PDA – Personal digital assistant – What’ new?

If you thought that these little hand held devices were just a fancy address book, you are behind the times. Now when I synch my Palm each morning, I not only get my up to date address book, but all my activities for the day, and the latest news from CNN, The New York Times, USA today and PC world. This is updated each morning through Avantgo, a free web based news service.

So, what is available in the handheld market? One of the first, 16 million devices sold, and most popular PDA (personal digital assistant) was the Palm pilot. (Newton by Apple was actually the first, but was discontinued by a poor marketing decision) With only a monochrome screen, low storage and poor delivery,  the Palm ran into serious competition and now there are several other rival devices. By converging with wireless phones, this technology is going to show the greatest growth in the next few years. The market for handhelds has been estimated to increase by 44% from 2002 to 2004. The newer devices with more storage and better screens have left the Palm a little behind. The main rivals are the Visor, which is a little cheaper and uses the Palm operating system. The new Sony device, CLIE PEG-N710C is really good multimedia PDA using the Palm OS with a memory stick for storage of pictures, music and video. The other competitors are the iPAC by Compaq, the Jornada by HP and the Casio which all use the Pocket PC operating system from Microsoft. This is a scaled down mobile version of the main Microsoft products, Outlook, Word, Excel, Reader, Internet Explorer and Windows Media Player.

One of the mobile phones by Samsung, and another by Kyocera have the Palm operating system and screen integrated as one device. To make a call you just tap on the name in the address book. This technology convergence is going to be the most interesting to see how it plays out. With the advent of the much faster 3G technology, the wireless phone will give much better access to the internet. The advantages of these gadgets are that they come on instantly to give you quick access to the address book, notes, to do lists, and applications that run on the Palm OSsuch as databases, and Avantgo, a web based information center.

            So, what applications are available on the Palm? The most important function is to have immediate access to the phone and address book. This is where the convergence with wireless is going to have the greatest benefit. Now you have to open the Palm find the number and dial it on the phone. The to do list and memo pad are very handy to use the pen like device (stylus)  to write the notes on the screen. There are programs that actually store the written scribbles or notes in the exact form that you used. Most  of the time the graffiti function is used to write on the screen. If you have to record any amount of data, then purchase the fold up keyboard. I use this to enter databases and to write longer documents. A program called documents to go can translate this word program into the Palm OS. The programs are compressed, without formatting, to very small 10-20 Kbs It is loaded on the Palm the next time you synch. You can use the keyboard and work at about the same speed on the Palm keyboard using only the Palm device. This means that you only have to carry around 2 small devices instead of the laptop. If you are taking notes at a meeting, the Palm and the keyboard are much faster, smaller, lighter, and less intrusive than the laptop computer.

The drawback in the past has been the small storage size on the palm, only 8 Mb. The new Palm 505 has expansion cards that increase the storage to 364 Mb. Now images and short videos may be stored on the card and displayed on the Palm screen. The Visor, Sony, HP and the Compaq devices all do the same, but with better resolution and with more memory for images and video.

The other valuable feature for physicians is the epocrates drug information program. This program has every drug listed with dosages, interaction with other drugs and is updated weekly. Now a vast pharmacopoeia is in your Palm with instant access to dangerous drug interactions. Most of the medical students, interns and residents find this the most valuable software.

The orthopedic residency program at Winston-Salem uses the Palm to synch the patient lists every morning for rounds. I have seen a program that will work with an internet based program called slimresidency to provide a surgical log book, on call scheduling and other house staff chores. The Palm synchs this information every morning for the house staff.

This same function can be set up on the AvantGo web site. A folder of information may be created with daily news and events that you can syncH to each day. This may be expanded to news, weather, stock market and other non-medical uses. The real advantage to this internet base program is that once it is configured, nothing more need to be done. The Palm is in the cradle, connected to the computer, which is on and connected to the internet, the synch button is pushed, you get a coffee and all the information for the day is loaded. This applies to the housestaff, who need their assignments and patients to the staff who need to know the meetings of the day and perhaps the news of the day. 

The HanDbase programs for the Palm OS are very easy to use as surgical databases. Up to 30 fields may be created to store information on surgical patients. These databases are instantly accessible and searchable for any of the data fields that you require. I keep about a dozen different databases such as interesting cases for rounds, PCL cases and a surgical database. At the present 511 patient records only takes up 81 Kb of space.

