support.

Everything in this document is a recommendation, not a requirement. The recommendations
made here are based on the best information available at the time of writing, but models, prices,
version numbers, and website addresses can change at any time, and may not be up to date. All
recommendations should be independently researched and verified to make sure they are the best
choice for your particular situation and needs. We encourage your feedback on the contents of
this document, so that future versions can contain the best and most accurate information
possible.

2. PalmOS       vs. PocketPC

There are a variety of different types of handhelds on the market today, which can make the
purchase decision quite complicated. The decision really boils down to which of the two leading
handheld operating systems (OS) you want to go with—that choice will define all your other
choices with respect to hardware, software, and peripherals. Our strong (and unchanged)
recommendation is to standardize on the Palm operating system (or PalmOS ), for a number of
compelling reasons:

       At 73% it has the highest overall market share (over 80% in healthcare)
       It is very simple to learn and use, and is optimized for the small screen
       Handhelds using it have much longer battery life than their competitors
       It still has the widest variety of 3rd-party add on applications available

For more information, visit the Palm, Inc. website at http://www.palm.com/. The most important
competitor to PalmOS is Microsoft’s PocketPC operating system (formerly WindowsCE ),
which does have certain advantages over the PalmOS in terms of multimedia and Windows
integration, and is becoming more popular. That said, it is also more expensive, and not nearly as
widely used or accepted in medical circles. We have also found that PocketPCs tend to be
significantly more complex than Palms to set up and use, and that people that use them tend to be
(probably by necessity) technically proficient. Many even own one of each! Many recommended
software titles are now available for both platforms, though the PalmOS is still in the lead.

The latest version of the PalmOS is version 4.x, which is in use on the Palm m500 line.
Version 5, with support for more powerful processors, enhanced multimedia, and built-in
wireless, is on the way, though we probably won’t see commercial models for another year or so.
HandEra and HandSpring (and some other clones) use proprietary versions of PalmOS 3.5


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which contain key features from version 4.x (especially the Virtual File System), and most
applications will run on any unit running PalmOS 3.0 or above (though there are exceptions).

The operating system is stored in ROM (read-only) memory, which is separate from the RAM or
working memory that applications are stored in. One issue that sometimes arises is the fact that
the ROM in models produced by Palm and HandEra are “flashable,” meaning that it is possible to
upgrade the OS on them when new versions come out. Handspring does not offer flashable ROM
on its models; however, the useful life of a PalmOS handheld is so short that an OS upgrade is
not often necessary—and even then, should only be attempted by a very technically-adept user.

3. Recommended Hardware

Once you have decided to standardize on a PalmOS handheld, your next choice is what specific
make and model to purchase. Because prices can range from $200 to over $1000, this can be a
daunting decision to make—and it’s made even more difficult by the fact that new models and
pricing are announced almost every month! To make it easier, here are six guidelines:

       a. Consider “clones.” Palm Inc. makes a wide range of PDA models, from their low-end
       m100 to their high-end m505 (with many in between). Their quality is high, but so are
       their prices. We highly recommend that you consider the “clone” PalmOS
       manufacturers:
               Handspring (Palm’s major competitor)– http://www.handspring.com/
               HandEra (formerly TRGPro) – http://www.handera.com/
               Sony (with their Clie line) – http://www.sony.com/

       b. Get a minimum of 8 megabytes of RAM (“working”) memory. Medical references
       are large, sometimes from 3MB to 4MB in size, and a 2MB unit will fill up immediately.
       Most midrange PalmOS units come with 8MB of RAM memory—don’t settle for less!
       And if at all possible, get one of the new 16MB units, like the Handspring Visor Pro.

       c. Get expandability. Because even 8MB or 16MB of memory can fill up fast, we
       strongly recommend that new purchasers to get a model which includes a VFS-compatible
       memory expansion slot of some kind. Handspring offers a proprietary “Springboard” slot
       on every model, Palm offers the open-standard Secure Digital (SD) memory card slot on
       their new m500 and m505 models, and Sony’s use the proprietary MemoryStick
       expansion cards. Only HandEra offers both Compact Flash (CF) and SecureDigital open-
       standard slots on their HandEra 330. Not all programs can be moved to expansion
       memory, but many static reference works can—check with the software publisher for
       details.

       d. Don’t try to predict the future. In our experience, most PalmOS units will have a
       maximum useful life of two years or less, due to wear and tear and rapid technological
       change. It’s not worth spending months shopping around for something that will last for
       four years—our advice is simply to buy the most powerful and expandable unit you can
       afford now, knowing that things will inevitably change.

