Handhelds in Medicine Springer New York Berlin Heidelberg Hong Kong London Milan Paris Tokyo Handhelds in Medicine A Practical Guide for Clinicians Scott M. Strayer, MD, MPH Assistant Professor,Department of Family Medicine, UVA Health System,University of Virginia School of Medicine, Charlottesville,Virginia Peter L. Reynolds, MD Major,United States Air Force,Staff Family Physician,United States Medical Clinic,Geilenkirchen,Germany Mark H. Ebell, MD, MS Associate Professor,Department of Family Medicine,Michigan State University,East Lansing,Michigan Editors With 633 Illustrations and a CD-Rom 1 3 Scott M.Strayer,MD,MPH Peter L.Reynolds,MD Assistant Professor Major Department of Family Medicine United States Air Force UVA Health System Staff Family Physician University of Virginia School United States Medical Clinic of Medicine 52511 Geilenkirchen Charlottesville,VA 22908 Germany USA Mark H.Ebell,MD,MS Associate Professor Department of Family Medicine Michigan State University East Lansing,MI 48824 USA Cover illustration:The cover illustration is by Roy Wiemann,New York,2003. Library of Congress Cataloging-in-Publication Data Strayer,Scott M. Handhelds in medicine :a practical guide for clinicians / Scott M.Strayer,Peter L. Reynolds,Mark H.Ebell. p. cm. Includes index. ISBN 0-387-40329-9 (alk.paper) 1. Diagnosis. 2. Clinical medicine. 3. Portable computers. 4. Pocket computers. I. Reynolds,Peter,1947– II. Ebell,Mark H. III. Title. RC71.3.S77 2003 004.16¢02461—dc21 2003052967 ISBN 0-387-40329-9 Printed on acid-free paper. © 2005 Springer Science+Business Media,Inc. All rights reserved.This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media,Inc.,233 Spring Street, New York,NY 10013,USA),except for brief excerpts in connection with reviews or scholarly analysis.Use in connection with any form of information storage and retrieval,electronic adap- tation,computer software,or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names,trademarks,service marks,and similar terms,even if they are not identified as such,is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press,neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made.The publisher makes no warranty, express or implied,with respect to the material contained herein. The views presented by David R.Blair,MD,Dale Patterson,MD,and Peter L.Reynolds,MD, do not necessarily represent the views of the Department of Defense or its components. Printed in the United States of America. (BS/HAM) 9 8 7 6 5 4 3 2 1 SPIN 10936832 springeronline.com We dedicate this book to our spouses: Karen Strayer,Katie Reynolds,and Laura Bierema To our children: Denton,Riley,Madeline,Sophie,Samuel,and especially,Lukas, who spent too little time with us,but taught us so much To our medical colleagues everywhere who seek out self-improvement through technical innovation Preface Have you ever wanted to calculate the predicted peak flow for one of your asthmatic patients without spending valuable minutes searching for that confounded little slide rule gizmo? How about being able to enter your patient’s risk factors and cholesterol number, and have the goal LDL cholesterol level spit out for you without having to read the latest version of the National Cholesterol Education Program’s guidelines in their entirety—let alone remembering how to use them in your busy daily prac- tice? Wouldn’t it be great if you could somehow remember all Mrs.Jones’ medications when the nursing home calls to see if it’s OK to treat her acutely elevated blood pressure with some atenolol? What would you give to be able to look up the dosing instructions for that newly released med- ication in seconds,without lugging out the 10-pound PDR (would it even be in there if the medication was just released)? All these medical tasks and many,many more can be easily accomplished using the current models of handheld computers.While earlier generations of handheld computers suffered from clumsy interfaces,short battery lives, and poor software, the latest models available from Palm®, Handspring, TRG,Sony,Hewlett-Packard,Toshiba,Casio,and others come very close to being the ideal information tool for clinicians at the point of care. In handheld computer user circles,the following quote is often used to highlight the trepidation with which most physicians view computer tech- nology:“That it will ever come into general use,notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble,both to the patient and to the practitioner because its hue and character are foreign and opposed to all our habits and associations.”Just look at the abysmal 5% of physicians who currrently use electronic medical records in their practice despite widespread availability for more than two decades.1 However,this quote was actually made in an vii viii Preface 1834 edition of the London Times,and was referring to the stethoscope,and not handheld computers.If the handheld’s future is as bright as the stetho- scope’s was in 1834,watch out! These handheld computers are coming to be known as “Medical Digital Assistants”or MDAs instead of the frequently used “Personal Digital Assis- tant”or PDA acronym of the business world.Nearly a quarter of physicians report using an MDA2and the numbers are growing rapidly,with more than two-thirds of family practice residencies reporting that they are using hand- held computers in their training programs.3 These devices are becoming so popular that physicians like Chris Vincent,MD,a clinical associate pro- fessor of family medicine at the University of Washington and Swedish Family Medicine Residency,proclaimed,“We think the PDA is the stetho- scope of tomorrow.Within five