The Palmdoc Chronicles

3 days to CES and counting. That’s when Palm unveils it’s new Nova powered devices. No one knows for sure what they look like but I hope for a large screen and a vertical slider keyboard.
You never know - if you wish hard enough, your wish might come true. John Biggs in Crunchgear posted an “exclusive” that the “new phone will have a full QWERTY keyboard that will slide down under a portrait-oriented touchscreen”

The new operating system is described as “amazing” and there will be a full software bazaar on launch. It will have media playback functions along with standard Palm calendar, email, and contact functionality.
As expected, the phone is described as “iPhone-like” and will probably be sourced by HTC like the Palm Pro. The official Palm announcement should happen this Thursday at CES.

via Palmadddicts

I can’t wait! This suspense is killing me!!

At the end of the day, we still have to see what this OS has to offer. The immediate questions for medical users would be how backward compatible would it be? Will Epocrates and Uptodate run on it for instance?

Continuing the interview from part I:

PD: What are your personal favorite PDA software - medical and non-medical?
JS: That’s easy! The stuff that I use constantly, which work, and which provide helpful medical info, that’s the stuff I like the most. Probably like everyone else, I use ePocrates, the free version. Right up there is STAT Cholesterol. I do not believe one can treat cholesterol for primary and secondary prevention of heart attacks without calculating Framingham cardiac risk. This is the difference between disease oriented and patient oriented, evidence based practice. I don’t care about cholesterol, I care about risk of heart attack and preventing those heart attacks. STAT Cholesterol looks at all the risk factors, calculates a risk, and allows me to have a patient-centered discussion with my patient about treatment options. I probably use it more than ePocrates. Next is Tim Allen’s OB Wheel, fantastic for its simplicity and value in obstetric care, can’t do squat in OB without carefully determining due date, so it all starts with his outstanding product (and the Bishop score he included is an added gem of a bonus). Next is Essential Evidence Plus, which used to be called InfoRetriever. It is a massive searchable database of nothing but evidence based resources and calculators — all of Cochrane, all of JFP POEMs (patient oriented evidence that matters), all of National Guidelines Clearinghouse. Love Shots2008, an indispensable resource for anyone who gives shots, especially anyone who takes care of children needing shots. I actually broke down and bought the Sanford ABX Guide, my only non-free software app, but I’ve never found a truly great ID/ABX resource, all are good, none are great. Then I have Up-To-Date, free since I was a beta-tester for the Palm version! Fantastic resource, but does anyone want to read long tracts of medical info on a tiny screen? I get Up-To-Date access at work on big PC screens, so I don’t use my Palm version much. And with modesty aside for a moment, I really like and use my programs — and that’s why I put 20-30 hours into each making them! I use PreOp Eval all the time when I do medical clearance before surgery, likewise I use Pneumonia to check the definitions of hospital acquired pneumonia for the tricky cases and indicated w/up tips.

Non-medical software… is there non-medical software? Ok, ok, I’ve played 8889 games of Klondike solitaire on Sol Free (and counting). But the rest is the Palm PIM stuff which I think is great as-is. I use Pics&Videos to carry pictures of my son with me everywhere. I use Tasks for grocery store lists, lists of medical topics I need to brush up on, lists of movies and books I want to get to, lists of everything. I use Memos to keep track of what the proper billing E&M codes are for hospital stuff like a vaginal delivery, a med consult, a 23 hour observation, etc. And my Contacts list is my lifeline to staying connected to everyone else, all my friends, all my family, all my partners, all my residents, all my consultants, all the take-out Indian food places, and ditto goes for managing my entire schedule with Calendar. Come to think of it, Calendar is probably my #1 most important Palm app, right up there with Contacts.

PD: What do you hope to see with regards to Palm’s pending release of the Nova platform and new devices?

I hope to see viability and resurgence! That’s it, really, I’m not hot for any special new features. If my Treo 680 had an awesome battery life, free 3G data service, and AM/FM radio reception for when I go running, it would be PERFECT, yes, perfect… for me. (I don’t even have data service on my Treo, I don’t need the e-mail and I don’t want to surf the web on a 2×2″ screen, and most of all I don’t want to pay!) I think the Palm OS is still fine as-is from a medical PDA user point of view. But the typical consumer wants accelerometers, streaming app stores, video conferencing, and probably aromatherapy, too, so I see the slick appeal of iPhone. And I know that developers have complained for years that Palm OS is busting at the seams of what it can handle, and I guess that’s important so that those developers can continue to bring us great things which keep the Palm OS platform thriving. Oh, wait, I am a developer. So easy to forget when I’m just an amateur. I certainly have no dreams of making the Palm OS old or new do dazzling things, I’m just a small-time medical app maker.