  2002 Dalhousie University Faculty of Medicine          Palm Recommendations – Page 3 of 17
       e. Color is nice, but not essential. For example, if your choice is between a color unit
       with no expandability option or an expandable monochrome unit, we highly recommend
       that you choose the latter. A number of models (the HandEra, and some Sony’s) now have
       high-resolution monochrome screens, which experience has shown to be very usable.

       f. Consider peripherals before buying. There are many add-on peripherals available for
       PalmOS units, from modems and keyboards to MP3 players and digital cameras. Most,
       however, are designed for specific makes and models: for example, a modem designed for
       the Palm IIIxe will not fit on a Handspring Visor, nor will a Handspring keyboard work
       for a Palm Vx. Keep this in mind when purchasing—or, more importantly, upgrading!

At the time of writing (March 2002), the lowest-priced 8MB PalmOS handheld with memory
expansion capabilities is the Handspring Visor Neo, priced at approximately $299 CDN (or
even lower). The Neo replaced the earlier Visor Deluxe and Platinum models. If you can afford
an extra $100 or so, the Handspring Visor Pro is the first PalmOS handheld available with
16MB of built-in memory, making it extremely attractive for medical use. Both are available at
PCPC.

The HandEra 330, with its Compact Flash and Secure Digital card slots, voice recorder and
high-resolution monochrome screen is very popular with doctors, residents and students. In
Canada it's available from PCPC or from www.handheldinterfaces.com., and costs approximately
$500.

The Palm m500 (mono) and Palm m505 (colour) are popular choices, have a stylish design, the
latest OS (4.0) and memory expandability via their SecureDigital (SD) card slot. At over $600 for
the m505, they also have the distinction of being among the most expensive units around.

The new Palm i705 model has wireless connectivity built in, though currently only on US-based
networks; and a new m515 model with color and 16MB will soon be replacing the 505. The
lower-end m125 has 8MB of memory as well as SD expansion (the m130, also with 8MB, is due
out soon), but its smaller screen makes it less desirable than the m500 or Handspring Visors.

Finally, Sony, a relative newcomer to the field, has a range of very attractive PalmOS
handhelds, both monochrome (like the Sony PEGS-320 at $300) and colour (like the Sony
PEGT-415 at $400), with the proprietary MemoryStick expansion slot. Some new 16MB models
have just been announced as well. If you own a lot of other Sony gear (digital cameras, MP3
players, laptops) then you may find the MemoryStick very useful; but otherwise, you may find it
quite limiting.

Note that the older Palms (IIIxe, Vx, IIIc and m105) all have 8MB of memory, but have no
expansion slots, taking them out of the running (along with low-end 2MB units like the Palm
m100 and regular Visor). There are also refurbished TRGPro and Visor Deluxe units available,
and you may find very good deals on these units, but remember—you get what you pay for! In
these cases, you’ll get a PDA that will probably seem old the first day you use it.

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Finally, no matter what make or model you purchase, keep in mind that although Palms don’t
contain any moving parts, they are nonetheless a relatively delicate and fragile piece of
technology. Screens break, styli get lost, and units can die completely when they get too hot, too
cold, or too wet. So, we recommend that you get some kind of padded case to keep your unit in,
that you keep it with you at all times (don’t leave it in your car), and that you take care not to drop
it or use it to hammer in a nail. If you need a rugged PDA, take a look at
http://www.symbol.com/.

4. Recommended Software

There is a huge and rapidly-growing selection of medically-related PalmOS software available,
which makes the selection of PalmOS hardware seem easy by comparison! To simplify things a
bit, we have researched the available software and have made ten specific recommendations that
make up the “software bundle” that is available from PCPC.

In this edition we have also included some alternative options in two major categories which may
be better suited to some uses; and have added a couple of new categories (Infectious Disease and
Evidence-Based Medicine) which are for reference only, and are not offered as part of the bundle.

       Note that the Faculty of Medicine is strongly opposed to the use of unlicenced or
       black market software, cracks, and so-called “warez.” We firmly believe that
       sharing illegally obtained software is behaviour that is inappropriate for physicians.

Keep in mind that these recommendations are based on the informed personal opinions of the
members of this committee, and are not official endorsements by the Faculty of Medicine. Also,
these recommendations are geared more towards medical education than clinical practice.

a. Medical Textbook

                             Harrison’s Handbook 14e ($)
                             http://www.handheldmed.com/
                      1,070 KB for the book + 111 KB for the reader

We have two recommendations in this area, the primary one (Harrison’s Handbook) an option
suitable for undergraduate medical students, and the other (Washington Manual) a reference
geared more towards residents and practicing physicians. The Harrison’s Handbook is included
in the software bundle, while the Washington can be purchased directly from the Skyscape
website.

