Tips for choosing and using the latest in handheld computers
By Edward Martin
NEW ORLEANS—Old problem: "I'm going to put these marks here so we can see how that lesion is doing. Please don't wash them off before you come back."
New solution: "Let me take this digital photo and when you come back, I'll pop it up on my handheld computer and see what kind of progress you're making."
At a session on how to choose and use handheld computers in medicine, Steven E. Labkoff, ACP-ASIM Member, used the above example to illustrate how increasingly smaller computer systems can serve as vital tools for internists.
While Dr. Labkoff, senior manager of medical informatics at Pfizer Pharmaceuticals Group in New York, was primarily talking about the growing use of handheld computers, he noted that physicians' use of tiny computers is linked to other technological developments. He said that with digital cameras selling for as little as $200, for example, handheld computers can easily be used to record dermatologic and rheumatologic benchmarks that can't be scrubbed off by patients. He made his point by snapping a photo of an audience member's hand and displaying it on his handheld computer.
While physicians use handheld computers to access clinical reference works such as "Lexi-Comp Drug Database" and "Ferri's Guide to Care of the Medical Patient," Dr. Labkoff noted that pint-size machines are also becoming popular for managing clinical data and record-keeping. Identifying how you plan to use a handheld computer is critical, he explained, because it will help determine which machine you should buy.
So what should internists consider in a handheld computer? If you're looking for basic communications functions, for example, Dr. Labkoff said that most handheld computers and personal digital assistants will allow you to update your schedule during the day and receive lab data instantly from any location. Most machines will also allow you to save messages like a nursing station patient update and later download them to your medical record software.
If you have more focused needs, there are also specialized models. Dr. Labkoff talked about the Franklin Digital Book System, which allows users to read reference books on a pocket-size device that costs about $125.
If you need technology with more versatility and power, Dr. Labkoff suggested the Hewlett Packard Palmtop 200 LX, a so-called clamshell computer whose cover lifts to become a screen. He also pointed to the PalmPilot from 3Com Corp., a favorite of physicians. He said that these machines offer substantial processing power, making them more like full-blown computers than handhelds. Dr. Labkoff said that the 200 LX retails for $600 and up, while the PalmPilot costs between $400 and $700.
When looking at individual features of handheld machines, Dr. Labkoff suggested asking if handhelds have an infrared port that allow them to print out a prescription or transfer data to another colleague's palmtop without a cable or some other physical link.
Physicians should also ask if the model uses PCMCIA cards—credit-card size cards that can store data or serve as modems to transfer data over telephone lines, among other functions.
What computer language or operating system should a palmtop use? Despite efforts by Microsoft to promote its operating system for handheld computers, Windows CE, Dr. Labkoff said that the widest array of medical software remains available for older DOS-based systems. The HP 200 LX, for example, can run 25,000 different programs, all based on the DOS language.
For handhelds like the PalmPilot, which have no keyboard and require users to handwrite text directly onto the machine's screen, there is the issue of handwriting recognition. When the Apple Newton, one of the earliest handhelds, was introduced, its weak handwriting recognition software was lampooned in the media. Dr. Labkoff noted that since then, handwriting recognition software has improved dramatically, making handhelds much easier—and faster—to use.
Graffiti is a highly-regarded handwriting recognition program that uses a slightly modified alphabet—"A" is missing its crossbar, for example—to achieve 100% accuracy rates. Perhaps best of all, most users say, the software is easy to learn and use. "Believe it or not," said Dr. Labkoff, "it won't take you more than 15 minutes to learn Graffiti."
Finally, if you take the plunge and purchase a handheld, Dr. Labkoff suggested taking some simple security precautions: Small palmtops are favorites with thieves. "If you've got critical information, such as databases with AIDS patients, you should make sure it's password protected," he explained. "If not, you've got a confidentiality and liability concern."
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