PD: Do you see potential in the trend towards cloud computing versus stand alone software?
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Greetings for 2009! I would like to kick off the new year by continuing our series of interviews with personalities in the world of medical PDA computing. The first two dealt with well known ones who have published their work in iSilo format: Carl Weber (of Clinical Med Consult fame) and Andrew “The Meister” Schechtman (of the iSilo Medical Depot fame).
This time we interview an MD who took to the programming road. This is a long and difficult one, and there are not many MDs out there who have set out to do this. Those who did often did so out of seeing a need and their labours of love are used today by doctors all over the world who use PDAs and smartphones. I think you would be interested to read more about these rarities and what spurred them to do what they do.
I’d like to start off with Joshua Steinberg MD. Josh has written a couple of useful freebie applications which some of you might be using: Pneumonia HAP-HCAP-CAP and PreOp Cardiac Eval Tool and Reference. Josh publishes his work in the Family Medicine Digital Resources Library as well as in Freewarepalm.com

Josh Steinberg

PD: Could you tell us a bit about yourself - your background, training, work experience and how you ended up being involved in Palm medical programming?

JS: I’m a 39 year old old-fashioned do-everything general family doctor. I do nearly everything a family doctor can do, including outpatient full-spectrum primary care of patients/families of all ages, hospital adult care, hospital pediatrics, hospital newborn care, and the full gamut of obstetric care for low and moderate risk OB patients. My 6 partners are the core faculty of Wilson Family Practice Residency in Binghamton, NY, a small Upstate NY city 3 hours west of NYC (the “Southern Tier” of New York State). Ours is a combined faculty-resident practice with 27 residents (9-9-9 program), along with students from Syracuse’s SUNY Upstate Medical University and from two regional osteopathic medical schools. I’ve been on faculty at SUNY Upstate, then briefly at Univ. Cincinnati, before life brought me back to Central New York again. Two driving forces in my work are evidence based medicine and patient-centered care.

That brings me to Palm medical programming. Information Mastery styled EBM is as much about thoughtful use of information resources as it is about dissecting flawed randomized controlled trials. Doctors, especially do-everything family doctors, cannot possibly know everything needed to do good care, so I’ve been a huge fan of Palm PDA’s as resources for “just-in-time” information — the good info I need at just the moment I need it. I’ve collected lots of Palm PDA resources over the years. But every now and then I’d have an information need for which I couldn’t find a Palm medical app out there. This became especially important when after basically 8 years away from hospital medicine, I took a job as a hospitalist! I suddenly needed tons of info which had slowly evaporated from my brain via disuse. This got me thinking, “hmmmm, is it really computer geeks, errr I mean geniuses, who make all these cool medical apps, or could a motivated regular schmoe like me do it too?” I decided to find out. I contacted just such a person, family doc Tim Allen. He maintains a website of PDA resources (http://www.fppda.com/about.htm) including many that he wrote himself. I asked him, “how did you do it, how could I do it?” I programmed through high school on Apple IIe’s and IBM PC’s in BASIC, C, Pascal, but not since. The gulf between programming then and now is pretty large, so I was basically starting from scratch. Dr. Allen recommended using rapid application development tools. This was the key to my having any prayer of getting stuff done! These software products allow me, the user, to focus on design and function of a medical app, while the rapid-app-development software takes care of many technical aspects of programming behind the scenes — perfect for a novice like me. I don’t know if it’s something to brag about, since it betrays my utter lack of knowledge, but I STILL haven’t written a line of programming code since 1987!

PD: Was it easy/difficult to start writing medical software? What obstacles did you face when you first started?
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Most would know by now it is crunch time for Palm. The date to watch out for is January 8. This is when the Palm “New-ness” will be revealed to us at last. The highly anticipated Linux-based Nova devices will probably debut or be demoed on this date during the invitation-only event Palm is holding at the Las Vegas CES 2009 show.
My guess is Palm will take the opportunity to show off a slew of Nova devices - new smartphones and tablets/MIDs - which will take Palm forward and differentiate them from their competitors. Will the new Palm be still the same old Palm? Some think they might, but I hope they pull it off. Right now there isn’t quite the perfect PDA phone for me. perhaps there will never be one, but what I would like is a device with all the following features:

1) A large screen and a great browser like the iPhone with all the accelerometer goodness
2) An excellent organiser with integrated features like Palm’s PIM + Agendus
3) Supporting all the known wireless protocols - 3G/HSDPA, Wifi, Wimax
4) Decent battery life
5) A real keyboard. Now I realise that a combination of a real keyboard and large screen would probably require moving parts but I hope for a vertical slider (slide-up) design like this

or perhaps a flip phone design

6) Good quality camera - at least 3MP

The Edelweiss comes close but it runs on ALP and we know very little about this PDA phone which is designed by an Israeli company. The thing is, backwards compatibility with tons of Palm applications would give Palm and their Nova devices a good start. Having an online App store like Apple’s (yet without the rigid rules which Apple enforces) would be a boon for developers. I think that online “syncing and backing up data” with a Palm “cloud computing” service or 3rd party ones like Google’s would be increasingly important in the future. I am aware that Palm shut down their beta online backup service but perhaps they have something new in store for us?