The digital version of the Harrison’s Handbook, by HandHeldMed ( www.handheldmed.com ), is
from a content and technical standpoint one of the best general electronic textbooks currently
available. The print version is already in use in our medical education curriculum, so it fits in well
with the COPS cases. Note that you need the free HandHeldMed Reader program to read this


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book, which can be used to read other HandHeldMed titles (there are many good ones for a wide
variety of specialties). Also available for the PocketPC .

Skyscape ( http://www.skyscape.com ) was an early leader in the Palm medical reference space,
and offers a wide range of medical references, including a version of the Washington Manual
(1.5MB, for $59.95 US), the latest 2002 edition of Griffith’s 5 Minute Clinical Consult (3.8 MB,
$64.95), and drug references such as DrDrugs. There are also good emergency and pediatric
titles, and most are available for the PocketPC as well.

A third publisher to consider is Franklin ( http://www.franklin.com/ ), who produce PalmOS
versions of popular titles like the Merck Manual, as well as drug references like the PDR, medical
dictionaries, and “Pearls” titles. Although less attractively designed than HandHeldMed titles,
they are still pretty good value, and some titles are even available in Springboard module format.
The free Franklin Reader is required to read any Franklin title. Also available for the PocketPC .

Finally, a highly recommended reference for medical students as well as emergency physicians is
the Portable Emergency Physician Database, or PEPID, available at http://www.pepid.com/.

b. Drug Reference

                                      DrDrugs($)
                               http://www.skyscape.com/
                                       1,900 KB

We have two recommendations in this area, one (DrDrugs) a lower-priced option suitable for
undergraduate medical students or those limited to 8MB of memory, and the other (LexiDrugs) a
higher-priced but also more powerful option for residents and physicians, especially those with
memory expansion cards. Both contain a wealth of accurate information, show Canadian trade
names and availability, and provide updates without sending personal data to the publisher.

Out of the wide variety of highly-regarded PalmOS drug references available, our research
shows thatDrDrugs from Skyscape ( http://www.skyscape.com ) is still one of the best, though
LexiDrugs has now surpassed it in a number of ways. However, DrDrugs is relatively
inexpensive, (approximately $49.95 US), is less than 2 megabytes in size, does not return usage
information to the publisher, and does includes Canadian product names and availability. A well-
integrated drug interaction package named iFacts is also available for $69.95 US (but it’s 2.8 MB
in size). In the previous version of this document, this was our only recommendation, since
LexiDrugs Platinum was not available; we still rate it highly. Also available for the PocketPC .

After a hiatus of nearly a year, Lexi-Comp ( http://www.lexi.com ) have recently returned to the
market with their LexiDrugs product, generally regarded as the best electronic drug reference
available. LexiDrugs Platinum ($75 US) is the core drug reference, and LexiInteract ($75 US) is
an add-on program that allows you to review a comprehensive list of interactions associated with
any individual drug. Together, the titles can take up to 6.5 megabyes, making use of a memory
expansion card pretty much essential (it fully supports the use of Handspring flash memory

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expansion, SD or CF cards, and the Sony MemoryStick). Canadian trade names are included (in
the “Comprehensive” view), as is a subscription allowing unlimited updates (to update, a
complete re-installation is necessary). If the two titles are purchased at the same time on their
website, the cost of the second will be reduced to $40 US; in addition, students, residents, and
faculty are eligible for rebate of $10 off the first and $5 off each additional handheld database. A
fully functional demo version is available. Not yet available for the PocketPC .

ePocrates Rx 4.0 ( http://www.epocrates.com/ ) is one of the best-known Palm drug references,
and although it is free (and therefore very popular), it has 3 major strikes against it. First, the
version that we reviewed contained some outdated or incorrect data (especially concerning
generic drugs and mechanism of action). Second, it contains no Canadian data or trade names at
all. And third, it includes a component (AutoUpdate) which, at every HotSync, returns to the
publisher a list of the drugs that have been looked up. Although it has its deficiencies for medical
education purposes, it remains a widely-used, user-friendly and generally well-regarded reference,
and its drug interactions feature (Multicheck) is very popular. Many people, if they have enough
free memory, will run this as well as another program, and will cross-check between them. Not
available for the PocketPC .

c. Infectious Disease References

        Note that these titles are not currently offered as part of the software bundle.

