Back from a week's vacation.

What's new in the Palm Medical PDA World? Skyscape has come out with 5 Minute Clinical Consult 2003 and it is not 2003 yet! Looks like a major revamp. Images now optional.:
Description

5MCC™ 2003 is the handheld version of Griffith's 5-Minute Clinical Consult 2003, an invaluable and unique clinical reference for students and practitioners. It covers thousands of topics that are indexed with terms and medications so that you can find the information in a quick and professional manner. Review the Basics, Diagnosis, Differential diagnosis, Treatment, Medications, Follow up, and important miscellaneous considerations when you use this reference on your favorite handheld device.

Download a trial

Diagnose problems with a Palm Handheld
Ok so its car engines:

"B&B Electronics has released version 2 of its AutoTap for Palm software. AutoTap software and its hardware component (AutoTap scan tool) allows the user to diagnose engine problems, monitor engine performance and clear the Check Engine light right from a Palm OS devcie. The company said version 2 adds new features that include graphing, gauges, large displays, color and more user-configurable screens.

According to the company, the AutoTap scan tool connects a special OBD II plug-in-port on or under the dash of your car or light truck to your handheld. The AutoTap scanner then reads the signals from your vehicle's computer-controlled sensors and displays right on the device. With AutoTap for Palm, users can view and log real-time generic OBD II parameters as well as view generic and enhanced diagnostic trouble codes. "

Hmmm, if only someone will comeout with a plugin module for patients.......

Source: Palm Boulevard

Medrules revisited

It's been sometime since I last tried out this freebie. It's great and now in version 3.0 has been enhanced further by the author, Kent E. Willyard MD.



It's now OS 5.0 compatible! Download from Ectopic Brain

What does the future hold for computers in healthcare for 2003? The crystal ball foretells:

Seven Key Physician Market Trends in 2003

· ROBUST PRACTICE WEB SITES EMERGE: Among all U.S. practicing physicians, 34% reported having a practice Web site in 2002. More than two-thirds of US physicians expressed an interest in having a Web site in the future. Data from the latest Cybercitizen®
Health research show a dramatic increase in the consumer use of practice Web sites,demonstrating a strong value proposition to physician end users.

· PDA AND HANDHELD COMPUTERS COME OF AGE: Approximately 35% of practicing physicians are actively using a PDA. Almost two-thirds of physicians using a PDA are actively using an Rx reference database on their PDA. In addition to the increased adoption of these mobile devices in general, improvements in the form factor and underlying technology, as well as the competitive pricing of new Windows devices, will drive significant growth and value in this market segment.

· INTEGRATED ELECTRONIC PHARMACEUTICAL DETAILING BECOMES A
REALITY: Thirty-six percent of primary care physicians have already participated inelectronic detailing programs offered by pharmaceutical companies. More than 80% expect of current users expect to participate in the next 12 months. The difference in 2003 will be a growing number of pharmaceutical companies realize the value of integrating the detail rep with extended online capabilities – as a compliment (and not a replacement) to the relationship.

· SOME SPECIALISTS BECOME VERY DEPENDENT ON THE WEB: Targeted segments of practicing physicians, such as information intensive groups including Oncologists, Neurologists, and Rheumatologists, become very dependent on the Web in 2003 as a critical source for the latest clinical news and pharmaceutical information.

· PATIENT CONNECTIVITY STILL ON HOLD: Despite consumer demand to “connect” with their physicians online, the evolution of the virtual online consult remains in a holding pattern as a majority of physicians are still waiting for an economic argument to participate.
However, pilot projects underway (funded by insurers in many cases) will begin to justify the value proposition to the payer community – in turn generating a greater general understanding of the offline impact of online consults.

· HEALTH PLAN PORTALS BECOME A VIABLE CUSTOMER SERVICE OPTION:
Following years of building online service solutions, and spurred by pending HIPAA deadlines, a majority of health plans finally deliver valued-added online solutions to participating providers in their physician networks. Building on administrative applications, early innovators also begin to roll out the first edition of e-care applications to support comprehensive patient care.

