Suzanne Duke

Decoding geekspeak: A glossary of PDA terms

 Half the battle in figuring out your hardware and software   needs is making sense of the terms beloved of computerphiles.  

You've probably noticed some words in italics in the preceding stories. Here's   where they're defined. 

To send software programs or data via an 

- or radio-wave transmission   from one PDA to another, or from a PDA to a desktop computer or printer. 

An external modem that hooks up to your computer through your cable network   (the same place your cable TV connection comes from). A cable modem Internet   connection is even faster than one via 

, and much faster   than an ordinary phone line connection. 

The ability to connect your PDA or computer electronically with other computers,   printers, or fax machines. The connection can be achieved through an internal   computer network, 

, the Internet, or a combination of   these methods. The transmission carrier can be electrical wires, phone lines,   cable lines, 

 Also known as the processor, chip, or "brain" of a computer, a CPU controls   the operation of a PDA. 

A small stand that connects to a desktop computer and allows you to transfer   (or 

) data from a PDA to a desktop PC or network.   You simply put the PDA in the cradle and press a button in the cradle base. 

A phone line that's used exclusively to connect to the Internet. The same term   is used to describe a phone line used to link one computer with another in a   modem-to-modem connection. 

DSL (digital subscriber line, also known as high-speed   DSL or HDSL)

 An accelerated means of connecting a PDA or desktop computer to the Internet   over regular telephone lines. While DSL transfers data far more quickly than   a conventional analog modem, it isn't universally available yet. 

A direct computer-to-computer file exchange. EDI messages usually travel over   private networks using dedicated phone lines, but they can also be transmitted   via the Internet on virtual private networks. With PDA prescribing systems,   EDI transmission is faster than electronic faxing and more secure than e-mail.   However, many pharmacies don't accept electronic prescriptions, and EDI transmission   to pharmacies is illegal in some states. 

A matchbook-size adapter that enables a PDA to connect to an Ethernet, the   most common type of local area network (

). The "card"   is a printed circuit board that plugs into a slot found on manybut not   allPDAs. An Ethernet card may require a cable connection to the network,   or it may connect wirelessly. 

An electronic boundary that prevents unauthorized users, like hackers,   from accessing confidential files on a private network, or a computer used to   maintain such a boundary. If your group or hospital is networked, it most likely   has firewall protection. 

A personal digital assistant that's larger than a 

 but smaller than a notebook computer. It may be roughly the size of   a checkbook or nearly as large as a magazine, and may weigh up to three pounds.   Many HPCs aren't pocket-size. In contrast to palm-size PDAs, HPCs have a built-in   keyboard and a larger display. 

 A permanent data storage device built into all desktop PCs that permits you   to save and retrieve information, and that stores the computer's operating system   and other software. The size of a hard drive is usually expressed in gigabytes. 

 A way to exchange information between a desktop PC and a PDA. Old data on   one device is replaced with new data from the other. 

A word, phrase, symbol, map, or any other item in a Web document that connects   you to a different place in the same document or to another Internet resource.   Hypertext links may be underlined, highlighted in color, or appear as icons,   to distinguish them from the surrounding text. The link must be "selected" by   clicking on it with a mouse. 

" information to each other,   or to properly equipped desktop PCs or printers. All PDAs have infrared communication   capability. 

A unit of measurement for computer file sizes. One thousand bytes equal   one kilobyte; 1,000 kilobytes equal 1 megabyte, and 1,000 megabytes equal one   gigabyte. 

 A network in which computers that are in physical proximity,   usually in the same building or complex, are linked via cables. See also: 

To start a computer program. Load time may affect your assessment of software   usefulness, particularly when patients are present. Some PDA software loads   almost instantly. Software that takes 10 to 15 seconds to load is considered   slow. 

A unit for measuring computer memory or file size. One million bytes equal   one megabyte (or 1,000 kilobytes). 

 The working space used by a PDA to hold and run a program and the data it   needs, and to process the data. The amount of memory available determines the   size of the programs you can run, and whether you can run more than one program   at once. Memory is also the means by which you store things on your PDA, whether   it's information you enter yourself, images you download from the Internet,   or software. There's no such thing as too much memory. The more, the merrier. 

 A peripheral device that connects computers to each other via phone lines,   allowing users to send and receive communications (such as e-mail) and to access   the Internet. Handheld PCs have built-in modems. With palm-size PDAs, a modem   is usually a separate expense, but all PDAs can accept one. Modems may be analog   or wireless. An analog modem must be connected by a cable to a phone jack. A   wireless modem requires no cable connection. 

