This is the second in my series of articles about the role for handheld computers in medicine. Each month I will focus on a different aspect of palmtop computing, and how it impacts or can be used in medicine. The next few articles will examine the role of standard applications as they apply to medicine.
Medical professionals use applications that fall into three broad categories:
- Simple text apps (including doc readers/editors and doc-like reference apps).
- Database apps (including todo, scheduling, spreadsheet, and tracking apps).
- Communications apps (including synchronization, fax, paging, and web apps).
This month I'll discuss text applications.
After playing with the built in applications and delving into the mysteries of hotsync'ing, most of us first apply our handhelds to medicine by storing pieces of information that were formerly maintained intracranially or on paper.
Clearly, pearls and brief notes are ideal for storage on handheld computers. They're easily accessible throughout the workday (typically kept in a lab coat or shirt pocket), can find that specific kernel of information easily using the global find function, and (as long as the ditty is not too long, and you've learned Graffiti) makes storing information rather painless. Early on in PalmOS computing, a standard for text documents compression was established. The Doc format is the standard for most (if not all) word processor type documents on the PalmOS device. The existence of this well acknowledged standard makes it easy to share documents and to use the Doc reader of your choice (freeware, shareware, or commercial). Several utilities exist that allow conversion of documents stored on the desktop into the Doc format. Entire books have been converted for handheld use in this manner; and many folks have published their own lists and documents of medical information to the public domain, making entering that information as simple as download and install. I'll bet that there isn't a medical professional out there who doesn't have at least one of these information documents on their Palm. I know I do.
There is a downside to this information storage method. Even with compression, large text documents require large amounts or memory. Unless you have more than 4 megs, text documents can quickly crowd your handheld; and although the built in global find works well for searching through up to about a Meg or so of memory, finding that single piece of information in a sea of text can take longer than most of us are willing to wait. In response to these problems, other text based methods for storing and retrieving information have evolved.
Outliners were the first atypical text applications available for the PalmOS. Outlines allow detailed information to be presented in a succinct and relatively easily navigable environment. Headings, sub-heading, and sub-sub-headings that can collapse and expand as desired, make for an uncluttered display. Global find is less important with outlines because of the hierarchical structure, allowing one to pinpoint information easily. Still, outliners are basically specialized document readers/editors. They suffer the same drawbacks with regard to memory requirements as their standard doc reader/editor brethren. Also, if the outline is set up less than logically (which happens more often than you would think), finding something particular can still be like finding the proverbial needle in a haystack. Worse yet, a standard outliner format never emerged as it did with docs. Users were left fumbling with converters and incompatible documents downloaded from various sites.
Several commercial software publishers have released text engines, that are designed for compact storage of large text documents (usually PalmOS versions of printed titles) with searchable content. Sequential searching seems to be the dominant and most useful of the searching methods in these products. In sequential search, your target piece of information is found by narrowing in on indexed keywords as you enter the name of the topic. As with the built in address book, as each letter is entered, you are taken closer and closer to you target which is shown within the list of indexed headings. This method works pretty well, but is limited by poor indexing (do you enter "CHF" or "congestive"?). Additionally, compression doesn't help that much when you are cramming the entire text of Harrison's or PDR into your 4 Meg PalmV.
The latest trend in text handling on PalmOS machines is HTML. HTML compatible editors and readers make navigating larger text documents much easier. Hyperlinks to and from various sections/topics is much more intuitive and physician friendly. Forward and back functions allow you to jump around but still keep your place. Newer programs can handle tables and graphics; making presentation of medical text material much more useful. Still, the usefulness of hypertext documents is greatly dependent upon the authors' use of links. It won't help much if useful links between topics are not established during the editing process. Programs that allow users to set their own hyperlinks should make this format even more useful. There are free and shareware HTML converters that will allow users to access desktop versions of HTML documents on the PalmOS. Next month we'll explore the many excellent database programs available for the PalmOS, and how they are making inroads into medicine.