hat, exactly, are “handheld computers”? What can you do with them? Who uses them? Just a few years ago, the answers were simple: The Palm company popularized its handheld computer, the Pilot “connected organizer.” The Palm Pilot was mostly a glorified electronic version of the daily planner, keeping track of appointments, contacts, to-do lists and quick notes. The only people using them were technology’s early adopters who liked playing with electronic gadgets. Today nearly everyone, from physicians and engineers to high school students, relies on a handheld computer. In addition to managing appointments and telephone numbers, they can be used to check e-mail and read medical textbooks.

Definitions
Handheld computer devices were mentioned in popular literature as early as 1956 (Isaac Asimov in “The Last Question”). Portable electronic devices with some advanced functions (e.g., calendars, diary, language translation) were starting to appear in the mid to late 1970s. These devices gained functionality during the ensuing 20 years (remember the Sharp Wizard or Apple’s Newton MessagePad?) Palm’s 1996 release of the Palm Pilot launched a revolution in handheld computers: a self-powered electronic device that can be held (and often operated) with just one hand, is capable of running a wide variety of applications, including built-in personal information management (PIM) tools, and can share information with other computers or devices. These devices are now often called personal digital assistants (PDAs).

“Smart” phones are combination devices: mobile phones with PDA functions. In 1994, IBM introduced the Simon, a large (8 x 2.5 x 1.5 inches), heavy (18 ounces) smart phone. Smart phones are now pocket-sized, and many include full-featured PDAs; they also can be considered to be handheld computers.

Choosing a Device
So which handheld should you get? The answer depends on how you intend to use your device. Most of us would like some or all of the features shown in Table 1.

Other issues to consider include size, convenience and battery life. The simple cellular telephone is rapidly disappearing — most modern phones can at least keep track of telephone numbers; many include a calendar and also may have a built-in camera. If you already have a cellular telephone that you are happy with and you would just like to run a few other key applications, choosing a simple PDA may be your best option. On the other hand, you may find the convenience of a converged all-in-one device truly compelling.

Which Simple PDA Should You Buy?
There are two main types of PDAs, those that run on the Palm OS platform and those that run on Windows Mobile (previously Pocket PC). There also are some devices running Linux and other operating systems, but they comprise a small part of the market and have little medical software.

The Palm was the first of these devices to become widely available. As such it had a significantly larger market share, and many more software applications were available. Windows has closed the gap significantly; today, choosing between the two platforms is a bit easier. Both offer devices with similar features (PIM, support for wireless connectivity, multimedia and global positioning system), and major applications are usually available in versions for both platforms. Palms do tend to be somewhat smaller (size) and easier to use (fewer actions needed to accomplish a task), have more applications (including freeware and shareware) and better battery life, and are generally less expensive. Windows devices often have larger screens (although with lower resolution, i.e., fewer pixels) and more built-in memory and usually do a better job interfacing with desktop Windows applications. Choosing between them is largely a matter of trying each one to see which is easier for you to use and which platform supports the specific applications that you would like to use.

Which Converged Device Should You Buy?
Smart phone market share has been increasing steadily over the last few years. The most important operating systems powering these smart phones are the BlackBerry OS, Linux, Palm OS and Windows Mobile.

• BlackBerry: Research In Motion (RIM) was the first to introduce two-way paging (1996). In 1998 it introduced the BlackBerry. BlackBerries include basic PIM functions but are best known for tight integration of e-mail and corporate data (e.g., customer details, pricing and inventory information and other enterprise applications) with handhelds. This information is automatically transferred to the devices, and replies are sent back out immediately. BlackBerries require a monthly subscription to the RIM service. The current line also includes devices with built-in telephones and wireless Internet capability. BlackBerries, which excel at e-mail, are widely popular in the corporate world but much less so in health care where e-mail is a less important means of daily communication. Furthermore, although the gap is closing, much less software is available for the BlackBerry.

• Linux: Some call UNIX the “third operating system,” believing it has the power to dethrone Windows on desktop computers. It is said to have more features and better security, and it is completely free. Apple’s Mac OS is based on UNIX; and Linux, one of the most common versions of UNIX, already runs on many desktop computers. Linux also powered 14 percent of smart phones shipped worldwide in the first quarter of 2005. As is the case for Linux-powered PDAs, however, the medical software currently available for these devices is very limited. While Linux devices will likely become more important in the future, they are not a significant consideration today.

• Palm OS, Windows Mobile: Palm was initially a PDA company, but it entered the smart phone market when it acquired Handspring. Although other Palm OS phones are available, Palm’s presence in this market is largely driven by its flagship product, the Treo. The Treo 650 provides full-featured mobile phone services, e-mail, PIM functions, Web support, an MP3 player, video capture, and playback and wireless connectivity (Bluetooth). In December 2005, it was the highest-rated converged device in the United States (versus BlackBerry 7100, Samsung SCH-i730 and UTStarcomm PPC6600 — Strategy Analytics, a research and consulting firm). In January, Palm introduced the Treo 700w, which runs the Windows Mobile OS. Additional software (e.g., Good Technology’s GoodLink or Verizon’s Wireless Sync) even gives the Treo push e-mail similar to the BlackBerry. Other non-Treo handheld computers also are available in both Palm and Windows flavors. As is the case for PDAs, the choice between Palm or Windows depends mostly on personal preference and specific software needs. You should try each device and attempt to answer two questions: Which device is easier to use, and which device supports the software application(s) that you are most interested in using?

Currently anesthesiologists are typically stuck in a site without desktop computing capability. PDAs excel as reference tools for such users, with drug databases and medical synopses likely being the main applications for the average physician. As desktop computers infiltrate the perioperative area, however, we will probably find our PDAs being used less for professional reference and data management. Nevertheless the continued merger of the telephone and the PDA will secure a place for the combined device as an essential tool for busy physicians. Most anesthesiologists today would likely choose either a Palm or a Windows OS converged device. The future should see these converged devices getting even smaller and more powerful. Who knows … maybe Apple will resurrect the Newton in a new form: a phone/PDA/iPod/GPS device that fits in your pocket, has a long battery life and is intuitive and easy to use.

Please see the ASA Web site <www.ASAhq.org/Newsletters/2006/05-06/prasad05_06.html> for an expanded version of this article, including references and additional links.

Editor's Note: The brand-name products mentioned in this article are trademarks or registered trademarks of the respective companies identified in connection with each product. The mention of certain brand-name products is not intended to be construed as an endorsement by ASA and is essentially the personal preference of the author.

Ravindra V. Prasad, M.D., is Assistant Professor, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

Lee S. Perrin, M.D., is Vice-Chair, Department of Anesthesia and Pain Medicine, and Associate Clinical Professor of Anesthesiology, Tufts University School of Medicine, Caritas St. Elizabeth’s Medical Center, Boston, Massachusetts.