The Palm can download all your new unread email messages in the morning and you can read them on the screen and reply to them as required. The next time that you synch the Palm will transfer the new messages and the replies to the computer Outlook e-mail program to be sent out.

The Palm OS does support a modem on the Palm 7 version. This     wireless service is not universally available and at the present time it is slow. The phone based e-mail is also slow, but in both these areas I would expect great improvements in the next few years. The palm company  has said that it will have the bluetooth technology integrated in the next year.

Another interesting development is a service that Medscape supplies for free. Go to www.medscape.com orthopedics, under journal scan. The most recent journal scans are available to download in a Palm format. The summaries of the main orthopedic journals, 4 or 5 articles of several paragraphs each are available to read on the Palm. This makes it handy to read the journal summary between cases, stuck in traffic, in an airport or airplane.  The improvement would be to have this available in a service such as AvantGo that automatically downloaded the summaries each time that you synch the Palm.

I look to the Palm type device to show us what the future holds for mobility and small size. The days of lugging around a 9 pound laptop are over.

            The main features on the Palm are:

• Address and phone book. One of the unique features that I like about the handheld is that I can beam my business card to anyone else with a handheld. This information is then entered into my address book. This makes it much easier compared to typing in all the business cards that I get at each meeting.
• Date book. All the daily events for the next 5 years can be entered into the Outlook program and downloaded to the Palm. The reverse is also true, if you enter a new event while traveling and away from your main computer, this is automatically updated on the next synch.
• Memo pad. You can write on the screen using graffiti or you can write using a program that records your very own hard-to-read hand writing!
• To do list. The main chores are listed, with deadlines if necessary
• Mail. This loads any of your e-mail that is downloaded and not read. You can read and reply to the mail at any time and send the messages out the next time that you synch the Palm

All these programs are syncHed to Outlook each time that you put the device in the cradle and push the hot synch button. The newer devices connect through the faster USB port rather than the slower serial port.

• Epocrates – This drug reference book is invaluable to anyone who has to order medications. (After you have been a sports medicine orthopedic surgeon for a few years, you only have to know about 4 drugs!) Epocrates is updated about once a week from the web site www.epocrates.com T
• Expense book. This is good for someone organizing a budget.
• Documents to go. Any word document from your hard drive may be loaded on the Palm. It compresses the program and removes the formatting, but restores it when you synch it back to your hard drive. This program combined with the portable folding keyboard makes my life much easier, no more 9 pound laptops to lug around. Now, with the colour and lighted screen, I can take notes in a darkened lecture room, or read the sports scores if the speaker is boring!
• AvantGo. The web based channels of CNN, The New York Times, PC magazine, USA Today, and so on, may be subscribed to, for free and updated each time that you synch the device. Anyone can make a new channel for his personal use and keep a database of patients or surgical log book
• HandDase. This is another one of the 1000 or so programs designed for the Palm This is a database that allows you to enter 30 fields. It is useful for a surgical log book, to keep track of interesting patients, or to make a list of patients for rounds. The residents can keep their surgical log book on this web based database.
• Firepad – This application allows you to show digital photos and video. I loaded a .avi file on the handheld that I thought was cool on my desktop computer 5 years ago, and now it is on the Palm.  Just think, in another 5 years we will be able to watch feature movies that have been downloaded on the wireless broadband modem.
• Access database. A compression program is available to allow you to transfer your access database to the Palm. This takes quite a bit of space and is a good use for the expansion cards.

To access more medical programs for the palm go to www.pdaMD.com 

A site that features all the products is www.mobileplanet.com

Pocket PC

What does the pocket pc operating system offer? The main function is that you can do everything that the Palm OS does and without downloading and installing other software. The familiar Microsoft programs such as Word, Excel, Windows Media Player, Internet Explorer and Outlook are all loaded and ready to use on the handheld device. A couple of other programs such as pocket TV to view mpeg movies and ipresenter to view PowerPoint presentations will round out the necessary software.