This is a new category, in which our preliminary recommendation is the Sanford Guide to
Antimicrobial Therapy (http://www.sanfordguide.com/ ), the recently-released digital version of
the world's leading antimicrobial reference. The PalmOS edition of The Sanford Guide contains
all the content of the print edition, takes up 1,500 KB of memory, and costs just $25 US from the
website. On the down side, it does suffer somewhat from usability issues, though the second
edition is better. To save space, the database portion of the program can be moved to memory
expansion (flash memory, SD or CF cards, or MemoryStick). Also available for the PocketPC .

The main competition to the Sanford Guide is ePocrates ID 1.0 ( http://www.epocrates.com/ ),
which calls itself “the fastest and most complete infectious disease application for Palm OS
handhelds.” It’s free, integrates tightly with ePocrates Rx, contains information on “over 400
bugs and 400 drugs” and takes up less than 450KB of memory. It is not nearly as authoritative as
the Sanford Guide, and is not available for the PocketPC . Finally, another free infectious
disease reference (which we have not evaluated, but hope to soon) is the Johns Hopkins
Antibiotic Guide (http://www.hopkins-abxguide.org/ ), which appears quite comprehensive and
authoritative, and is available for both the PalmOS and PocketPC . It does, however, require
registration, and an agreement that your personal information may be used for marketing
purposes.

d. Evidence-Based Medicine References

        Note that these titles are not currently offered as part of the software bundle.


  2002 Dalhousie University Faculty of Medicine             Palm Recommendations – Page 7 of 17
MedRules (http://pbrain.hypermart.net/medrules.html ) is a popular, free EBM tool featuring
useful clinical prediction rules taken from the medical literature, ranging acute sinusitis to UTI
diagnosis, with additional rules being released occasionally. It requires about 330 KB of memory
(including its required libraries), and is not currently available for the PocketPC .

Other than MedRules, there are no standout full-text EBM references for the PalmOS . The best
that we have found is Medical InfoRetriever (http://www.medicalinforetriever.com/ ), which is
only available for the PocketPC (or for desktop Windows 95/98/2000 computers). This very
impressive reference work includes hundreds of InfoPOEMs, abstracts from the Cochrane
database, clinical prediction rules, evidence-based guidelines, and much more. No PalmOS
version has been announced, and we have been told that limitations in the PalmOS make one
unlikely; however, the newer versions of the PalmOS are much-improved, so we still have
hope.

The Center for Evidence-Based Medicine, funded by the Mount Sinai Hospital in Toronto ON
(http://www.cebm.utoronto.ca/ ) has a number of free titles available for the PalmOS , including
an EBM Calculator designed to “calculate relevant statistics for Diagnostic studies, Prospective
Studies, Case Control Studies, and Randomized Control Trials (RCT)” as well as a set of EBM
tables including Number Needed to Treat, Likelihood Ratios, and Sensitivity and Specificity.

e. Medical Calculators

                                    MedCalc (free)
                      http://www.collectivemed.com/p_medca.html
                                         240 KB

                                              AND

                                     MedMath (free)
                                 http://www.pdamd.com/
                                          37 KB

Of the hundreds of medical calculators available, these two freeware medical calculators are the
most useful, and widely-used, and are therefore our recommendations. Although there is some
overlap between the two, each has different strengths; MedCalc in particular has a feature where
calculation results can be saved under a patient’s name, for future reference.

Of the variety of more specialized calculators, PregCalc Pro ( http://www.medicaltoolbox.com/ )
for pregnancy calculations, DoseCalc ( http://pocket-doc.com/ ) for drug dosage calculations, and
ABGPro (http://www.stacworks.com/ ) for arterial blood gas calculations are the most widely-
used, most of which are freeware or shareware. Rarely will a calculator program cost more than
$20 US. Finally, make sure to install the ParensLite calculator that comes as an add-on with all
Palms, rather than using the simplistic built-in Calc.

f. Document Reader

  2002 Dalhousie University Faculty of Medicine            Palm Recommendations – Page 8 of 17
                            DocumentsToGo Pro 4.0 ($)
                               http://www.dataviz.com/
                      650 KB for the program, more for documents

For document readers, we have looked at many Palm DOC readers and desktop companions. But
in the end, DocumentsToGo reads Palm DOC documents as well as Word, WordPerfect, Excel,
and now even PowerPoint and PDF (Adobe Acrobat) files. You can even edit documents with it!
It’s not a “full-featured” word processor like WordSmith ( http://www.bluenomad.com/ ), which
is very highly-regarded, or a mini-office suite like QuickOffice ( http://www.cesinc.com/ ) but for
real-world use on a handheld, it’s very useful. Note that QuickOffice is included with the
HandEra 330, and that an earlier version of DocumentsToGo standard edition is included with the
m500 and m505—but we still highly recommend DocumentsToGo Pro 4.0 for the sake of
compatibility.

