Something a little different: A palmtop as a healthcare patient

[Dave Britten]

I'm sure you all know me as a big fan of the HP 200LX palmtop computer and its siblings. Even though I work in IT with fairly large modern database systems and development environments on a regular basis, and drool over the latest tablets and portables (I'm composing this from my iPad Air, in fact), I still have tremendous respect for what the HP team achieved 20 years ago with their DOS-based palmtop line, namely the 200LX. Frankly, I don't think this model has been topped yet.

I've been exposed to HP the palmtops since the mid '90s, when my dad obtained a 1 MB 95LX from his employer, and I've since often pondered what I find so appealing about them, and why they seem so perfectly suited for any job. I think what it really boils down to is a very flexible and well-integrated system of applications that allow for tight workflow customization without needing to be an expert coder. For the expert coders, the sky's the limit when you get your favorite BASIC/Pascal/C involved.

As a sort of weird nostolgia for a time period that I wasn't ever really on the front-line of anyway, what with being born in 1982, I frequently find myself browsing the archives of the Palmtop Paper, appreciating the efficient, real work that thousands of users had tailored their own machines for, and sometimes picking up a few tips for myself. This was the heydey of personal information management, in contrast to today's internet-connected world of global information management.

My iPad and iPhone are wonderful if I need to deal with the outside world. I've fixed server problems while walking around a flea market in the middle of nowhere, or from the Ohio turnpike (as a passenger!). Having both my and my wife's calendars sync automatically between our devices via iCloud is a truly great feature. Finding a good local pizza joint no matter where I happen to be? Piece of cake. But none of these devices has anywhere near the level of polish and integration that makes managing one's own personal data and information a pleasure, rather than a frustrating sequence of repetive taps and interactions and application instabilities.

But I'm not here to complain about what isn't working now; I want to point out what we've since lost. And in the vein of the user stores presented in the Palmtop Paper, I thought I might make a short case study of myself.

Currently, I am hospitalized due to Crohn's disease (don't panic - it's going well so far). For those not familiar with it, it's a digestive disease which presents a number of challenges, particularly with pain management and mental health care as an auxliary effect. I've been hospitalized for surgery twice in the past, and the coming operation on Monday will be the third. I learned from last time two very important lessons: 1. Boredom leads to stir-craziness and depression. 2. Depression greatly inhibits the healing process.

So, how not to get bored? First, I've packed way more than I realistically need: electronics, video games, you name it (including my 200LX, more of which I'll discuss shortly). To mitigate depression, I need to both distance myself from my current situation as an analytical bystander, while at the same time producing concrete data with which I can reassure myself of steady post-op improvement.

Let's get right down to Exhibit A: the pain management spreadsheet.



I briefly toyed around with the idea of doing this in Numbers on my iPad. Numbers is a lovely program, as long as you aren't worried about data entry. To give you an example of what it would look like, any time I might want to log my current pain level, I would have to tap my way into Numbers, open the Pain spreadsheet, extend the sheet by one row, fill in the current date/time in column A, then fill in column B with the current pain level. I could then theoretically put together some kind of chart showing pain vs. time, but charting in Numbers is essentially broken for this purpose. You can't even have a proper scalar X axis with dates.

Doing this kind of data entry is second nature for Lotus 1-2-3. I have a few column headers in row 1, an Alt-A macro that inserts a new row at the end of the table, copies values from a row template (current date/time in A and B, all cells preconfigured with correct formatting), and positions the cursor for me to just hit a number to enter the pain level.

Hypothetically, I could also use the Data commands in 1-2-3 to do further analysis, such as instances of pain reported over 6, trends in time between subsequent doses of a medication, etc.

Then I've got a nice Alt-G macro that spits out a 12-hour pain graph, with labels displayed at points where I took some medication:



I imagine this particular graph will become a much more central focus after the surgery has taken place, and I'm pounding the button on the PCA morphine pump like I'm playing Galaga.

So while the iCloud sync functionality in Numbers is great for simple files I want to have available at all times (a basic list of current maintenance medications, for example), for real number crunching and graphing on the go, Lotus 1-2-3 is still king of its weight class after 20 years. And I have a number of different use cases all based on this same simple sheet design. Weight monitoring, vital signs, daily pedometer steps (will need this one after the surgery), etc.

Going back to the pain scale, most institutions ask patients to rate their current pain on a scale of 0-10. It's a good initiative for communicating pain, but I don't feel the hospitals provide for a lot of consistency or guidelines in the measurements. I spent a little time quantifying what the numbers mean to me, and tossed them in a Memo file I can pull up quickly:



This allows me to be more consistent in my responses to the nurses and doctors.

And then there's the database application. It's one of the most wonderfully versatile tools I've ever seen on a PDA, and I sincerely lament the absence of anything modern like it. Imagine it as being a very slimmed-down MS Access, which gives you a single table and form per database, as well as a handful of views and reports. It doesn't sound like much, but the sorting, filtering, importing, and exporting capabilities really bring it to another level, giving you great flexibility without a lot of development overhead. And if you want to get really fancy, you can start bringing System Macros into play (more on that later), or dupming your data out to 1-2-3 for more in-depth analysis.

I have one database in particular called MEDJRNL. I'm using this to record all manner of odds and ends: symptoms, medications taken, notes on mood and general wellbeing, excretory function (the less said the better), foods eaten, general notes, and procedures I have done. Then I can chop it up via a subset to figure out the last time I took my pain medication, or see if there were any problematic foods I might have eaten. And it makes it a lot easier to answer those "When's the last time you.../How often do you..." questions that doctors always ask, and nobody is ever equipped for without laborious thought.



I have another simple database called DRENCNTR for recording encounters with doctors, and taking notes. I can indicate who, when, where, and whatever we discussed, including my outgoing instructions. Not too elaborate, but very important to have.



The System Macros tool goes even further in allowing the built-in application to be integrated. It allows the user to define a sequence of a couple hundred keystrokes that can be played back with Fn+F1-F10. In the case of my database files, I normally define them with Date and Time being the first two fields. So naturally, I have a macro assigned to Fn-F2 to act as a fancier "Add" button. This macro adds a record, and immediately fills the Date and Time fields, leaving the cursor ready on the third field: `{F2}{Date}{Tab}{Time}{Tab}` Simply by holding Fn when creating a record, I can have it time-stampped automatically. Pretty important when you're logging medical events in near-real-time. I have seen examples of users going far, far beyond this simple example, though. Lurk around the Palmtop Paper archives if you're curious.

That I've gone this long without any real mention of the 200LX' hardware I think speaks volumes for the quality of the software. The hardware certainly lives up to its end of the bargain of course. The keyboard is snappy and responsive, and while the machine isn't a speed demon, the keyboard buffer ensures that you can out-type the machine and have it catch up to you with no dropped keystrokes. Screen contrast is good, and although lacks a backlight, the bezel is thin enough to clip an inexpensive LED e-book light on the corner to light up both the screen AND keyboard (pretty useful if you need to quickly fire it up to log some data in a dark hospital room). Being able to turn on and off instantly is a great plus. Battery life is about as close to a non-issue as possible. Pop in a fresh set of alkalines or NiMHs, and you're set for another 30-40 hours of run time, assuming you aren't draining them playing Hearts & Bones all day. Don't forget to pack your Gameboy to give your 200LX a rest.

So there are plenty of articles about doctors using their palmtops as part of their profession, detailing the effective workflows they've come up with, but I don't believe I've ever seen it from a patient standpoint. And at the very least, I've got to be one of the youngest/only legitimate 1-2-3 users left at this point, so that counts for something.