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Canadian Journal of Rural Medicine
CJRM Spring 2001 / printemps 2001

Handheld computers

Barrie McCombs, MD, CCFP, CCFP(EM)

CJRM 2001;6(2):138-40.


"I got my education, out behind the barn, I ain't a-fooling, no-o-o sir-ee-ee. Passed each examination, out behind the barn, but it almost made a wreck out of me" — Little Jimmy Dickens (c. 1950)

Handheld computers are practical tools that provide medical information right at the bedside or any other "point of need." The latest models have enough memory to store large amounts of information, such as drug databases, clinical practice guidelines and summarized versions of medical textbooks. Reviewed here are a few popular handheld computers, useful medical software programs and selected Web sites. Additional information on these handy devices is also provided.

Purchase decision

Before purchase, think about how you plan to use the device and how much you wish to spend. The most popular size is the palmtop, which is small enough to fit in your pocket. Monochrome models cost from Can$250 to $500; colour models cost $500 to $800. The low-priced "entry-level" computers are only really useful for basic functions. They do not have enough memory to store many medical applications.

Palm OS computers

In a recent report, computers using the Palm operating system (Palm OS) (Palm, Handspring Visor and TRG Pro) have a 90% market share. The operating system is simple and user-friendly because it concentrates on doing a limited number of tasks, and doing them well. Because of the popularity, there is much more software developed for these computers.

Pocket Windows CE computers

Pocket Windows CE is related to the operating system used on PC-type desktop computers. It is more powerful than the Palm OS but requires more memory. Programs available include limited versions of Word (word processing) and Excel (spreadsheet). This may be attractive if you already use these programs on your desktop computer.

Video display

Basic models have a monochrome (black and white) display that interprets colours as shades of grey. Colour displays vary in quality and price, so get a demonstration before you buy. The colour displays on the Handspring Visor and Compaq models are highly rated. The downside of colour models is that they require more power and have a shorter battery life.

Keyboard

The video displays are touch-sensitive, so many functions are activated by touching an on-screen menu. You can also use a stylus (pointer) to "type" on a "virtual keyboard." Many models also provide handwriting recognition. A new accessory this year is a folding keyboard. When folded, it is as small as the computer. When unfolded, it provides a full-size keyboard and a cradle to hold the computer.

Connecting to a PC

Most handhelds are sold with a docking cradle or cable that connects to a desktop computer. Software is installed on both computers, enabling them to exchange information when the handheld is placed in the cradle. Be sure that your desktop computer has the appropriate communication port (typically USB or serial) to match the handheld.

Beam me up, Scotty!

Many handhelds have an infrared input/output so that information can be quickly exchanged (beamed) between handhelds, even those of a different brand. This port can also be used to send information to printers or personal computers.

Voice recording

Windows CE computers provide a microphone for recording short voice messages. The Palms and Visors do not offer this feature. If you do a lot of dictation, consider the new handheld digital recording devices. Some of these include voice-recognition software to convert your recording to typewritten text. However, even with the latest software, you still have to proofread the results carefully.

Memory expansion and accessories

Several brands provide expansion slots or other methods for connecting accessories, such as extra memory modules, cell phones, modems or wireless transmitters. The manufacturers of cell phones and pagers are competing by adding data processing and storage capability to their products.

Basic software

The built-in calendar tracks important dates and appointments. You can use the alarm function to remind you of appointments a few minutes beforehand. The address book keeps track of important names, mailing addresses, phone numbers and email addresses. Instead of carrying business cards, it is now the "in thing" to beam your name and address to another handheld user, using the infrared port. The memo feature can store hundreds of pages of text information, including medical references. The calculator function is great for calculating pediatric drug doses. Thousands of other programs can be downloaded from the Internet, many of which are free.

News channels and Web sites

News channels are a new service provided by AvantGo and other vendors. When your handheld is linked to a desktop computer, new information on selected channels is automatically downloaded so that you can read it at your leisure. The University of Calgary is developing customized news channels for its rural preceptors, and for other interested rural physicians. Many Web sites, including the Canadian Medical Association Journal, now provide information that is formatted for downloading to a handheld computer.

Pharmaceutical databases

Among the most frequently used medical applications are drug databases that are similar in function to the Canadian Compendium of Pharmaceuticals and Specialties (CPS). The most popular are the US ePocrates and LexiDrugs programs.