 Running more than one program at a time. When a PDA has sufficient memory   to allow this capability, it's easy to switch between programs to perform sequential   tasks. 

  The main control program that interacts between a PDA's internal machinery   and the software programs you run to ensure that everything works smoothly together. 

The company that makes Palm PDAs and the Palm OS. 

An operating system specifically engineered for PDAs that are made by Palm,   Handspring, TRG, and Sony. 

A type of PDA that fits in the palm of your hand. It may or may not refer to   a PDA made by Palm. PDAs made by Handspring, TRG, Sony, Casio, Hewlett-Packard,   Compaq, and other companies are also palm-size. 

Not necessarily a PDA made by Palm. PDAs with the Palm operating system are   made by Palm, Handspring, TRG, and Sony. 

The latest line of computer processors, or chips, made by Intel. Pentium III   chips run at speeds ranging from 450 megahertz to 1.3 gigahertz. 

A scrollable list of tasks presented to you by PDA software. Tap a choice with   the stylus and the program automatically performs that task. 

The newest type of palm-size PDA. It runs the latest version of the Windows   CE operating system: Windows for Pocket PC. In addition to using a unique OS,   Pocket PCs differ from most other palm-size computers in that they're slightly   larger, have color screens, and include more built-in storage capacity. 

A PDA socket into which you insert a cable to connect the PDA to other devices. 

 A means of using electromagnetic waves to transmit wireless signals. All PDA   prescribing systems either offer or soon will offer radio-wave transmission   capability. This enables you to 

 scripts from your exam   room or office to a desktop PC or a printer in another room. It also lets you   access the Internet and send and receive e-mails from a remote location via   a satellite network. 

Articles

Half the battle in figuring out your hardware and software needs is making sense of the terms beloved of computer files.

PDAs for Doctors: Decoding geekspeak: A glossary of PDA terms

 I appreciate that attorney Evelyn Bradford is "advising" us to settle small   claims without the hassles of prolonged litigation ["

How   to squash a small malpractice claim

," July 10]. No doubt the fact that she   and her ilk would receive a nice chunk of money for simply writing a letter   or making a phone call has nothing to do with her helpful recommendations. 

 In the present legal climate, we need to treat every patient as a potential   adversary, and be aware that we can't afford to be less than 100 percent perfect.   Just about every procedure carries a risk of complications. Bradford knows this,   but she just doesn't care. It's all about money. 

I was sure Bradford's article was a joke, or perhaps   a test to see whether we physicians were reading your magazine. But I'm afraid   you've discredited yourself by printing such a one-sided view of human error. 

I agree that there's something wrong with our medical system, but there's something more wrong with the legal system and Bradford's attitude. At least two of the scenarios she presents look like honest human error, in which the physicians tried to do their best andwhen things went awryreacted responsibly by trying to remedy the problem. However, in Bradford's perfect world, people who make mistakes should immediately pay money.

McDonald's should not serve this woman hot coffee.

 As a DO, I was surprised that osteopathic physician Carl Pesta took you to   task for referring to a doctor as an "osteopath" [

, June 19]. I had no idea that title was considered outdated   and inappropriate. Since MDs are sometimes called allopaths, I thought DOs could   be called osteopaths. For future reference, what are the politically correct   terms for DOs? 

Editor's Note: We generally try to use "osteopathic physician," or we simply indicate the doctor's specialty.

 Electronic outsourcing should streamline office procedures 

Will   the Internet finally put an end to paperwork?

" [July 10], misleads readers   to believe that the companies mentioned in the article will handle all of their   practice management needs. It's evident that the author doesn't fully understand   the term "practice management." 

 Sending claims electronically to a payer is only a small part of practice   management. Comprehensive practice management includes data entry, filing invoices,   balance billing, resubmission of rejected claims, following up on slow invoices,   generation of aged accounts for follow-up, and generation of practice reports.   None of the companies listed in the table that accompanies your article provide   practice management. 

 Thank you for your news item regarding credit theft ["

" Financial Beat, June 19]. Here's a tip on   how to prevent this from happening. 

Each of the three major credit bureaus allows consumers to add a statement to their credit report. You can save yourself a lot of grief by writing the following: "Do not issue any credit cards or approve credit lines without personally contacting applicant at work." You can even indicate a code word that the credit bureau has to get from you. This simple step protected me when someone tried to secure a credit card under my name.

Editor's Note: Residents of Colorado, Georgia, Maryland, Massachusetts,   New Jersey, and Vermont can obtain free credit reports. So can those with credit   or employment problems. Otherwise, you'll pay $2 to $8.66 per report, depending   on which state you live in.

