Join our Consultations
Mailing List

The Medical Professional�s Guide to the Palm

by Genlinus D. Yusi, MD, FPUA, FPCS

       Except for a few specialties, medical professionals have to be dragged kicking & screaming into the information age.  The irony of it is that the logarithmic growth of available medical information is such that doctors are among those who need it the most.  Another problem is that doctors, especially hospital-based clinicians, are among the most mobile professionals with most of their work flitting from one hospital to another and then from one ward to another.  This mobility & information load doesn't decrease as one's career progresses but rather worsens as one sees more patients in more hospitals.  Not to mention the academic & administrative activities which require him to conduct lectures, write papers or articles, and attend meetings.  Management of patients also requires a highly compartmentalized mind which need to handle different decision-making tasks for each individual patient.  Having patient information available to you at all times in a well-organized, concise and convenient fashion is essential.

       Enter the Palm, a highly portable, configurable, fast, user-friendly, easy-to-understand and connectible device which makes just about any kind of information available in a blink of an eye.  The Palm Personal Digital Assistant (PDA) is fast becoming an essential companion for both young and seasoned doctors.  And why not, with a Palm, you can keep a lot of the usual frayed notebook with niggling bits of paper or Post-Its in one small convenient unit that will fit in your coat pocket or belt.  The following is a list of things that medical professionals can do with a Palm:

1. Handy notepad for clinical pearls

2. PDR (Physician's Desktop Reference, local version-- PIMS) or any other reference.

3. Calculator (to compute various clinical formulas like arterial blood gases and creatinine clearance)

4. Phone numbers or pagers (of consultants/attendings/residents)

5. Things to do list

6. Day-to-day planner

7. Patients database

8. Special/OR procedure list

9. Laboratory value reference

10. Games during quiet moments

11. Word processor when writing reports or articles

12. Endorse patient data to the incoming house officer-on-duty by just beaming it from one Palm to another.

13. For some Palm models whole medical textbooks can be stored in just one lightweight unit that can fit in your coat pocket or belt.

       Not convinced yet?  Well, the applications available for this baby number in the tens of thousands with just about anything you could imagine and growing by the day!

Hardware

       So you want to get one now� which one?  There are about a half dozen models available?  It really depends on your need and of course, budget.  Here are a few guidelines:

1. Memory � Get the most memory (at least 8 MB) that you can with your budget.  You�ll never know when you�ll need it especially when the new e-book medical textbooks and apps come out.

2. Color or monochrome screen � To date only the IIIc has a colored screen.  Some argue it�s an unnecessary luxury.  I tend to disagree.  I used a Palm III for 2 years before upgrading to a IIIc and I cannot overemphasize the how pleasant a colored screen is to read!  It also anticipates the next generation of Palm applications, most of which will take advantage of the colored screen. 

3. Palm III or Palm V form factor � simply put, the V style is smaller, thinner, sexier, and lighter with a metal finish as well as a rechargeable LiIon battery.  Only the IIIc among the III style units has a LiIon battery.  The V style beats the III style hands down except for a few traditionalists like me who find handling the latter to be more comfortable.

4. Manufacturer � Currently there are 5 companies which produce a Palm OS PDA, namely Palm Inc, TRG, Handspring, and IBM.  In a nutshell, Palm Inc. machines are the industry-standard and thus you run the risk of having incompatibility problems with the others.  The other machines however are infinitely more expandable and upgradeable and that is their primary advantage.  The second advantage is their price.  The other makers are invariably less expensive but much more difficult to find in this country.  Choosing which brand and model to buy would require a whole article by itself and is beyond the scope of this one.  Simply put, if you need a lot of RAM more than anything else, get a Handspring Visor or a TRG Pro.  If 8 MB is enough for you then any of the Palm �x� models as well as the �c� models would be sufficient for your purposes.

Accessories

 Cases - Considering the high mobility and portability needed for the average medical professional, as well as the high-risk for robbery in the areas where they work, I believe that for men a belt clip is the only way to go.  You have your hands completely free to do your work when seeing and treating a patient yet have the Palm within reach.  Some would argue that the big pockets of the doctor�s gown are sufficient and thus a belt clip isn�t need.  I disagree mainly because there are times when doctors would need to run towards a part of the hospital for an emergency call and this can cause loss or even breakage of the Palm.  Another reason is doctors don�t usually wear the gown after office hours so you tend to hang it up in your car or locker� to me an unacceptable condition, I need to have it at reach at all times.

The Palm Portable Keyboard � For those medical professionals who do a lot of academic work, a keyboard may be indispensable.  Personally, I�m quite adept at Graffiti, the native pen recognition system of the Palm, however when you�re making articles, reports, lectures, speeches and the like, a keyboard is a godsend.  This keyboard folds to a very compact size, James Bond-style, and is very lightweight, fitting in your lab gown perfectly.

Software

What makes the Palm series the market leader in the field of PDA�s are its simplicity, ease-of-use and most of all the amount of software available.  Unlike traditional software, the Palm applications are almost 100% exclusively marketed through the Internet.  What makes the Palm�s so marketable in the Internet is the small size of its programs thus, downloading is swiftly accomplished.  The best place on the net where you can get software, whether they be freeware, shareware, or commercial is at http://www.palmgear.com.  Although the applications available for the Palm encompass everything-under-and-not-under-the-sun, I shall limit this discussion to just those that apply to the medical profession in decreasing order of their usefulness to me.

ePocrates

Perhaps the single most useful piece of software for the Palm.  It is a special drug database containing data on dosing for both adult and pediatric patients, contraindications, drug interactions, and adverse reactions.  The data is quite compact taking a total of 1 MB (other databases require a LOT more).  The data can be updated regularly via AvantGo (described later) and is reviewed by a board of specialists.  The only drawback is that the drugs listed are only those that are available in the United States.  The Philippines has a lot of European drugs which aren�t available in the US.  Perhaps a Philippine-formulary ePocrates will come out when there are enough Palm-equipped medical professionals out there.  Freeware available at http://www.epocrates.com.