Medical textbooks

Several textbooks are available in a condensed format for handhelds. These include the 5 Minute Clinical Consult (5MCC), Harrison's Principles of Internal Medicine, the Merck Manual, the Washington Manual, and Cline/Tintinalli's Emergency Medicine. These can be downloaded from the Internet (for a price). Some are available on memory modules for the Handspring Visor computers.

Web sites

Palm computers

www.palm.com

The Palm brand was the first popular palmtop. The new M105 model replaces the popular IIIxe. Some users may prefer the smaller, but more expensive, 500 series. A colour screen is available on the IIIc and M505 models.

Handspring computers

www.handspring.com

The Handspring Visor computers provide an expansion slot for memory cards or other accessories. The Prism model offers a colour screen.

TRGpro

www.trgpro.com

Physicians who wish to carry large quantities of information may prefer this lesser-known brand. It is only available in a monochrome-screen model. It has an expansion slot for high-capacity Compact Flash II memory cards. If you are an information junkie, IBM makes a 1.0-gigabyte Microdrive that fits into this slot.

Compaq iPAQ

www6.compaq.ca

The iPAQ uses the Pocket Windows CE operating system. Its expansion modules fit outside the computer. It is available with either a colour or monochrome display.

Medical Information Service

www.ruralnet.ab.ca/medinfo/

The "Handheld computers" link on this University of Calgary Web site provides links to all sites mentioned in this article. It contains additional information about other computers, accessories and software, including models released since this article went to print.

PocketProf

www.ruralnet.ab.ca/pocketprof/

This site provides information on the "PocketProf" project, which provides handheld computer information for rural preceptors at the University of Calgary. By the time you read this article, it should also have information of interest to all rural physicians.

PDAStreet

www.pdastreet.com

PDAStreet is a good place to compare handhelds from different manufacturers. However, some details on its "Specifications" pages do not match the manufacturer's information.

pdaMD

www.pdamd.com

pdaMD is one of the best Web sites on the medical use of handhelds. Its unique features include discussion forums and tutorials.

American Academy of Family Physicians

www.aafp.org/fpnet/pda/

The AAFP Web site has several handheld-related articles and links. There is also an excellent online slide show, "The Palm Pilot in Medical Practice," which is worth viewing before you purchase your first handheld.

Jim Thompson's Pilot Page

www.jimthompson.net/palmpda/

Dr. Thompson, a PEI emergency physician, manages a well organized Web site that deals with the medical use of the Palm and the TRG Pro computers.

MedicalPocketPC

www.medicalpocketpc.com

Here is a resource for medical users of Pocket PC computers. It contains articles, links, plus hardware and software reviews.

AvantGo

www.avantgo.com

This Web site provides the free AvantGo newsreader software.

ePocrates

www.epocrates.com

Go here to download the free ePocrates qRx 4.0 drug database and a free Infectious Disease database, but first read the user agreement carefully!

MedCalc

www.calc.med.edu

This excellent site provides online medical calculations, such as AA gradients, Body Mass Index and Number Needed to Treat. You can download a free version for Palm OS computers. It also has a database containing the diagnostic criteria for a number of clinical conditions.

Handheldmed

www.handheldmed.com/

This vendor sells a wide range of medical software, including the 5MCC, Cline/Tintinalli's Emergency Medicine and Harrison's Principles of Internal Medicine. It also provides AvantGo channels containing abstracts from popular medical journals.

Skyscape

www.skyscape.com

Skyscape's products include the popular LexiDrugs database, a drug interactions program, an infectious disease database, the 5MCC, and the new 5 Minute Emergency Medicine Consult (5MEC).

Franklin

www.franklin.com/medical/

Franklin sells a variety of books, including medical textbooks that can be downloaded or purchased pre-loaded on memory expansion modules for the Handspring Visor.

Portable Emergency Physician Information Database (PEPID)

http://63.89.206.228/

This Web site provides a free demonstration version of a popular multi-purpose software package for emergency physicians.


Dr. McCombs is Director, University of Calgary Medical Information Service, Calgary, Alta.

Correspondence to: Dr. Barrie McCombs, Director, University of Calgary Medical Information Service, 3330 Hospital Dr. NW, Calgary AB T2N 3Z0; bmccombs@ucalgary.ca; www.ruralnet.ab.ca/medinfo/

© 2001 Society of Rural Physicians of Canada