Right now I am on vacation. I have with me my Palm Centro which I use as my main phone, organiser and run my key applications - Agendus, SplashID, Daynotez, Handbase, Medcalc, Uptodate & Lexidrugs. For mobile Internet access (and a secondary phone) I now use a Wm Palm Treo Pro. The faster 3G speeds are noticeable and when this is tethered to my Asus EeePC it makes mobile surfing a joy. Having said that, a WM device is still not quite the perfect PDA phone for me as I find it sluggish compared with my Centro and the PIM/Organiser is not as good. It’s the better mobile Internet connectivity which makes me carry on using the Treo Pro. Now if a Nova smartphone comes along which blows WM away, then I am all for it!

It’s a 10 (or 11 depending on where you are) day countdown now till January 8. On behalf of all the Palm fans out there, I hope that Palm pulls it off and that you would make our wishes for 2009 come true. Keep on battling Palm! If you guys need any cheering, here’s a video with 40 inspiring speeches compressed into 2 minutes for you

I wish you all Happy Hols and a Happy New Year!!

Unbound Medicine has launched native applications which you can install and run on your Blackberry. The applications feature convenient over-the-air installation, wireless automatic updates and superior navigation. Other features include full text with tables and images, index selection, cross-linking between titles and full memory card support.
Products now available for BlackBerry include Nursing Central, The 5-Minute Clinical Consult, Davis’s Drug Guide, and the The Merck Manual.
Visit the Unbound store for more details.

Only if you are lucky enough to be in Ohio State

With the use of portable media players, medical students at The Ohio State University Medical Center can now carry the equivalent of heavy textbooks and medical references in their lab coat pockets. The portable media players are part of the current technology making it easier for medical students at OSU to navigate classroom lectures and clinical duties with patients.
Justin Harper, a third-year medical student, saw the Apple iPod touch and helped launch a program for OSU medical students. The Ohio State University College of Medicine is the only college currently using the iPod touch to give to all its students for educational purposes.

Congratulations, Justin. I am sure all your fellow medical students will be happy. I for one, still think the iPod Touch is not quite a PDA replacement since it has a poor PIM and is more a multimedia device, but with Epocrates (and Epocrates Essentials) out as well as an increasing number of medical applications available for the iPhone and iPod Touch it’s not a bad deal. Especially if it’s free! Perhaps someone should do a study and see the usage pattern in OSU - educational vs “non-educational” use of the iPod Touch?

Now who will be the first to offer an iPhone for every medical student?

Since Epocrates launched its free drug reference for the iPhone in July, 50,000 physicians and thousands of consumers and other healthcare professionals have downloaded the application. Soon, the full subscription version will be available to iPhone users.

The first 1,000 users to pre-order Epocrates Essentials for the iPhone before December 19, 2008 receive 25% off ($38 savings) plus a chance to win a $500 Apple Gift Certificate!

1-year subscription
2-year subscription

The beta is over, and it is now available any place as long as you have a web browser- on your desktop, laptop, or mobile device - including your iPhone. You can save over 35% With a Web/Mobile Bundle. Normally $39.95 each, purchase a 1-year subscription to the Web Edition AND the Mobile Edition for only $49.95.
Click here for more information.

Renal Artery Stenosis Calculator v1.0 is available for download from Freewarepalm.com

Description:

This is a simple calculator that allows physicians to determine the probability of Renal Artery Stenosis based on a patients clinical parameters.
By setting the clinical parameters (Sex, Age, Creatnine etc.) and hitting calculate, one can easily determine the pretest probability of RAS.
This equation is just as sensitive as Renal Scintigraphy when a pretest probability of 30% is used for angiography.

Strangely, this app is listed at $5.99 at the developer’s website

Did your parents tell you to remember your scarf when you went out, so you wouldn’t catch a cold? Today, the advice might be: ‘Remember your cell phone!’ A maker of over-the-counter cold and flu remedies released a program this week for the T-Mobile G1, also known as the “Google phone,” that warns the user how many sick people there are in an area.

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