· E-PRESCRIBING RESURFACES … UNDER NEW MANAGEMENT: After a very tough
year, electronic prescribing makes a comeback with new backers. After a failed attempt by umerous pharmaceutical companies to gain control over the prescribing process at the point f care (through third party investments), the true beneficiaries of electronic prescribing insurers and PBMs) begin investing in more projects to demonstrate and capture the economic benefit (such as increased Rx formulary compliance).

source: manhattanResearch

Earning CME credits with your PDA
Eventually compulsory CME will come to Malaysia. There is online CME being trialled by MMA. It would be even more handy if we could do this away from our desktop PCs i.e. from our handhelds.

This is not science fiction but now reality and happening in USA.
"Physicians who use handheld computers to access evidence-based medical information while caring for patients will now have the opportunity to earn continuing medical education (CME) credit for their efforts. The American College of Physicians- American Society of Internal Medicine (ACP-ASIM) announced its participation in a pilot program with the American Medical Association (AMA) to provide AMA PRA category 1 CME credit to physicians using PIER(TM), ACP-ASIM's evidence- based clinical decision support tool, integrated with TouchWorks clinical software from Allscripts Healthcare Solutions. "

Source: Palm Boulevard

Hmmm. Complementary medical software seems to be making its way into the PalmOS arena now. Spotted this on the web:



Acupressure & Do-in for PalmOS

"Acupressure & Do-in" is an easy-to-use guide for everyday acupressure. While not in any way a replacement for professional medical care or emergency medical treatment, it is very useful for relieving minor to moderate symptoms and pains, and can be used to supplement other medical care. First, select the most appropriate body area (Head, Trunk, Limbs or Body/Anywhere), then navigate the list of symptoms to the one best describing your complaint. Acupressure & Do-in provides a list of pressure points, with descriptions and illustrations.

Debateable whether on not it (accupressure, not the software!) works. But at least its freeware....

Drug References in Your Palm
Indispensible. ePocrates is free. A2Z Drugs from Skyscape is also very good. Trouble with both ePocrates and A2ZDrugs is that they are based on the American Formulary so some of the medications prescribed in Malaysia are not listed. However the easiest workaround I find is the use the online DIMS which you can get from Atmedica. A2ZDrugs has a Personal section where you can add your custom drugs. By simple Cut & Paste you can add the drugs not listed into the Personal section of A2Z making it as complete as can be!

Handheld Computers for Health Workers in Africa

I am impressed that the medical PDA usage in Africa continues to show great promise. This is technology put to good use!!

"A Red Cross volunteer in Ghana stared in surprise when the screen on his PDA first lit up, but during a training session laughed and said, “I had never touched a computer an hour ago, but now I can use one!” He was one of 30 volunteers working with SATELLIFE, and organizaion with the mission to improve health in the world's poorest nations through the use of information technology, and the American Red Cross (ARC) in their Measles Initiative, which aims to vaccinate at-risk children across Africa. This in turn was part of a larger project conducted by SATELLIFE to test PDAs as a tool for data collection and information access in Africa"

read more in Palm Boulevard

"Natural" Medicine on your Palm

Increasingly Medical Doctors have to be aware of the nature of alternative medicines their patients are taking. I have had on numerous occasions the need to check up possible adverse effects and drug interaction with herbs and what not. Now Skyscape has come up with new databases on "Natural" medicines to enable physicians to look these up "on the go".


Skyscape, a provider of healthcare-based mobile solutions, has announced three new natural medicine and alternative therapies references for PDAs, including the Guide to Popular Natural Products (GNP) published by Facts and Comparisons, a complete version of Natural Medicines Comprehensive Database published by Therapeutic Research Corporation and the Nursing Herbal Medicine Handbook published by Lippincott Williams & Wilkins. Skyscape's solutions are available on multiple platforms, including Palm OS, Windows CE, and Pocket PC.