iSilo Free 1.5 is a document reader that uses HTML to save 20% more memory than the standard
doc format. Many free documents of medical interest are available in this format, and a free
converter app named iSiloX is available to convert existing HTML and text files to the iSilo
format. Although the free version of the reader is still available on an old website, the latest
reader, version 3.05 can be purchased on the web for only $17.50 US. ( http://www.isilo.com/ )

g. Image Viewer

                               FireViewer Suite 6.0 ($)
                      http://www.firepad.com/products/fireviewer/
                        162 KB for the program, more for images

Let’s face it: monochrome Palms are not a very good for viewing many images. The low screen
resolution of most units and the lack of colour make photos grainy and hard to see. However,
some lower-resolution images (maps, charts, and diagrams) work fine, and the addition of colour
and higher resolution screens is starting to make even colour photographs look good.

FireViewer is one of the best image viewers available for the PalmOS —the viewer itself is
free, but the FireViewer Suite 6.0 also comes with FireConverter, a Windows program for
converting regular images (.bmp, .gif, .jpg) into images that can be viewed on the Palm.
However, note that you can’t actually do any drawing with this program—for that, you will need
something like TealPaint ( http://www.tealpoint.com/ ). But experience has shown that is usually
easier to create images on the desktop, and to use the Palm as a viewer. FireViewer may not
support the HandEra or Sony high-resolution screens yet.

Recently, graphics software has started to be bundled with certain PalmOS models. For
example, the MGI PhotoSuite Mobile Edition, which has basically the same functionality as
FireViewer Suite, is now included on Palm m500 and m505 handhelds, and Sony bundles some
proprietary graphics software on their Clies. However, for the sake of compatibility, we still
recommend the use of FireViewer, so that you will be able to share images freely with others.

  2002 Dalhousie University Faculty of Medicine            Palm Recommendations – Page 9 of 17
h. Database Program

                                HanDBase Plus 2.75 ($)
                             http://www.ddhsoftware.com/
                       186 KB for the program, more for databases

In databases, HanDBase ( http://www.ddhsoftware.com/ ) is our clear recommendation because
of the number of medical databases available in this format; its ease of use, simplicity, and speed;
its PocketPC compatibility; the fact that it supports semi-relational databases (where JFile
doesn’t); and the fact that the desktop application and conduit are easier to use and seem more
stable than ThinkDB. It integrates well with Windows computers via a desktop “companion”
program and conduit (both included in the “Plus” package), and a special ODBC conduit is
available for $49.95 if you want to link HanDBase directly to Access databases.

Once you have HanDBase, the next step is to find some databases that you can download and
view. A huge variety of databases are available at the ddh Software website, including ICD9 and
other coding databases, anatomy databases, herbal drug references, and many more. Many are
free, but some do cost money, so make sure to check. But one of the great advantages of using
HanDBase is the ease with which you can create databases of your own.

i. Security

                                    TealLock 3.50 ($)
                                http://www.tealpoint.com/
                                         63 KB

The Palm's standard security application is too cumbersome to use, and is very easy to break into
using applications that are available freely on the Internet. TealLock replaces it with a powerful
and flexible system with many activation and customization options, essentially giving your Palm
the same type of PIN security your bank uses for ATMs. And the cost of TealLock is also very
low when compared to similar programs that cost $49.95 or more. In medicine, data security is
not an option, it is essential; all Palm users at the Faculty of Medicine, especially those
doing clinical work, should definitely own and use TealLock, with or without the bundle.

j. Web Browser

                                    AvantGo (free)
                               http://www.avantgo.com/
                       290 KB for the program, more for channels

AvantGo is an offline web browser that allows you to bring web content onto your Palm every
time you synchronize. AvantGo is actually a combination of software that you install on your
Palm, and an account that you set up on their website, which is where you identify the website (or
“channels”) that you want to view. The software is also available for the PocketPC .

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A huge variety of websites have optimized channels available to AvantGo users, from general
interest news sites to specialty medical sites. Even some of the most respected medical journals,
such as the New England Journal of Medicine and British Medical Journal, make their abstracts
available in AvantGo format: to get them, visit http://www.handheldmed.com/. In addition, the
Canadian Medical Association ( http://www.cma.ca/ ) has started a channel, with news and CME,
and under the “Coming Soon” banner they mention a “downloadable drug database.”