 In my opinion, FP Gil Solomon's patient education advice ["

Turn   your computer into a patient education library

," Computer Consult, June   5] is sorely lacking in wisdom. He reports how he saved a panicky 75-year-old   patient an office visit by e-mailing her a pamphlet on benign positional vertigo.   That sounds good until one considers her complaint: sudden onset of vertigo.   Solomon ought to remember that other, not-so-benign conditions, such as blood   pressure disturbances, electrolyte abnormalities, andoccasionallymyocardial   infarction can present the same way. 

 Solomon's action exemplifies the danger of being more conscious of speed and   economy and, as he writes, "less focused on treating acute illnesses." Practicing   in the "managed care era" is no excuse for providing "the average 15-minute   office visit" that doesn't give patients the attention they need. We must not   allow the convenience of modern technology and the pressures of time and money   to make us careless. 

Why practice defensively if jurors ignore the facts? 

 I'm amused at your frequent articles on ways to avoid malpractice judgments,   particularly your cover story about cases in which doctors failed to provide   adequate information about their experience with a particular procedure or financial   incentives to withhold treatment ["

When are we going to realize that under the current tort system, very little depends on the facts? Many cases are decided by courtroom theatrics. There's a rich doctor and a rich insurance company on one side, and a relatively poor injured party on the other. To compensate him for his injury, we should take some money from the doctor and give it to the patientregardless of the facts.

Do you really think that if doctors disclosed financial incentives and other information, plaintiffs' lawyers wouldn't find other angles to pursue, such as medical history?

Contrary to the oft-repeated cliche "the system works," our justice system is hopelessly broken and needs to be replaced. Expert jurorsnot lay people who don't understand the nuancesshould decide cases in highly technical and scientific fields.

Edited by Suzanne Duke,
  Senior Associate Editor

Address correspondence to Letters Editor, 

 magazine,         5 Paragon Drive, Montvale, NJ 07645-1742. Or e-mail your comments to 

,         or fax them to 201-722-2688. Include your address and daytime phone number.         Letters may be edited for length and style. Unless you specify otherwise,         we'll assume your letter is for publication. Also, let us know if you         don't want your e-mail address printed with your letter. 

  

Suzanne Duke. Letters to the Editors. 

Advice we can't afford to follow; Professional name-calling; Electronic outsourcing should streamline office procedures; How to safeguard your credit; Replace high-tech with high-touch; Why practice defensively if jurors ignore the facts?

Letters to the Editors

 Hospitals
  How CEOs have learned to manage managed care 

 Maybe there's a lesson doctors can glean from hospitals' dealings with HMOs:   Just say No. 

 Almost a third of hospitals nationwide have canceled an HMO contract. Among   those with 500 or more beds, that figure is close to 60 percent, according to   Deloitte & Touche's survey of about 1,000 executives at acute care hospitals.   The most common reasons for discontinuing an affiliation with an HMO: poor return   on the contracts and the plans' lack of responsiveness. 

 What might account for hospitals' assertiveness in negotiating with HMOs?   The institutions aren't as reliant on managed care as they thought they'd be.   Two years ago, most CEOs surmised that HMOs would account for more than 20 percent   of their business in 2000. The reality is that only a quarter of the hospitals   responding to the survey say that managed care accounts for that much, and many   respondents predict that the growth of business attributable to HMOs and PPOs   will slow. 

 Physician Retirement
  Why older doctors are bailing out early 

One sampling of physicians 50 years and older indicates they're voting with   their feet. Tired of managed care and Mediplan hassles, more than a third are   opting to retire soon, according to Merritt, Hawkins & Associates, a physician   recruiting firm in Irving, TX. 

 Though 60 percent of the 300 physicians surveyed say they relish their relationships   with patients, they have a less than sanguine outlook on medical practice. More   than half found medicine to be less satisfying in the last five years, and nearly   that many said they would reconsider going into the profession if they were   starting out today. Even fewer doctors would encourage their children to pursue   a medical career.

 Medical Practice
  Losing patients? Don't blame health plans 

 Insurers may not be driving consumers to change their doctors, hospitals,   and other providers to the extent that anecdotal evidence suggests, says Marie   C. Reed, an analyst for the Center for Studying Health System Change (HSC).   According to a new HSC study, patients who switch doctors or hospitals are more   likely to be motivated by personal preference than by health plan rules. 

