A HANDHELD COMPUTER 1996-2001
Is the Future in the
Palm of Your Hand?
I am not sure you can put a "price on organization," which is one
reason I flew to China to pick up a 64K Casio Boss before they were
available in the US, around 1990. I used my Boss for ICD codes and
reference notes. Needless to say, I bought my first
Palm the very first day it became available to the public. I use both the Palm and PocketPc. While I favor the Pocketpc
platform, for now, it's really all about personal productivity,
which hopefully translates to better patient care. "Personal
Productivity," is really a subjective factor, largely contingent on
what you want your PDA device and software to accomplish. For
example, as a medical student, your needs will be different from if
you are making a living in practice for yourself, or in a group
practice. Purchase decisions, must be predicated on such factors.
For me, it is not a question of being a gadget junkie or having deep
pockets. It's about organization, productivity, and the acquisition
of the very best tools to facilitate that goal.
- The advantages to using a computer
system in a practice clearly outweigh the perceived disadvantages,
such as cost and lack of "computer literacy."
- Capturing critical patient data,
and referencing medical software, at the point of care, on a PDA, is one such perceived
- There are many functions a
computer system can provide to your practice, outside of the
obvious -- A/R- billing and electronic medical records.
- Clear communication with your
staff is the most effective way to introduce change in your
- Buying a computer or PDA is like buying a
car or house. Each individual's needs and wants drive the
- The three C's of PDA acquisition:
• Cost: high benefits relative to the cost and potential risks
• Convenience: conforms to how the physician works
• Complexity: easy to use in the office
You can't go wrong with Palm, but you can't be more right than with
the decision process diffuses down to several points: It really
helps to know specifically what points are critical to your needs.
1. Budget/Cost: How much are you willing/able to spend? Bear
in mind that most handhelds have a 1-2 year lifespan, tops. Keep in
mind that these units are most likely to be a tax write off as well.
Consult your accountant of course.
How much are you willing/able to carry around? If you don't have
your handheld with you, it won't do you any good. Make sure that you
can carry your handheld virtually anywhere you go comfortably. Not
everyone wants to wear a belt-clip case. I prefer a belt clip as
opposed to risking the unit dropping from my dress shirt pocket. Now
it only drops from my waist, in a padded case. ;-) Note: Do
you need a wireless unit with a NIC card and possible sleeve? This
COLOR: Although this does not really help you in the Palm vs.
PocketPC decision, it can narrow down the number of models you are
considering. Ask yourself whether you really need color, or if it's
just a luxury. Note: Do you need color for reference material? No. Is color necessary? Not really. Is it nice?
Definitely! I think color applications are the only way to go if
programming takes advantage of color. It is tantamount to the
difference between watching black and white or color TV. Also, on a
minor note, keep in mind that even a nice color Palm like the Clie
NR70 is going to be dealing with most applications not written for
color. Most PPC applications are written for the color screen. Note: Color
consumes the battery # 7
4. Software: This is really one of the most important points,
since your handheld is merely an expensive paperweight if it doesn't
do what you bought it to do. The
Palm platform has the advantage in
terms of the sheer number of applications available, not to mention
large number of excellent freeware programs out there (Shots,
Med Rules, and
users have fewer programs to choose from, but remember, all of the major
categories of applications are abundantly represented (http://www.medicalpocketpc.com).
Also, of extreme importance, especially if you are in practice, is that you won't find many, if any,
robust EMR programs written for such a simple, non multitasking, OS
as the Palm. The bottom line is, what do you want your handheld
computer to do (realistically)? Do you have one particular "killer
application," that you must have? If this applications is
found on only one OS, your choice is made simple.
5. What do your
friends/coworkers use?: This is not a trivial point either,
especially if you're new to handhelds. Not that there's anything
wrong with being different, but you may find it harder to get help
and share files and applications. This can be an extremely important
factor if you are a med student, and time is a premium.
6. Do you want
to write your own programs?: If so, explore the various
options available on both platforms. Historically, it's has been
far easier to write for the Palm platform, which I believe,
is the major reason
why there's more software for the Palm, at this time. I believe this is no
longer the case with Microsoft making a free SDK kit available to
end users. (http://www.microsoft.com/mobile/developer/default.asp). The Palm OS still lacks multithreading, multitasking and
other features that are considered basic in the enterprise
market--and that have always been part of Windows CE devices
For applications with any degree of complexity, Pocket PC devices,
using Visual Basic or Visual C++, are a better alternative than Palm
(plus, PocketPC will soon become part of the .Net framework
development environment). Although Palm development can also be done
in C++ or other development environments (such as VB add-ons,
Metrowerks and Satellite Forms), this requires an
information-technology developer to learn new skills and the PQA
language. In addition, Pocket PC offers affinity to Internet
Explorer, Exchange, Word, SQL Server, Exchange and so on, and is a
more secure environment than Palm. Security is a big issue in Health
Care with HIPAA stipulations and requirements.