            The handheld is synched with your main computer by active sync. This will download all the Outlook mail, calendar, to do lists and memos. You can modify these on your handheld and then synch back to your main computer. Avantgo is also loaded and configured. You pick your channels from the Avantgo web site and each time you synch the information is downloaded on the handheld. The note function has been improved compared to the Palm. On the Palm you have to use the graffiti function to write a note. On  the pocket pc software, you can write in your own handwriting, or dictate a short note. This is stored as a .wav file that can be played back later when you have time to listen and make a formal note. I find that this is one of the most useful functions on the device. I make use of the short dictated note several times a day.

A comparison of the most popular devices in the PDA market (personal digital assistants)

Palm has had the highest medical market penetration with over 17 million units and at least a 1000 software programs. The latest version, the Palm 505 has a bright color screen, shows images, plays video and has retained the same functions and has remained small enough for your pocket. However, for pure multimedia the Sony Clie 760C - $499 US is awesome. It has the best screen resolution, 320 x 320. (It uses quick time .mov compressed file 10x1) Plus the Sony does audio (but only with headphones or external speakers) , so the video clips are really multimedia. It also functions well as an mp3 player.  Both devices use the Palm OS version 4.0

The most impressive difference between the Palm 505 and the Sony is the screen brightness. The memory stick for the Sony is the cheapest, $150 for 128 Mb.

The big competition is coming from the iPAC by Compaq - $599 US. It uses the Windows CE, now called Pocket PC 2002, a scaled down Windows program with Word, Excel, Windows Medial Player, Internet Explorer and Outlook. . It has an expansion slot for a secure digital card up to 64 Mb, slightly more expensive than the memory stick. These are the same cards that the Palm 505 uses. There is also an expansion sleeve for the pcmcia cards. This will increase the memory up to 2 gig with the IBM microdrive cards. The sleeve also has another rechargeable battery, as. all this multimedia is a drain on the battery.  The screen is as bright as the Sony, and is larger in size, but the resolution is slightly smaller, 320x240. The big plus is that it uses the Windows Media Player to play images, video (only plays Windows Media File) and audio (with built in speaker). This make is easier to load the video. The video must be changed to a Windows Media File and then it can be dragged and dropped into the storage card.  A  download from www.pockettv.com allows the playing of mgeg view on the pocket pc operating system.

The HP Jornada also uses the Pocket PC operating system. It is a little smaller than the compaq, has a slightly smaller screen size, backlights only from one side, but does all the same multimedia as the iPAC. The flash card is built into the unit, so you don’t have to buy an expansion pack. This will also take the IBM cards in 1 and 2 gig cards. The real advantage of the HP is that is retains the pocket size of the Palm, but has all the functions of the iPAC. What will happen with these two devices after the merger of HP and Compaq is anyone’s guess. The new devices are all have blue tooth enabled which will increase the usefulness for the office setting.

The pocket pc system will also use soft ware from Aristar (www.aristar.com)  to record the patient history and physical examinations. The software also has an electronic OR report, and the IKDC outcome documentation forms.

A VGA card is available to allow you to project a PowerPoint presentation from the handheld directly to the projector.

The HP also has a removable rechargeable battery to handle to power intense multimedia programs.

The one downside of the Pocket PC operating system is that it works just like Windows. I have to soft boot the device at least once a day. I never had that problem with the Palm OS.

The new hot device is the Samsung phone with the integrated Palm OS. You turn on the screen, open the phone book, tap on the contact, and the phone dials. Now you can avoid carrying around both the phone and the Palm. Better wait for a year for this one. Sometime next year this will be available with the 3G wireless format which is lighting fast compared to the current phone transmission,  370 kilobyte per second compared to the present 10 kilobyte per second. This means that services such as Avantgo with be updated wirelessly, without having to synch with your computer. It also means that “Just in Time” surgical video can be downloaded to the Palm/phone and viewed just before you do the case.

So, who is going to win the battle of the operating systems? Obviously you can’t count Microsoft out; the rumor is that they are bringing out their own version of the phone and Pocket PC system sometime in the next few years. The two large phone companies, Samsung and Kyocera have both opted for the Palm system and both are available now. This gives them a significant market edge in the near future.

The important question is “have I given up lugging my laptop around? No but maybe very soon”

Comparison Chart for the Palm,  Sony and iPAC and HP Jornada

  Summary

    I have been a long time user of the Palm, but have switched to the HP Jornada. It is the same size as the Palm, fits in my pocket, but has wireless connectivity with 802.11b, bright screen, dictation to notes feature, and my surgical documentation software.