 Twenty-two percent of patients who changed providers in 1998 and '99 did so   for health insurance reasonsa statistically significant drop from 26 percent   in 1996 and '97. Among patients who switched providers in '98 and '99, two in   five cited personal preferences as the reasonnearly twice the number that   blamed their health planswhile another 38 percent gave miscellaneous reasons   for their decision. 

 Medical Marijuana
  Hawaii's legislature and governor okay it 

 While ballot initiatives have legalized medical marijuana in several states   (Alaska, Arizona, California, Maine, Oregon, and Washington), Hawaii has become   the first state to pass a marijuana bill through its legislature. 

 Gov. Benjamin Cayetano has signed legislation that allows patients to use   marijuana to relieve severe symptoms of cancer, glaucoma, HIV, AIDS, multiple   sclerosis, epilepsy, and Crohn's disease. The law also allows those with chronic   diseases who suffer from cachexia, pain, nausea, seizures, and muscle spasms   to use the drug. 

 Under the tightly worded measure, patients must register annually with the   Department of Public Safety. They may not use marijuana in public places or   in moving vehicles. "If the law is abused, I will not be surprised to see a   move to repeal it," the governor cautioned. "So I hope the practitioners who   believe in the medicinal value of marijuana are aware of this and take precautions." 

 The bill's passage, however, may be a Pyrrhic victory for marijuana proponents.   A recent study in the 

 reports that THC, the major   psychoactive component of marijuana, can promote tumor growth by reducing the   body's anti-tumor immunity. Previous studies have found that THC can also lower   resistance to bacterial and viral infections. 

 Electronic Prescribing
  A financial incentive to embrace technology? 

 iScribe, a San Mateo, CA, health care technology firm, has partnered with   The Doctors' Company, the country's largest physician-owned malpractice insurer,   to offer discounts to physician members who use electronic prescribing software. 

 TDC members will receive an annual 5 percent discount on malpractice insurance   premiums, up to $1,000, after they've used the iScribe system for one year.   iScribe will give free prescribing softwarealong with a handheld computer,   wireless printer, and customer service supportto member physicians nationwide.   The Doctors' Company hopes that the software, which checks for drug interactions,   duplications, and allergies, will reduce the number of medication errors. These   mistakes cost nearly $29 billion a year in the United States. 

 In addition to its safety benefits, the software will alert physicians to   formulary information, drug copayments, and costs. Prescriptions can be printed,   faxed, or sent electronically with encryption to pharmacies. 

 Report Cards
  Patients nationwide will rate your nonclinical skills 

 In what may be the largest study ever undertaken outside the US Census, Nebraska-based   National Research Corp. will survey patients nationwide to find out how they   rate the quality of their primary care physicians' nonclinical performance.   Rather than focus on technical issues, the survey will elicit information on   topics of more interest to consumers, such as whether the doctor answers questions   patiently and explains what he's thinking. 

 Earlier this summer, more than 250,000 households in Cincinnati and Portland,   OR, received surveys seeking information on roughly 1,750 primary care doctors.   NRC will begin adding more markets early next year. Ultimately, the company   hopes to rate the nation's 143,000 primary care physiciansa task that will   require 15 million households to be surveyed. 

 The report cards will be a valuable tool for patients and physicians, says   NRC President/CEO Mike Hays. Patients will have access to information that will   help them find practitioners they can build relationships with, and doctors   will be able to identify aspects of their service that patients find wanting. 

 Health plans are expected to purchase the information and provide it to potential   enrollees during open enrollment periods. NRC is also negotiating with several   Internet and E-health companies to post the data through links from their sites   to NRC's. 

 Nearly a third of adults ages 19 to 29 have no health insurance. They're     twice as likely as children and older adults to be uninsured. 

 Seventy-five percent of uninsured workers in that age group don't have     access to employer-sponsored health plans. 

 One-quarter of young adults have below-poverty-level incomes (about $8,500     for singles and $13,000 for families of three). Health coverage for individuals     in the 20 to 29 age bracket can cost more than $2,000 a year, and $5,000 for     families. 

 Young adults without health coverage are twice as likely as their insured     counterparts not to seek medical care when they're sick. Half of the low-income     young adults who go without needed care do so because they can't afford it.       

Hospitals, Physician Retirement, Medical Practice, Medical Marijuana, Electronic Prescribing, Report Cards, Did You Know...

Practice Beat

 I'd like to thank FP Richard Waltman for sharing his thoughts about why he   enjoys medicine ["

" June 5]. The article was engaging, entertaining, and   inspiring. One passage resonated with me in particular: "The answer came to   me last Sunday, as my wife and I walked through a wildlife preserve and stopped   to gaze at the awesome sight of two bald eagles soaring across the horizon and   settling above us on a tree branch: 

I'm really good at what I do, and I really   like doing it

 I feel the same way that Waltman describes in his articleand   I'm 10 years older than he is. I couldn't have said it nearly as well. 