HandBase

The second most important program.  This is a relational database program that is completely configurable for just about any solution you would possibly need.  The programmer has many doctor friends whose recommendations were taken into consideration in the latest version.  I use it to manage my in-patients, finances, laboratory values, gas mileage, special numbers (TIN, PHIC, PMA, S2, etc.), etc.  Their website has many other medical applications you can adopt or even edit to suit your own needs.  Shareware available at http://www.ddhsoftware.com.

MedMath

This is a clinical calculator which has 28 clinical formulas in which you merely plug-in the clinical or lab data, choose the corresponding unit then voila!  You have the result.  Examples of formulas include:  Anion gap, basal energy expenditure, body mass index, body surface area, corrected QT, creatinine clearance, ideal body weight, osmolality, reticulocyte index, etc.  If you don�t know what that formula is for or just forget, one tap and you�ll get a short description with reference.  Freeware available at http://www.palmgear.com.

ABG Pro

During your stint in Internal Medicine, you�re constantly computing and analyzing patient�s arterial blood gases.  I wish I had this sucker during that time.  You just plug-in the needed data namely, pH, pCO₂, HCO₃ then tap �calculate� and you�ll get a flawless interpretation.  If you want to have anion gap or expected pCO₂ provide Na+ and Cl- levels and you�ll get it.  Donationware available at http://www.stacworks.com.

SmartDoc

A document reader AND editor.  Most document software available merely read e-text, SmartDoc can edit and create new documents.  Very useful when you need to do some writing on the fly.  The Palm�s Memo application to me is very limited since it can hold only a very small document.  SmartDoc�s memory ceiling per document is limited only by your available RAM.  If you use SmartDoc a lot (meaning you write a lot of articles or reports), then I suggest you purchase the Palm Portable Keyboard. This article by the way, was drafted using SmartDoc in a Palm IIIc equipped with a Palm Portable Keyboard.  After writing your article, you can HotSync to your computer and import it into your word processing software, format it and print it out.  Shareware available at http://www.cesinc.com.

Avant Go

Is both software and a free service.  With AvantGo installed and your computer connected to the Internet, when HotSyncing your Palm to your computer, the program accesses its website and downloads information from the Internet to your Palm, sort of like an online journal or newspaper which you can read during your leisure time.  Subscriptions to just about any topic are listed on the AvantGo site.  Medical topics at present include Handheldmed which is a news service dedicated to handheld computers or PDA�s and the medical profession, and eMDnetwork which is a medical news service.  Freeware available at http://www.avantgo.com.

iSilo

An HTML viewer.  Ever find a web page that you want to study at length but have to run?  Want to bring it with you without printing it out?  iSilo can download the page into your Palm, compressing it at the same time to save memory and allowing you to read it at your leisure.  Its compression scheme is even tighter than that of SmartDoc.  I also use this when I have very long docs that I want to review, I convert it to iSilo format, HotSync then take it with me wherever I go.  Shareware available at http://www.iSilo.com.

JTutor

After my residency, I developed a unique study technique.  While doing my readings, when I ran across a statement which made a good multiple-choice exam question, I wrote it down in my PDA.  At night I would run through all these statements and formulated nifty multiple-choice questions, complete with choices and answers then type it into my computer.  When I discovered JTutor, which is a personal quiz application which you can program yourself and supports multiple-choice, true/false, or flash card modes, I converted my questions (numbering a little less than a thousand by that time) to its format and downloaded them into my Palm.  Thus during quiet times, I fire it up and give myself a quick quiz, only to find out that I don�t do that well in a test that I myself made.  You can set it up to present the questions randomly so no two exams have the same sequence.  I use it now to make in-service exams for my residents as well as regularly testing myself on things I know or used to know.  Shareware available at http://www.land-j.com.

MedLabRef

A comprehensive and searchable list of laboratory values.  Shareware available at http://www.newsflow.com/medlabref.

Patient Keeper

This is a complex application which can serve as a portable patient chart.  It is extremely comprehensive and can hold just about any piece of information needed in a patients course-in-the-ward.  Its potentially very useful but you would need to pour a lot of time inputting your patient data in it.  A future evolutionary offshoot of this program, making it more detailed can potentially replace the patient chart as we know it.  If you want to try it out, it is shareware available at http://www.patientkeeper.com.

Other Resources

There are literally hundreds of medical applications available for the Palm, most of which were made by fellow doctors, residents, and medical students.  Just about everything made for the Palm whether it be hardware or software is available at http://www.palmgear.com. 

For more information on the medical use of PDA�s try browsing at http://www.pdamd.com, http://www.healthypalmpilot.com and http://www.handheldmed.com. 

For help in the form of a users group, join MAPALAD which is the official palm users group in the Philippines.  Visit it at http://www.mapalad.org. 

Dr. Genlinus D. Yusi is a practicing Urologist at the National Kidney & Transplant Institute, St. Luke�s Medical Center, Capitol Medical Center, and FEU-NRMF Hospital and a Fellow of the Philippine Urological Association and the Philippine College of Surgeons.  He is a member of MAPALAD (the Philippine Palm Users Group) and the Philippine Medical Informatics Society. You may contact him at [email protected].

This article was first published in PC World Philippines September 2000 issue.