According to the company, its titles are PDA versions of the same medical reference publications used by physicians and other healthcare practitioners. Skyscape said its smARTlink technology enables end users to seamlessly connect with other medical references loaded onto their PDAs, allowing them to move in real time from diagnosing to determining treatment options and potential drug interactions and now between natural products and traditional drug therapies. The new natural medicine and alternative guides are slated to be available over the next several weeks.

source: Palm Boulevard

Been working out lately? Mens Sana In Corpore Sano....

For those of you using threadmills as part of the workout session, this Brighthand article is interesting -

"Handheld devices operating with Palm OS software can exchange -- or "beam" -- workout data to and from the Star Trac Pro Elite treadmill console. This capability, created by software programmer Jay Wright, CEO of SingleTap, offers the unique ability to accurately monitor exercise performance over time. In development for more than a year, SingleTap and Star Trac found research that revealed many treadmill users were also handheld device owners"
This cool! And what's more, you can even upload your own exercise programme:
"Users also can create their own custom workouts on the handheld and "beam" them to the treadmill. In the future, ready-made workouts will be available online as well. Users will be able to use self- or professionally-designed workouts based on individualized fitness goals."

The object of my desire......

When will they:

1) Come out with an Avantgo which is OS5.0 compatible
2) Release the promised MP3 player
3) Lower the price.......

What's the PDA usage like in your workplace?
At the hospital where I work, there are 100+ staff specialists.
The breakdown of PDA usage is as follows:

Total No. of PDA Users - 19
Palm OS - 15 (m5xx series - 7, Vx -2, m130-1, Clie -3, Visor -2)
PPC - 4 (all iPaqs)

Looks like PalmOS is the dominant one......

If you're in a hospital ever notice the increasing use of PDAs amongst colleagues? You might have noticed they are also being used by the Pharma sales force (IIANM those dealing with Zuellig) - they can tally and report their visits electronically on their Palms and upload the data later. It's happening foks - the PDA revolution is here!
And here's yet another example of PDA usage in the field:

Mobility Electronics Palm Cradle Helps with Clinical Trials

Mobility Electronics has worked with Palm, Inc. to design a modem cradle for Document Solutions Group (DSG), a company that specializes in clinical trial electronic data collection. DSG plans to use Mobility Electronics Portsmith subsidiary’s device-specific modem cradles with Palm handheld computers to capture Patient Diary clinical data for pharmaceutical companies.

According to DSG, it offers its pharmaceutical clients Palm handheld computers configured to collect trial-specific information. The companies said that through these devices, physicians and sponsor personnel, such as monitors, can track subjects' reactions to investigational drugs in real time, providing trial sponsors with more accurate data faster. Subjects record their reactions on the handheld and transmit the data by placing the device in Portsmith's modem-equipped cradle. The data is then uploaded into DSG's CRFs (Case Report Forms) in either a stand-alone diary database or through DSG's eCaseLink electronic data capture software and can be viewed by sites and sponsors to determine trends in the data.

Since August 2002, DSG has been collecting clinical trial information in the U.S. using Palm m500 handhelds and Portsmith's device-specific modem cradles.

Source: Palm Boulevard

Ah.... if only I had a Palm PDA when I was a medical student. Shucks, there were hardly any computers back then - vaguely recall some TRS-80 or something very primitive back then :) Life would have been much easier, being able to carry all the lecture notes and what-not around, hand references literally in the Palm of your hand. I can imagine also taking lecture notes with a Palm and PPK keyboard.
Well, the Med Students at IMU have come up with their very own Med Student PDA webpage called the IMU PDA User Group. Great effort chaps!

Using your PDA for data collection

This article about PDA usage for data capture in clinical trials is very interesting.