The DalMedix intranet has its own AvantGo custom channel available, allowing users to take
news and notices, undergraduate student schedules, a faculty email/phone book, and even
departmental calendars with them on their Palm. In the future, this channel may also be used to
distribute clinical practice guidelines, formulary, and other information common to Faculty of
Medicine users. Instructions for setting up this channel can be found in the Instruction Sheets
folder of the Palm Support File Library on DalMedix (www.med.dal.ca).

The bad news is that, as this document was being finalized, AvantGo announced its plans to cut
off its heavily-used free custom channel service, and to charge for all custom channels with 8 or
more subscribers (including non-profit and educational institutions like us). This may affect the
selection of 3rd-party channels available, and may also mean a change in DalMedix channel.
Again, updates will be available in the Palm Support area of DalMedix.

k. Utilities

                                  BackupBuddy 1.4 ($)
                               http://www.bluenomad.com/
                                        290 KB

BackupBuddy backs up everything on your Palm much more thoroughly than the built-in Palm
backup routine does (including all 3rd-party applications), and also checks for viruses, allows full
beaming of anything on your Palm, and syncs the Palm to your computer’s clock. This is a must-
have application; it will pay for itself the very first time you drop your Palm and lose all your
data! Note: this program conflicts with ePocrates AutoUpdate (which you can turn off), and you
do of course need a computer to sync with, unless you are using the VFS version and are backing
up to expansion memory like a CompactFlash, SecureDigital or MemoryStick card.

l. Patient Tracking

There is no clear winner in this category, so we do not currently have a recommendation to make.
Most of the products available are either too expensive, too specialized, too americanized, or too
complex to be of general interest or use at the Faculty of Medicine. Some of the options include
PatientKeeper (http://www.patientkeeper.com/), PatientTracker (http://www.handheldmed.com)
and WardWatch (http://www.torlesse.com/).

The Palm committee is currently working on a plan to create a customized patient tracker for use
by Dalhousie medical students and residents using hanDBase, making the widespread use of a

  2002 Dalhousie University Faculty of Medicine            Palm Recommendations – Page 11 of 17
standard database program like this much more important. A package something like HandEchart
( http://www.ddhsoftware.com/products.html ) may work, though some customization may be
necessary. More information on this project will be posted in the Palm Support area of DalMedix
when it becomes available.

m. What’s not on the list

First, although there has been a lot of talk about viruses for the PalmOS , we have still not yet
actually seen such a virus “in the wild” and do not consider it necessary to purchase on of the
PalmOS virus checker programs currently available. This may change in the future.

Second, we have not recommended any Personal Information Manager (PIM) synchronization
programs, because there are too many different systems and configurations in use out there to
recommend any specific solution. In our experience, the conduits for Outlook, Outlook Express,
Groupwise, Exchange, and MeetingMaker seem to work fine (once properly configured).
However, you are unfortunately still limited to syncing to a single account—you won’t be able to
sync to Groupwise from the hospital and then MeetingMaker from your campus office.

A final category that we have avoided are those programs that require additional hardware in
order to operate, such as the ActiveECG cardiac monitor.

5. Optional Software

By design, the list of recommended software doesn’t include optional interface enhancements,
system add-ons, and other special-purpose tools, which are much more dependent on personal
taste, preference, and needs. For power users, here are some possibilities:

       Launch’Em ($) is an improved program launcher that allows you more control over how
       you organize and access your Palm program. ( http://www.synsolutions.com/ )

       DiddleBug (free) is a simple little freehand drawing and alarm/reminder program that
       some people can’t do without.
       (http://www.palmgear.com/palm/product.cfm?prodID=3457)

       Z’Catalog ($) is a file manager, giving you a complete view of the software installed on
       your Palm. ( http://www.eblong.com/zarf/zcatalog.html )

       Bonsai Outliner, ($) from Natara software, is a hierarchical outliner that can be very
       useful for recording clinical guidelines and other structured text, and can synchronize to a
       desktop application as well. ( http://www.natara.com/ )

       If you want to be able to print from your Palm, some possible solutions include TealPrint
       ($) ( http://www.tealpoint.com/ ) or PalmPrint ($) (http://www.stevenscreek.com/palm ).

6. Bundle pricing summary (as of March 4, 2002)
  2002 Dalhousie University Faculty of Medicine           Palm Recommendations – Page 12 of 17
Based on the software recommendations listed above, here is the estimated price of the software
bundle and the financial savings (not to mention the savings in time) to be had by purchasing the
bundle at the Personal Computing Purchase Centre (PCPC), rather than separately:

           Core software bundle
           7 commercial titles, 3 free titles

               o Retail cost: $488.00 CDN
               o PCPC cost: $390.00 CDN

Note that because most of the titles are listed in US dollars, the current retail cost in Canadian
dollars is an estimate based on the current exchange rate, and may vary.

