Hand-Held Computers for Family Physicians Mark H
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Technology Review Hand-held Computers for Family Physicians Mark H. Ebell, Ml), MS; Wayne Hale, MD; Joel E. Buchanan, MD; and Paul Dake, MD Detroit and Troy, Michigan, and Chapel Hill, North Carolina Hand-held computers such as the Apple Newton Mes variety of software, including computerized medical sagePad, HP 200LX, Psion 3a, and Franklin DBS-2 are records, medical calculators, and medical references, is Lw powerful enough to be useful to family physicians available. in their care of patients. Each fits in a laboratory coat Key words. Computers; computerized medical records; pocket, weighs a pound or less, costs less than $700, family physicians; medical informatics computing. turns on instantly, and has excellent battery life. A wide ( / Pam Pract 1995; 41:385-392) While computers have seen wide application in medical ware, programming languages, and other sources of billing, inpatient laboratory, and research applications, information for physicians. The features of each unit are their use in the clinical setting by physicians has been summarized in Table 1, and a glossary of terms is pre- quite limited. A variety of reasons may explain this lack of sented in Table 2. acceptance: unfriendly user interfaces, physician inability to use a keyboard, concern that the keyboard and monitor may interfere with the patient-physician relationship, and Apple Newton cost. A steadily increasing volume of reference and When initially introduced, the Newton MessagePad patient-related data, however, is increasing the appeal of (Apple Computer, Cupertino, Calif) was criticized for its computers for clinicians. Also, managed care creates new lack of memory, short battery life, and inconsistent hand incentives for physicians to practice in a cost-effective writing recognition. Apple listened to its critics and le- manner, which can be facilitated by the quick access to leased the MessagePad 110 in 1994 and the MessagePad information offered by computers. 120 (MP 120) in February of 1995 (Figure 1), both of A new generation of lightweight, easy-to-use, and which do an excellent job of addressing these concerns. relatively inexpensive hand-held computers addresses all An update to the Newton’s operating system software, jthese problems. In this article, the Apple Newton, HP which will improve the unit’s speed and functionality, is 200LX, Franklin Digital Book System, and Psion 3A expected to be available this month (October). The orig hand-held computers are described. Known as personal inal MessagePad 100, with upgraded memory and soft .digital assistants (PDAs), each weighs a pound or less, costs under $700, fits in a physician’s coat pocket, turns ware, is still available at the time of this writing (March 1995) for only $199, while the new MP 120 retails for on instantly without a lengthy “ boot” process, and has a $599 in a 1MB random access memory (RAM) configu [battery life of at least 20 hours. The advantages and dis ration and $699 for a 2MB RAM configuration with a advantages of each PDA in the medical setting are dis cussed, along with an overview of available medical soft- lax/ modem. Readers affiliated with an educational insti tution may qualify for a discounted price for the latter model of approximately $520. kbmitted, revised, July 14, 1995. The MP 120 weighs approximately 1 lb and fits com lim the Department of Family Medicine, Wayne State University, Detroit (M.H.E., fortably in the pocket of a laboratory coat. The screen 111), and the Department o f Family Medicine, William Beaumont Hospital, Troy covers most of its surf ace area, and a small telescoping pen Michigan; and the'Department of Family Medicine, University of North Carolina, Chapel Hill (W.H.). Requests for reprints should be addressed to Mark H. is stored internally in a spring-loaded compartment. It has Bill, MD, MS, Department of Family Medicine, Wayne State University, 4201 St a built-in speaker for sound reproduction, and additional Mtoine UHC-4J, Detroit, M I 48201. 