Cleared for take-off: The Anesthesiologist and the Palm Pilot™

Anesthesiologists are by nature and by trade technological individuals; from the operating room (OR) to the intensive care unit (ICU), our motto could easily be 'gadgets are us'! For me, and in my practice, the Palm Pilot™ has become an indispensable tool for personal information and clinical care. The Palm Pilot™ is part of a diverse group of devices known as Personal Digital Assistants or PDA's. PDA's are any hand-held device, which keeps track of names, dates, appointments, and etcetera. Some offer a broad range of functions, which we will explore in this column.

There are many stripes of Palm Pilot™ but they all utilize the same operating system, and differ only in the amount of memory and types of Internet access available. I will focus primarily on the Palm Vx (~$400) as I think this represents the 'sweet spot' in terms of cost, and functionality. The Vx has 8 MB of memory, which represents a relatively large footprint for information storage. An absolute must for any Anesthesiologist is a program called ePocrates, available over the Internet at http://www.epocrates.com. ePocrates is a relational database currently containing over 1600 drugs. The database fields include adult dosing, pediatric dosing, drug interactions, and adverse reactions. This is extremely handy during pre-operative evaluations, when taking a patient's medication history, and during rounds in the ICU. Furthermore, the program is freely available over the Internet, and has regular updates. Last month alone, 10 new antibiotics were added. Another must on my list is MedCalc by Mathias Tschapp, MD (http://netxperience.org/medcalc). MedCalc contains 50 different formulas useful in a variety of OR and ICU situations. In addition, most of the formulas have classic references listed for bedside teaching rounds with students, residents, or fellows. For those interested in following their data, I highly recommend a program named Quicksheet. Quicksheet is available from Cutting Edge Software http://www.cesinc.com, and allows you to view Excel spreadsheets on your Palm. If you are in a large group, as I am, the 'to-do' list can be used to keep track of the call schedule, day assignments, and meetings. My practice would be lost without our Palms!

Communications, Internet access, and email are where the Palm Vx™ really takes the lead over all other PDA's, including the much touted, and too big to carry in your pocket Palm VII™. The Vx is a sleek companion, which easily fits into your pocket all day with no bother. For Internet access you can snap on the Vx modem (~$300), which connects at 33.6 kps and voila, off you go. With your Internet Service Providers (ISP) local dial-up number, you can send and receive email. Several programs are available but my favorite is MultiMail Pro from Actual Software Corporation http://www.actualsoft.com. This program can be configured for either pop3 or IMAP 4 servers so you can check any email account in the world. Furthermore, you can configure it for up to four different accounts. This is especially nice for travel when you want to check your mail but not carry along a laptop. For staying in touch with the world, my favorite Palm Pilot program of all time is AvantGo. AvantGo is freely available from at http://www.avantgo.com. AvantGo allows you to download a wide variety of information including the major stories of the New York Times, headlines from the Wall Street Journal, lead stories from the New England Journal, and the movies in your own zip code. The choices are innumerable, and there is something for everyone. I hot-synch to the Internet in the morning before I leave for the hospital. Over the course of the day, I can read all the information in my AvantGo file in bits and pieces. Once you try this you will be hooked. You even have the option of creating your own AvantGo channel that you can upload to the server for others to read. Major football fan, excellent chess player, wine authority? Publish your AvantGo channel and let the world know! While I have highlighted some of my favorite programs, there are literally thousands of programs for the palm-computing platform. An excellent place to start is cNet.com. Alternatively, you can also write your own programs for the palm in 'chipmunk' basic using cBasePad, which is also freely available at the same site. An excellent site devoted to medicine and all handheld platforms is http://www.handheldmed.com.

The Palm VII™ is sold and touted as the 'wireless Web'. While this is certainly true, it is far too bulky to keep in your pocket for true daytime use. The Palm Vx™ now whips the VII without trouble as the wireless champion, with a nifty attachment called OmniSky. The OmniSky (~$300) attaches to the Vx just like the Palm modem, but it has wireless Internet access! Now before you get too excited, this wireless access has a separate ISP fee. However, as with the dial-up modem, you can send and receive email, trade stocks, buy books, etc. Many mobile phones now also feature wireless access but none have the screen size, visual clarity or custom tailored content of OmniSky. The wireless service costs $40.00 per month and connects at a painfully slow 19.2 kbs. However, for the Internet addicted and technologic must-have the OmniSky is the current bull's-eye.

I have spent the bulk of this column on the Palm Pilot™ platform. However, other options are also available. Part of the original Palm Pilot™ creative team has formed a new company, Handspring http://www.handspring.com that sells a Palm Pilot™ clone called the Visor™. The Visor™ utilizes the palm software platform and offers the 'advantage' of a changeable module. Plans are underway for radio modules, bar code modules, and even the OmniSky. Personally, I do not see the value in this advantage, but can foresee some special circumstances where a specific module, e.g. a bar code reader, might be of some use. Elsewhere, especially in Europe, the Psion holds the major market share. The Psion™ comes in three models and is really a micro-laptop. Psion™ suffers from a relative lack of software when compared to the Palm Pilot™, but still offers an excellent system.

In closing, I would say that the hand-held platform is here to stay, and will become even more valuable to the physician. At present, I find the Palm Vx™ with the attachments, programs, and services outlined above the winner. How long this will last is unknown but whatever can replace it will be even more indispensable.

Gerald Anthony Maccioli, MD, FCCM
Director of Critical Care Medicine
Critical Health Systems, Inc., Raleigh Practice Center
Medical Director
Medical/Surgical ICU, Rex HealthCare, Raleigh, NC
Assistant Consulting Professor of Anesthesiology
Duke University Medical Center

Disclaimer: The author has no fiduciary stake, claim or interest in any of the products or programs mentioned in this article. Anesthesia Web does not endorse any of the products or programs mentioned and they are solely the choice of the author.