6/28/96
Ever wished you had that one key piece of information you need to treat your patient right at your fingertips in a form you could carry with you always? Ever wish for an easy way to document patient encounters in the hospital, in the clinic, on the phone,.... Do you carry a stack of index cards with every little piece of key information you need to remember or have your sacred black book of pearls? If so there is a palmtop computer somewhere in your future.
Palmtops are the smallest of "fully functional" computers. They are loosely defined as those computers that can easily fit in the palm of your hand and easily into your lab coat pocket or on your belt. They are designed as the ultimate in portable information retrieval. Ideally capable of not only accessing information in their memory and disks, but remotely accessing your practice's main computer, the Internet, and able to send an receive faxes.
What can they currently do to enhance your practice? They can act as the ultimate "peripheral brain." Drug dosages, code protocols, laboratory interpretation, procedure references, phone referral lists, differential diagnosis lists, admission protocols, growth curves,... all can be at your fingertips. They also can do repetitive calculations, link to your practice management software, organize your scut, and provide continuing medical education.
What can they do in the future? The future will likely see the addition of multimedia capabilities to the palmtop level of computing. Videos, audio, and still pictures will enhance your education and clinical practice. Links to the Internet will likely provide you with access to large decision support databases, consultants, pharmacies,.... Ultimately you will not even need a keyboard or pen to communicate with your palmtop. A voice interface is the pot of gold at the end of the rainbow. Real time dictation and verbal data entry will have a significant impact on the efficiency of clinical medicine in the future.
What specifically is available for me right now and how do I make a decision when to invest the time and money to get a palmtop system and use it in my practice? Currently there are two main competitors in the true palmtop market. The Apple MessagePad 130 (running the Newton operating system and often called a "Newton") costs around $700.00 and is primarily a pen based computer with a great dependence on handwriting recognition. The product is continuously being upgraded and rumor has it that despite the current structural reshaping occurring at Apple, the Newton will continue to be supported and upgraded in the future. There are several different programs available specifically for practice management and clinical medicine on the Newton, however, as is true for most of this market at this time, they all suffer the same hardware limitations despite being truly great pieces of software. The pen-based system of entry is fraught with many difficulties. Despite numerous improvements in the Newton's handwriting recognition, nothing is ever 100%. The time needed to translate the handwriting is cumbersome as well. Certainly these two problems alone will significantly slow your practice to a crawl if using this system. On top of this difficulty is the problem of the MessagePad's pressure-based input screen. The computer recognizes pressure from the pen stylus on the screen as handwriting and tries to interpret what is written. Unfortunately, it also interprets the pressure of the heel of your hand on the screen in the same way if you rest your hand on the screen as many do as they write.
The other option is the Hewlett-Packard palmtop computer line, most recently the HP200LX. These are well designed, durable, truly hand held computers with non-backlit LCD screens that are priced similarly to the Apple MessagePad. You can think of the HP palmtops as basically the equivalent of the old IBM XT desktop computer in the palm of your hand. While not able to support Windows or other graphical user interfaces, it is a reliable, relatively easy to use information input and retrieval system. The input mechanism, as is true for all computers in this genre is the rate limiting step. It boasts a smallish keyboard which is very usable and perfect for hunt and peck typists such as myself, but will be very frustrating for traditional typists. Even so, features like the appointment scheduler, phone list, limited programmable database, equation solver, and others make it a flexible and useful addition to an efficient clinical practice.
The most difficult of all questions to answer is when to invest time and money into purchasing a palmtop system. This will be individual-specific and depend much on your familiarity and comfort with computers in general. There are some who will say, "This is great! I want one right now for my practice. I can see so many uses and I don't mind the limitations of difficult information entry, slow retrieval times, slow modem access to networks,...." There will be others who will wait until they can wear a watch like Dick Tracy that will allow them to communicate verbally with their office computer and have an artificially intelligent office and practice manager. There are, of course, others who will always grump and say, "It won't do all that I want it to do so why bother?" You have to decide where you fall in this continuum.