6 1995 Appleton & Lange_________________ _____________ ISSN 0094-3509 385 [The Journal of Family Practice, Vol. 41, No. 4(Oct), 1995 Hand-held Computers Ebell, Hale, Buchanan, and Di Table 1. Comparison of the Characteristics of Four Hand-held Computers Characteristics Newton MP 120 HP 200LX Psion 3a Franklin DBS-2 j Central processing unit ARM 610 reduced 80C186 Proprietary 16 mHz chip (frequency) Proprietary 65C8I6 instruction set (7.91 mHz) 16 mHz chip processor (20 mHz) Operating system Newt 0.8 1.3 MS-DOS 5.0 Proprietary multi-tasking (DOS-compatible files) Programming languages Newton Toolkit Any DOS-based OPT is built-in NA available NS Basie Newt language (BASIC-like language) Screen 320X240 pixels 640X200 pixels 480 X160 pixels Sound/speaker Yes No No No PCMCIA 2.0 for expansion Yes Yes No No Battery life (type of battery) 20-50 hours (4 AA) 40 hours (2 AA) 200 hours (2 AA) Interface Pen Keyboard Keyboard Handwriting recognition Yes No No No No Yes Yes Yes Applications Notepad Yes Yes Yes No Address book Yes Yes Yes Add-on Date book Yes Yes Yes Add-on To-do list Yes Yes Yes Add-on Calculator Yes Yes Yes No E-mail Yes (NewtonMail) Yes (CC-Mail) Add-on No Spreadsheet Add-on Yes Yes No Database Add-on Yes Yes No Financial Yes (Pocket Quicken Yes (Pocket Add-on No with 2 MB MP 120) Quicken) Fax/modem Optional (included Optional Optional No with 2 MB version) Size 203X100X30 mm 160X86X25 mm 165X85X22 mm Weight, g 540 312 275 132 Cost MP 100: $179 1 MB: $549 512 IS: $399 DBS-2: $129 MP 120, 1 MB: $599 2 MB: $699 1 MB: $499 DBS-2 with 1 book: $199 MP 120, 2 MB with 2 MB: $599 DBS-2D: $199 fax/modem: $699, DBS-2D with 1 book: $521 for educational $259 users 1 elephone 1-800-909-0260 1-800-443-1254 1 800-547-7466 1-800-762-5382 N o th : “A dd-on” refers to software that may be purchased separately. RAM, a fax/modem, or a network connection can be ware. Well over one thousand programs have been writ added using the PCMCIA version 2.0 plug-in card slot. ten for the Newton, including references, specialized All MessagePads also have a serial port, which can connect calculators, spreadsheets, databases, and electronic ver them to an external modem, a printer, or a desktop com sions of books. puter. Software is available to automatically exchange The major advantage of the Newton for physicians is and synchronize information with either Macintosh or that one interacts with it using a pen, much as with a Windows-compatible personal computers. An infrared traditional paper-based medical record. Its small size and transmitter/receiver port allows for wireless transmittal of familiar tablet-like shape allow it to resemble a traditional data (beaming) between two Newtons, or between a record, making it less likely to interfere with the patient Newton and a printer with an infrared port. This capabil physician interaction. The Newton also comes with a fea ity is especially useful for physicians who wish to share ture known as “ Newton Intelligence,” which assists users patient information, such as a to-do list or a sign-out list. by anticipating their needs. For example, writing “fax A wireless version of the Newton called the Marco (Mo Laura” on my (M.H.E.) Newton and pressing the “as torola Corporation, Schaumberg, 111) has just been re sist” button results in the Newton creating a fax cover leased, which enables the user to remain connected to a page and addressing it to my wife at her office with her central computer. In this way, physicians can access office fax number filled in. If there were more than one records stored on a central computer and send informa person named Laura, I would have been able to choose tion to a printer, all while walking around their offices. from a list. Because all information in the Newton is Built-in software for the Newton includes a notepad, cal stored in a single “soup” of data, it is possible to quickly endar, to-do list, calculator, electronic mail, and fax soft find all references to a patient, address, diagnosis, or any 386 The Journal of Family Practice, Vol. 41, No. 4(Oct), 1995 Hand-held C om puters Ebell, Hale, Buchanan, and Dake Table 2. A Glossary of Hand-held Computer Terms — — k Term Definition I Byte A single character of information, such as a letter or digit CGA A standard for computer displays, it supports a resolution of up to 320 by 240 pixels in graphics mode or 80 characters by 25 lines in text mode. DBS-2 The Franklin Digital Book System 2, a hand held computer. Handwriting The ability of a computer to convert handwriting recognition to typed characters, which can then be stored and manipulated. The Newton is the only computer reviewed in this article to support handwriting recognition. 1HP200LX The Hewlett-Packard 200LX, a hand-held computer. Infrared A way to send information between two transmission computers or a computer and a printer. It requires that the computers be within a few feet of each other, and is also called “ beaming.” i Kilobyte, equal to 1024 bytes. Ml! Megabyte, equal to 1024 kilobytes, or just over one million characters (about the size of a printed Bible). MP 120 The Newton MessagePad 120, a hand-held Figure 1. The Newton Message Pad 120 is a pen-based, hand computer. held computer from the Apple Corporation which incorporates PCMCIA 2.0 card About the size of a thick credit card, these can handwriting recognition.