years,everyone is going to have one.”4 Will these technological marvels improve the quality of care? Do they hold the promise of making physicians more efficient, informed, and less error-prone? Can they help patients and physicians manage chronic diseases more effectively? These provocative questions, and many more, are currently the subjects of researchers’ inquiries across the country and throughout the world. While MDAs are rapidly gaining acceptance in medical practice,designing the best interfaces (interfaces are how we inter- act with the computer) and eliminating error-prone or buggy devices and software will be critical. Additionally, designing handheld-based systems that patients can use to keep their physicians up-to-date on their latest peak flow readings or blood glucose trends may change the way we treat chronic disease. This book is not intended to be an exhaustive review of all available hard- ware and software options. Rather, it should serve as a brief overview of how practicing physicians can use these tools in their practices.The book is written by practicing physicians with handheld computer expertise and will illuminate various unique and useful ways to employ handheld computers in your practice.It is designed to be helpful for all kinds of users,from the novice through the computer wizard.In Section I,we will take you through choosing your first handheld,its basic uses,and how to download and install software on your new machine. In Section II of this volume, the various types of medical software are introduced,including where to find them and how you can use them on a daily basis to enhance your practice.Types of software covered range from keeping track of your patients to medical references and calculators. Creating simple tools for tasks such as tracking your CME hours is also covered.Finally,the ever-important task of capturing your patient charge information deserves a chapter.Although the focus is on tools for practic- ing physicians in this section,we will also learn how nurses and physician assistants use handheld computers in practice. Finally,Section III contains some food for more advanced users,so keep it for later if you are a beginner handheld enthusiast,or you might want to Preface ix skip to this section if you are a Star Trekfan trying to emulate Dr.McCoy, carrying a handheld since the introduction of the Apple Newton in 1992! Here we cover advanced topics, including wireless networks, creat- ing your own databases,and programming your own software.This section also has a chapter for the academics in the group who want more informa- tion on how to teach about the use of handhelds in their “ivory towers,” and a chapter on server synchronization reviews advanced deployment and retrieval of formation over networks and servers. This is the first book of its kind devoted to healthcare professionals,and we realize that this is a rapidly evolving field.Every effort to bring you the latest, most up-to-date information was made at the time of printing, but the details will change very fast.The framework for the book should be an excellent guide through this dynamic topic,and it is our intention to provide Web updates of certain tables and text and to produce future editions on a timely basis.Please go to www.handheldsinmedicine.com for updates. The book is also organized so that if you learn by doing things you can skip to the “hand-on”exercises in nearly every chapter denoted by the icon .There are also “power users” tips throughout the book for advanced handheld users. It is our hope that using a handheld computer in medical practice will improve your efficiency while enhancing the quality of care at the same time. Sharing the small handheld screen to illustrate a medical concept for your patient, showing them how quitting smoking will improve their cardiac risk profile, and quickly looking up a medication dose give you precious additional seconds in the exam room, improve the quality of care,and show your patients that you are on the cutting edge of medical technology. Scott M.Strayer,MD,MPH Peter L.Reynolds,MD Mark H.Ebell,MD,MS References 1. Stringer J.Broken Records.Red Herring.Retrieved from the World Wide Web at http://www.redherring.com,December 11,2003. 2. HarrisInteractive.Physician’s use of handhelds increases from 15% in 1999 to 26% in 2001.Harris interactive poll results.Vol.1,Issue 25.Retrieved from the World Wide Web at http://www.rnpalm.com/harris.htm,August 15,2001. 3. Criswell DF,Parchman ML.Handheld computer use in U.S.family practice res- idency programs.J Am Med Inform Assoc 2002;9(1):80–86. 4. Connaughton D.“Stethoscope of tomorrow”puts medical information at your fingertips.FP Report.October 2000. Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Registered,Trademarked,and Copyrighted Material . . . . . . . . . . . xvii Section I Getting to Know Your Handheld Computer 1 Choosing a Handheld Computer:PDAs,MDAs,and the Alphabet Soup of Handheld Computers . . . . . . . . . . . . . . 3 Scott M.Strayer and Mark H.Ebell 2 Getting to Know Your Handheld: Palm OS and Pocket PC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Peter L.Reynolds and Mark H.Ebell 3 Getting Software from Cyberspace to the Palm of Your Hand: Downloading and Installing Software on Your Palm OS or Pocket PC Handheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Scott M.Strayer and Mark H.Ebell Section II Medical Software 4 “Where in the World Wide Web Do I Find All This Stuff?” Finding Medical Software and Information on the Web for Handheld Computers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Peter L.Reynolds and Scott M.Strayer xi