How to Choose a Handheld Computer



PPC and Palm

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 advantage.
  • 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 practice.
  • Buying a computer or PDA is like buying a car or house. Each individual's needs and wants drive the decision-making process.
  • 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 PPC!

Essentially, 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.

2. Size: 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 adds bulk.

3. COLOR/NO 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 StatCoder). PocketPC users have fewer programs to choose from, but remember, all of the major categories of applications are abundantly represented (  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. ( 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 (including PocketPC).

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.

7. Battery: 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 3800, I 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.

8. 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. The 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 healthy. 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.

17. PIM: 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?

A: 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 desktop. 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.