"Participating physicians and researchers who make house calls to the DVT patients will use the Palm handhelds with PHT's solution, called SitePad, to input critical medical data onsite. With this portable solution, patient symptoms such as swelling and pain, fever and rapid heart rates are captured, sorted and analyzed in real time. Reactions to and effects of treatments are also duly noted and saved. This mobile solution saves researchers time and reduces errors associated with paper diaries, giving medical research facilities accurate and attributable clinical trial data in electronic form for regulatory approval.

PHT will supply clinical investigators with the SitePad solution, which runs on the Palm m515 handheld. Observations and data are entered directly into the SitePad at a patient's bedside. Once investigators return to their offices and clinics, all captured information is uploaded directly to the secure PHT Study Server via a specially designed modem called the TeleCradle. Physicians and researchers involved in the study can access the secure Study Server to analyze the trial results in real time.
"

At the moment I enjoy using HanDbase as a flexible Data collection tool. You plan your own database and can input PopUps to speedup entry of common items in each field. The data files can be exported to Excel or Access. I believe there is great potential in this area. As a data collection device, PDAs are very much underused and underrated. Out with pen and paper!!

Do PDAs save lives?

Food for thought. There's this newsbit from Palm Boulevard about PDAs loaded with Skyscape medical applications for use in Africa where medical information resources are scarce. I wonder if this has ever been so in my case. I have always viewed the Skyscape apps as a handy mobile references. At the most they have saved me some time rather than having to search for printed references. Perhaps detecting drug interactions which I would not have suspected would be the closest thing to "life saving". When it comes to information at your fingertips, I would need wireless Internet access to search Medline. As WiFi is not pervasive enough, GPRS still costing an arm and a leg, there is still a long way to go before we can have true unlimited access to medical information. It won't be long I hope before this dream becomes reality....

Using Bluetooth and GPRS

More ramblings on my Wireless Palm experience using Bluetooth and Digi's GPRS - this is a basic Walk-through

Equipment

Phone: Ericsson t39m. Although this phone is an older model, it's reasonably priced (RM800+) for all the features you are getting including GPRS and Bluetooth built-in. Voice reception is good and with the Ericsson Bluetooth headset you get complete wireless handsfree. The higher end Ericsson t68i costs twice as much but if you fancy colour then go for it.



PDA: Palm m515 (cost RM1350). Good value for money color PDA for first time buyers. Runs on Palm OS 4.1 and has lots of software available form the Internet, many of which are free. Many medical software applications are also available on the Palm format.


Palm accessory: Palm Bluetooth SD card. The m515 does not have built-in Bluetooth (later models with OS 5 are likely to have this built-in). This is a little pricey (RM490). An alternative is the TDK Bluetooth Sled but it's more bulky. Bluetooth allows you to connect wirelessly to your Bluetooth capable phone within about 10 feet range. This is very convenient as the other wireless connection commonly used is IR (Infrared) which requires "line of sight" and is short range. With Bluetooth, your phone could be in your pocket or briefcase and the Palm can still communicate with it.

Setting Up Everything


1. Setting up Bluetooth connection between the Palm and Ericsson t39m

This is fairly straightforward. The Palm BT SD card comes with a CD which installs the appropriate drivers for the Palm and also the Ericsson t39m phone driver (other phone drivers are available from Palm). You need to enable the BT on the Ericsson - change the Operation mode to Always On (Menu 5/Bluetooth/Operation Mode). From the Preferences panel select Phone and make sure the Ericsson BT phone is selected and you can click the Test button to test the connection.



2. Setup the GPRS data connection on the Ericsson t39m and Palm



This information is for Digi since I am using Digi's GPRS service. The service is available for both pre and post-paid Digi users and costs 10s/10kb (post-paid) or 20s/10kb (pre-paid). Post-paid users are charge RM2/mth.