For professional users with a need for more advanced references—and also, not incidentally, with
memory expansion cards to provide more space—the following recommended titles are available
directly from the publishers’ websites:

           Washington Manual, Skyscape ( www.skyscape.com ) - $59.95 US
           Griffith’s 5 Minute Clinical Consult, Skyscape ( www.skyscape.com ) - $64.95 US
           LexiDrugs Platinum and LexiInteract ( www.lexi.com ) - $75.00 US each

7. Synchronization Issues

PalmOS handhelds are designed to synchronize (or “hot sync”) easily with a desktop computer,
a process which installs new software, backs up the data the handheld contains, and ensures that
the data on both devices is consistent and up-to-date. Through a desktop computer, they can also
be set up to sync with networked applications such as email and schedule servers (MeetingMaker,
GroupWise). Because of the wide variety of hardware in use, no central sync server or cradle
bank is currently available at the Dalhousie Faculty of Medicine; so, to synchronize your
PalmOS handheld, you must have a computer of your own to sync it to, either at home or
your office. Any reasonably recent PC or Mac computer with a serial or USB port will work
(Handspring Visors come with USB cradles, older Palms with serial cradles).

8. Network & Wireless Connectivity Options

Much of the activity in the handheld market today centres around network connectivity, whether
it’s wireless internet access (the Palm i705), always-on text paging (the RIM Blackberry), the
integration of PDAs and cellphones (the Handspring Treo), or even traditional dial-up or Ethernet
network access using add-on cards. This is a very interesting and potentially revolutionary area,
but in our experience wireless is not yet ready for general use unless you have the time, the
money, and the technical skills necessary to get it working. For most people, we recommend a
“wait and see” approach, until the equipment is more widely available and easy-to-use.



  2002 Dalhousie University Faculty of Medicine             Palm Recommendations – Page 13 of 17
Low-speed internet access over the MTT CDPD (cellular data) network (called their WireFree
service, http://www.mtt.ca/Mobility/Wirefree/ ) has been widely available in the region for some
time, but with a maximum speed of 19.2 kbps, we have not been able to identify a common
medical education use that would justify the reasonably high monthly cost ($49.95 for the Web
service, plus per-minute charges) as well as the cost of buying a pricey Minstrel modem.

A new GSM / GPRS digital network currently being installed in the region by Rogers AT&T
(http://www.rogersatt.ca/ ) has some potential, as GPRS networks provide “always on” Internet
connectivity, and speeds can reach 128 kbps. However, although some GSM phones are
available, coverage is still quite limited, and neither the Treo or RIM Blackberry, nor the
“Portage” add-on kits for connecting a Palm to the GSM phone are yet available (though the
older, near-obsolete 9600 kbps Portage kits are still being sold—stay away from them!).

Keep in mind that the network access necessary for the i705 to work is not currently available in
Canada, although US marketing would lead you to believe otherwise. Currently, the only really
easy-to-use wireless handheld available in this region is the RIM Blackberry, available from a
number of providers. The only drawback is that the Blackberry is a proprietary unit and does not
run the PalmOS , so you would need to carry two organizers in order to be able to take full
advantage of both. That said, the Blackberry 957, with a screen about the same size as PalmOS
units, is a very capable unit, and can be used for paging, email, and even for surfing the web
(although websites really need to be specially design to work properly on it). The cost, with one
year of network service, is approximately $550.

Finally, the lowest-cost option for getting Internet connectivity on your PalmOS handheld is to
get a regular phoneline modem (get the one appropriate to the make/model you’re using), and
then use it to access your existing dial-up Internet account (such as Premium Dialup, Sympatico,
etc.). With a program like MultiMail or OneTouch Mail, you will be able to send and receive
email from any POP3 email account, and with AvantGo or Handspring’s Blazer 2.0 web browser,
you will be able to visit websites (though they won’t look very good unless they’ve been designed
for handheld use). Ethernet network cards for PalmOS handhelds are also available, but are
obviously only useful when you are in a location with a network that you can plug into—and in
those cases, a desktop computer will usually be available as well, and would be much preferable.

9. Suppliers and Support

The Dalhousie Personal Computer Purchase Centre (PCPC), located in the basement of Howe
Hall, on the Dalhousie University campus in Halifax, is the official supplier for most of the
hardware and software recommended in this document. The PalmOS hardware and software
that they carry is available to anyone, whether or not they are connected with Dal, and no matter
what the location (they deliver!). For more information, call 494-2626 in Halifax, (888) 757-
PCPC outside of Halifax, or email pcpc@dal.ca.