Longevity may be critical to you. Palms and certainly non-color Palms
have a longer battery life than the color Ce devices. With my Ipaq
can go 8 hours at work, and this depends on what exactly a user is
doing. If you are using a machine to chart one patient after
another, propagating text files, parsing and concatenating text and sentences, IR printing, doing queries and
reports on your handheld, it is going to consume the battery as compared
to a simple and occasional to frequent look up of information
and medical reference material. If battery life is really a serious
issue, don't buy color, or make darn sure you have a source of power
or extra battery. When you compare the most expense color units with
a PalmOS or Pocketpc OS, the battery life appears on par.
Multitasking/Multithread robust EMR Programs: This can be a big plus
depending on the applications you use. The Palm OS is not capable of
multitasking, and multi-threading operations, but will be when they change to the Strong Arm
Processor and the new BE OS. Application performance (or application performance
potential) on the PocketPC is much closer to desktop performance
than demonstrated by any Palm OS application known to me. I
"think" this is a reason why companies developing genuinely robust
EMRs (not just reference material, not there is anything wrong with
reference material), are using the Ce environment instead of the
Palm. I think Palm knows this as well, hence the incipient
chip change to StrongARM processor and new OS. Multi-tasking is
another big reason. It is a real pleasure to "one tap" from a drug
database software program to charting software, without having to
restart either application. It is nice to be able to pick up exactly
where you left off and not back at the beginning of the program.
With reference material, this is less of an issue.
9. Memory: Pocketpc come with
more memory than a Palm. Palm advocates state that Palm applications
take less memory. While this is true with many similar applications,
in part because the pocketpc program can do more, the Pocketpc ratio
of program to memory is still greater. Even if PPC applications are
double the size of the Palm, (perhaps for good reason), let's do the
math. With the average Skyscape application being say 3MB for the
Palm and 6MB for the PPC, you can get 5.33 apps. on your 16MB Palm
and 10.66 on the 64MB PPC. That's a two to one ration for the PPC!
The Palm typically comes with 8-16 megs maximum and the Pocketpc2002
with 64Megs of RAM and 32 ROM.. This large native memory avoids the
troublesome scenario of trying to run "some," applications off an
extra memory card. Updatable applications (ePocrates) often refuse
to run off a memory card.
10. Memory cards:
I believe they are much easier to use on the Pocketpc with simple
drag and drop implementation of files onto the card via the Explore
of Active Sync, as well as installation of applications onto the
card. With PPC, the memory card is just like a hard drive, zip or
floppy from an organization point of view. Not so with Palm. You
need 3rd party software for the same organization, on the Palm.
Also, keep in mind that memory cards swap applications from the card
to Ram. If you have a 600 kb program on your card, you better have
that much ram free on your device! No trivial point when your device
locks and you need a soft reset. See # 9
11. CPU: The
PocketPC uses the StrongArm processor now, and any month now the
X-Scale. Fujitsu alleges to have an X-scale available in late March
or May of 2002. The Palm will be moving
the StrongArm shortly. In my opinion, by the time the Palm has fully
implemented the StrongArm, the PocketPC will be using X-Scale, the
upgrade to the StrongArm processor.
Future of PPC and X-Scale
12. Sound/Voice: Do
you need a tape recorder? Do you need to record a quick note or
dictation? You can with all PocketPCs. All work and no play is not
All the PocketPCs can play movies and mpegs. Some of the newer Palm
OS devices can as well.
13. Input: The PocketPc has 3 options for input. Only Pocketpc uses Transcriber which
recognizes handwriting in print or cursive and converts it to text.
This works outstandingly well with a little practice. Note: Works best if you write in size
14 font. Palm's Graffiti is very good too but it does not recognize
cursive and speed of input is very important.
(Transcriber allows writing in cursive on the Pocket PC screen and
the handwriting turns instantly to text! Transcriber recognizes all
handwriting, be it cursive, printed or a combination of both. It
employs advanced fuzzy logic and neural net techniques that allow it
to recognize your handwriting with remarkable accuracy and speed).
Calligraphy is another program that licensed Transcriber to
Microsoft. With Pen Commander of Calligraphy you
can create your own custom scripts
(macros) to add personalized text and customized edit functions. You
can start programs or produce memorized text by simply drawing a
circle around a command word you've created. This feature is great
for standard medical procedures often used or any repeated
procedure, signature, spell checking, opening another medical program from within
any program! I normally use a combination of cursive and printed
letters in my handwriting, and the software translates this into
editable text with a high degree of accuracy. I find these programs
much faster and easier than Graffiti, the comparable Palm
application that requires the user to learn specific keystrokes.
Furthermore, the Pocket PCs recognize text entered from anywhere
over the entire screen - not just a small input box as on the Palms.
14. Imaging: Imaging on a
pocketpc is as simple to manipulate as on your desktop. Drag and
drop or copy and paste and you're done. You can make custom
subdirectories on your Pocketpc just like in your desktop Windows
OS. Very easy to stay organized in a "Customized Fashion," with
subdirectories for Anatomy, Dermatology, X-ray etc. The images are
excellent at 65000 colors. Additionally, if imaging is important,
all PocketPCs have the ability to attach a camera as well.