Phone Setup for Internet connection via GPRS for t39m

1. Go to Settings menu and scroll to Data comm
2. Press the Yes button and choose Data accounts
3. Choose Add accounts and press the Yes button
4. Choose GPRS Data and press the Yes button
5. Enter the new account name and press the Yes button
6. Choose APN and press the Yes button
7. Enter the APN and press the Yes button
8. Leave User id and Password empty
9. Scroll down to Save and press the Yes button
10. The phone will prompt ?New GPRS account created?



Field Name Values:

New account name GPRS Internet
APN diginet
User id Nil
Password Nil
Password request Off
Allow calls Automatic
IP Address Nil
DNS Address Nil
Advan.settings Nil



For other GPRS providers or other phones you can consult their respective web pages




Palm Settings

- goto Prefs > Network, create a new Service and put in digi for both User Name and Password

- type in *9***1# for Phone:
- under Details, unselect Query DNS and type in 203.92.128.131 & 203.92.128.132 for the DNS fields
- leave IP Address: Automatic checked
- under Script, make sure you have selected End
- now click OK twice and GPRS on your Palm via BT to your phone is ready to use


If you got all the above working, then your Palm should be able to "talk" wirelessly to the Bluetooth capable phone and also connect to the Internet via Digi's GPRS service.

Decided to complement this site with more ramblings from my Blurty blog site. Mainly because I am undecided which Blogging site suits me more. I like Blurty 'cos it allows me to upload my entries via Avantgo using my Palm . Have to be on my PC for Blogger.....

Why doctors should carry a Palm and not a PocketPC

• Palm PDAs are smaller - won't compete as much for your already crammed pockets
  
• Palm PDAs have a better battery life - won't conk out on you after a long clinic or ward round
  
• Lots more medical software for PalmOS in general compared to PPC
  

But most importantly of all, Palms can do this but PPCs cannot ;)

Palmdoc goes wireless - or how to surf wirelessly using your Palm and Bluetooth

Equipment: Palm m515 + Palm BT SD Card; PC on WinXP with ADSL connection;
MSI USB Bluetooth adaptor

The MSI BT adaptor comes with a set of drivers on CD. Installation was quite
smooth on WinXP. You get a Bluetooth Neighbourhood on your Desktop and you
can connect to PC or LAN via Bluetooth to other BT devices. It's pretty
cheap too RM160 (USD 42)

I anxiously tried a BT to PC connection from my Palm and indeed it could
establish the pairing though the Palm had to do the initiation. With a Palm
to PC virtual serial (Com4 on my machine) connection I can Hotsync
wirelessly via BT though it is slower compared to the cradle but faster than
IR.

Attempt #1:
First attempt at wireless surfing was to use MochaPPP since I have
established a virtual Com port connection. Unfortunately MochaPPP does not
recognize the virtual Com port so scratch that option. (It may work with the Tungsten T though, according to a review in Palminfocentre)

Attempt #2
The MSI USB BT adaptor also automatically sets up a virtual Bluetooth
Network Adaptor which WinXP recognises. You need to adjust the Internet
Connection sharing for the Bluetooth LAN.
I managed to establish a Palm to LAN connection which was recognized by the
PC and a new Connection in the Prefs was established. After some twiddling
about with the settings I managed to get wireless surfing enabled from my
Palm.

Here's the settings:

Palm Prefs

Connection:
Bluetooth Lan
Connect to: Local Network
Via: Bluetooth
Device: PCName
Speed 115,200 bps
Flow Ctl - Off

Network
Service: Bluetooth Lan
Username: blank
Password; blank
DNS 202.188.0.133 and 202.188.1.5 (my ISPs DNS)
IP: 192.168.0.3 (or similar)

Kicking off... Still with my trusty m515 Palm PDA, loaded with apps, only about 4MB left of the 16MB Ram available. Flash ram chock full of stuff too.
Currently most used apps are:

- Agendus
- HanDbase
- Avantgo
- Worldmate
- Wordsmith
- 5 Minute CLinical Consult
- Lexidrugs
- Medcalc