The Medical Computing and Media Services (MCMS) division of the Faculty of Medicine will
provide front-line support to Palm users at the Faculty of Medicine, via phone at (902) 494-1234
or toll free at 1-866-327-8256, or by email at mcms@dal.ca. Note that MCMS can only support

  2002 Dalhousie University Faculty of Medicine           Palm Recommendations – Page 14 of 17
the day-to-day use and configuration of Palms, and cannot repair broken hardware or sell
products or peripherals. For that, contact PCPC or the store you bought your hardware at.

The Medical Society of Nova Scotia is working with us to obtain good bulk discounts on Palm
hardware, to provide training, and to generally promote the use of Palms as a tool in the practice
of medicine in the province of Nova Scotia. Detailed information about the Society’s activities in
this area, and other services, are available on their website at http://www.doctorsns.com/.

10. Selected Web Links

       PalmOS Hardware Manufacturers
          www.palm.com
          www.handspring.com
          www.handera.com
          www.sony.com

       Experienced Clinical User & Medical Schools
          www.jimthompson.net (Dr. Jim Thompson, Prince Edward Island)
          www.library.utoronto.ca/medicine/med/tau/index.htm (U of Toronto)
          www.library.ualberta.ca/subject/pdas/ (U of Alberta)
          www.student.med.umn.edu/palmpilot/ (University of Minnesota)
          www.mclibrary.duke.edu/respub/guides/pda/index.html (Duke University)

       PalmOS Portal & Content Sites
          www.pdamd.com (medical Palm portal)
          www.palmgear.com (general consumer Palm portal)
          www.handheldmed.com (medical palm portal)
          www.healthypalmpilot.com (medical Palm portal)
          www.collectivemed.com (medical Palm portal)
          www.memoware.com (collection of references, including medical)
          www.rnpalm.com (now called PDACortex, Halifax-based site, good content)
          www.geocities.com/medicaldocs (has some CMA Clinical Practice Guidelines)
          themedicalguide.hypermart.net (huge list of medical Palm software for $5 US)
          pbrain.hypermart.net (Ectopic Brain, a family practice site)

11. Disclaimer and Copyright

Although care has been taken in preparing the information contained in this document, Dalhousie
University does not and cannot guarantee the accuracy thereof. Anyone using the information
does so at their own risk and shall be deemed to indemnify Dalhousie University from any and all
injury or damage arising from such use.

PalmOS is a registered trademark of Palm, Inc. All other trademarks included in this document
are the property of their respective trademark holders.


  2002 Dalhousie University Faculty of Medicine           Palm Recommendations – Page 15 of 17
12. Palm Committee Members and Contributors

       Wes Robertson, Faculty of Medicine
       Dr. John Ross, Department of Emergency Medicine
       Dr. Jonathan Blay, Department of Pharmacology
       Dr. Jim Thompson, Department of Emergency Medicine, Charlottetown, PEI
       Dr. Stewart Cameron, Department of Family Medicine
       Bruce Holmes, UMESA/LRC
       Grace Patterson, Medical Informatics
       Anne Barrett, Kellogg Health Sciences Library
       Chris Emeneau, Medical Computing and Media Services
       Stephen Bourke, Personal Computer Purchase Centre
       Steve Anderson, Medical Society of Nova Scotia
       Ivan Wong, Dalhousie Medical Student Society

13. Contacts

If you have questions, concerns, or suggestions to make about this document and the information
and recommendations it contains, please feel free to contact any of the following:

       Wes Robertson, Director of IT, Faculty of Medicine
       (902) 494-2709 or wes.robertson@dal.ca

       Chris Emeneau, Support Technician, MCMS
       (902) 494-1234 or chris.emeneau@dal.ca

       Stephen Bourke, Manager, PCPC
       (902) 494-2626 or stephen.bourke@dal.ca

       Bruce Holmes, Executive Director, Learning Resource Centre
       (902) 494-1879 or bruce.holmes@dal.ca

       Steve Anderson, Director of IT, Medical Society of Nova Scotia
       (902) 468-8935 or steve.anderson@doctorsns.com

14. Website

A website based on this document has been created, which will be maintained and kept up-to-date
on a monthly basis, as opposed to the twice-yearly review of the document itself. The address of
the website is as follows:


                           http://www.medicine.dal.ca/palm/


  2002 Dalhousie University Faculty of Medicine         Palm Recommendations – Page 16 of 17
                      2002 Dalhousie University Faculty of Medicine




2002 Dalhousie University Faculty of Medicine      Palm Recommendations – Page 17 of 17

				
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