Compassion ought to be part of end-of-life care 

 Professional Editor David Azevedo decries the indifference   of his father's doctors during the days leading up to his dad's death ["

" Memo From the Editor's Guest, May 22]. As a former   hospice medical director and an internist with long experience caring for the   elderly, I couldn't agree with him more. It's awful that doctors are not there   for their patients at the moment of death. 

These days, however, many things conspire to frustrate the situation. End-of-life care is not a priority. We physicians are paid to intubate patients and monitor ventilators. We're not paid for palliative care in the ICU. 

 With the AMA's Educating Physicians in End of Life Care program, the medical   profession is trying to make end-of-life care a higher priority. In the meantime,   doctors can help by sending a sympathy card to let the patient's family know   the struggle they and their loved one just experienced is not forgotten or unappreciated. 

While I sympathize with the lack of personal attention   that Azevedo's father received while dying, I'm disturbed about the son's misunderstanding   of the medical system, especially since he's the Professional Editor of your   magazine! 

The realities are simple: Our increased patient loads, along with staggering administrative demandscreations of the insurance companiesleave physicians with no time to play the emotional caregiver. Maybe Azevedo should spend a week shadowing his father's primary doctor. Walk a mile with him before criticizing him. 

 Azevedo asks, "Where were my dad's doctors?" He ought   to think where he himself might usually be at 8 pm on a Friday: attending his   daughter's birthday party perhaps, or celebrating an anniversary, or watching   a ballgame, or spending quiet time with his wife after a long and grueling week   of work. They're the kinds of things most people are doing Fridays at 8. That's   where the doctors were. 

It's not possible to be in all the places we would like to be, so every minute of the day we have to choose where we 

What's more, we doctors deal with a full range of patient personalities and family dynamics. Some families prefer to be alone with their loved one in the final moments; some prefer the guidance of their doctor. But unless someone tells us, we don't know which. Did Azevedo and his family explain their wishes to the doctors?

 As a family physician, I don't routinely treat patients in the hospital. I   do, however, stop in to see them before my workday starts, and many of my colleagues   do the same. Most of the time the family doesn't know this, and if the patient   isn't talking, it's usually our secret. Does Azevedo know that his dad's physicians   didn't? He may have been surprised. 

 If these physicians are like most doctors I know, they   were trained by those paying for medical care, who taught them to provide only   the most cost-effective care adequate to the situation in the least expensive   setting. And, having learned the lesson, the primary care doctors knew they   wouldn't be paid for a hospital call because their services were not "needed." 

The support at the time of Azevedo's father's passing was delegated to "midlevel" providers. The doctors didn't think it was better medicine; they were just following the rules. 

 The doctors who treated Azevedo's father were hiding   from the pain of his dad's death. We physicians are trained to absorb medical   information, but there are no classes on how it feels to be a doctor. John Azevedo   Jr.'s death will be discussed, but none of the participants will be asked how   they feelonly what might have been done differently to keep Mr. Azevedo   alive a few more days or minutes. 

Doctors have trouble using the word "death." So what do we do? We build a wall to hide behind. That's where the doctors were when David's father died.

 Bucking the stopwatch trendand reaping the rewards 

 It was so refreshing to read internist Michael Monaco's article about his   stand against stopwatch medicine at his family practice group [

Like Monaco, I hung out my own shingle. Though I was a hospital employee with guaranteed income, I chose to open my own office because I believed patients would seek out quality care. At the beginning, it was scary. But now that my practice is doing well, I enjoy going to work in the mornings. I'm glad I'm not the only person who has taken this jump.

Don't blame the insurer for a bad contract 

 Karen Johnson's attorneys were able to shake down Humana for $13 million for   denying payment for her hysterectomy to treat cervical dysplasia; a sympathetic   plaintiff and just the right jury were enough ["

Straightforward   URor a 'machine of denial'?

I'm certainly no apologist for the managed care industry, but Humana followed its contractual obligations to the letter. To state that a hysterectomy is "also" acceptable or appropriate in the given circumstances proves nothing. Johnson's contract didn't promise any and all appropriate treatments based on patient (or physician) choice, regardless of cost. 

Edited by Suzanne Duke,
Senior Associate Editor

Author | Suzanne Duke

Articles

PDAs for Doctors: Decoding geekspeak: A glossary of PDA terms

Letters to the Editors

Practice Beat

Letters to the Editors