15. Active Sync or Hot Sync: Not
a trivial point at all, since this is the conduit by which critical
data is passed to your PC! Active Sync has more options for user
customizing convenience, but that doesn't make it better than the
one touch sync of Palm's Hotsync. In fact, it leaves it open to more
potential problems. ( Note: If you look at both Palm
and Pocketpc forums, you will have no difficulty finding threads of
user complaints for both methods).
16. Operating System (OS): The Pocketpc uses an OS by Microsoft presently called
CE3 or Pocketpc2002. The pocketpc is a 32 bit multitasking,
multithreading OS. It is more complicated than the PalmOS. For many,
it is more time consuming to learn than the linear OS of the Palm.
Although it is much like the desktop version of Windows, which makes
it intuitive for many. I really find navigating the PPC just
like a hard drive which I am use to. You won't find this as seamless
in the Palm OS. File management in general is easier on the
PPC, at least if you are use to a Windows OS on your
Desktop PC. In many cases, simple is better, but
not always. A more complicated OS can do more, and that is precisely
why Palm is moving to a 32 bit OS by BE. Is simple better? That is
up to the individual user. I think of the PalmOS as a sleek cool,
simple and fast motorcycle. Analogy: The PocketPC is more like a car. Slower
off the line, but with more options and utility.
The real Personal
Information Manager efficiency and productivity gains will be lost
if you don't keep your PDA in sync with your desktop PC. Use the
PDA's sync features to keep all your contact info, calendar and task
lists up to date with your PC (and vice versa). "I consider my PDA
to be a mobile extension of Microsoft Outlook, as well as my
patient information. You might buy your
PDA for medical applications but don't overlook organization.
18. Wireless: Last
but not least. Both Palm and
Pocketpc are capable of being used for wireless purposes for
accessing Wireless Services, Bluetooth, mobile phones or modems. The
Pocketpc has a distinct advantage here with respect to being able to
utilize a wireless NIC card to connect to an office LAN. Once
connected, the PPC becomes part of the network and can employ shared
resources such as printers and databases and even Terminal Server.
Terminal Server client on the Pocketpc, allows a user to run actual
Windows applications right on the PPC, if you have Windows XP
Professional. This seemingly impractical arrangement can become a
powerful corporate tool when running an application specifically
designed for the PocketPCs small display.
19. Network: The PocketPCs are designed to use corporate
networks. The PocketPC 2002 software lets you set up multiple
networking profiles to use in the office, at home, and on the road.
A virtual private network (VPN) program lets you use a phone line or
a high-speed Internet connection at home or in a hotel to reach
corporate Web setups or mail servers behind a firewall. The
integrated software works only with Microsoft-based VPNs, but an
add-on program from Certicom (CERT ) (also available for Palm) gives
access to VPNs from Cisco Systems (CSCO ), Nortel Networks (NT ),
Lucent Technologies (LU ), and others.
There's even a program that allows a PocketPC to log into a Windows
NT, 2000, or XP computer running Windows Terminal Server. In theory,
you can run any Windows program on a remote computer from a
PocketPC, but you'll be able to see only perhaps one-tenth of the PC
screen at a time. This seemingly impractical arrangement can become
a powerful corporate tool when running an application specifically
designed for the PocketPC's small display.
There's no way any Palm can compete with the PocketPC's networking
prowess at least until new designs, using a new operating system,
hit the market. If you need a handheld with sophisticated networking
ability, the PocketPC may well be your best choice, then again, you
may not even give a hoot.
Q: Why Digital-Doc chose the Pocketpc over the Palm?
Briefly, because the Pocketpc is more technically robust than the Palm OS. The
pocketpc can offer more sophisticated applications because of ARM's
power (X-Scale) and making use of a multitasking and multithreaded OS. The Pocketpc is
more than a medical reference tool. The Pocketpc, with its
Strong Arm Processor, is more capable of running a full-fledged
multitasking, multithreaded, EMR program than the Palm OS. The Palm
cannot multi-task at all! Color (16-bit) is now essentially
standard, superior sound, a faster Processor, more RAM, and a better
symbiotic relationship with Windows desktop machine applications
like Word, Excel, Access, and Outlook. The PocketPC allows a user to
take advantage of MS Access on the desktop by transferring files
between an MS Access table on the Desktop (.mdb) and the .cdb on the
Pocketpc. The fact that
it interfaces so easily with Access is also a big plus because it
allows the handheld to function as a seamless extension of your
Arguably, corporate enterprise users (including hospitals and
private offices) find a closer affinity to the Microsoft-dominated
PC world. Palm has acknowledged for more than a year that it needs
to move its operating system to ARM to give its handhelds the
megahertz kick necessary to create applications, which can compete
with Microsoft-based devices using the same chip.