Yes, handheld computers can simplify and improve healthcare delivery. No, not everyone agrees. On the individual level, some people naturally gravi- tate toward technologic solutions like handhelds. Others, however, just don’t get the appeal. They’re simply not interested. A third group of people, maybe the largest group overall, likes the idea of handheld computers but hesitates to invest time in anything new. If you’ve got a good thing going (“My inpatient-billing 3-by-5 index cards work just fine, thank you very much!”), why take chances with the unknown.
Our experience as teachers shows that these three group—early adopters, nonadopters, and slow adopters—must be recognized and approached differently. Implementation of handhelds within a large organization, such as a training program or hospital staff, succeeds best when each type of adopter receives training specific to their needs.
So, you may ask, what else is new? Target training to the needs of the learner—everyone knows that. Well, in practice, targeted training rarely happens. Take, for example, the first group, the early adopters. If you give an early adopter a current-generation handheld computer, in no time at all, they have mastered the basics and are telling everyone how wonderful life has become. No joke—something about these devices lights the techno fire within a nerd. Often, however, organizations drag their feet with new tech- nology and make Huge Mistake #1.
Huge Mistake #1
20
Teaching People to Use Handheld Computers
Peter L. Reynolds, Scott M. Strayer, and Mark H. Ebell
439 Store all newly purchased handhelds under lock and key, and only release them to users once they’ve completed their mandatory 2-hour “Handhelds and Me” training.
Amazing, isn’t it, that you’ll trust a nurse to calculate dopamine drips or a resident to deliver a baby, but you won’t trust them to take a $200 hand- held computer out of the box by themselves. Instead of Huge Mistake #1, consider Wonderful Training Tip #1.
Wonderful Training Tip #1
When deploying handheld computers in your organization, buy them and hand them out when they arrive.
Deploy handhelds and, from day one, force all providers to submit billing charges using charge capture software only.
Early adopters will love you and train themselves. With great books like this one available, they’ll find and implement useful medical applications quickly. Most slow adopters, on the other hand, will play Tetris and that’s about it (because they’ve got that good 3-by-5 card thing going). Some, believe it or not, will be won over by the early adopters and become fanat- ics themselves. Nonadopters, unfortunately, will probably take their hand- held home in the unopened box and go out for sushi. You win some—you lose some. Regardless, you’ve already got a significant number of users training themselves without drafting a single lesson plan.
More importantly, you haven’t wasted time training an uninterested, unreceptive audience. It takes time to move an organization to the point where they can embrace handheld computing as a group. Handheld appli- cations like schedule dissemination and charge capture save time and money. They only work, however, if a majority of people come on board.
Likewise, handheld applications are easy to sabotage. If you force non- adopters to use a handheld without gradually warming up to the idea, their resistance will likely grow, not diminish. That’s Huge Mistake #2. Don’t do it. Resistance tends to rear its head in the form of dead batteries, lost sty- luses, synchronization trouble, and all sorts of other handheld maladies, all of which hurt your cause.
Huge Mistake #2
Instead, encourage experimentation and gradually introduce new appli- cations as per Wonderful Training Tip #2. Ideally, you want an 80% to 90%
adoption rate for a given application before you make its use mandatory.
In the example of charge capture, if 9 of 10 providers use billing software,
by our experience, 9 of 10 providers will be billing for more money with lower administrative overhead. At some point, the nonadopter holdout has no choice but to switch over or take a pay cut. Also, don’t worry too much about folks playing games, showing family photos, and beaming jokes back and forth. Early on,Tetris and Solitaire are just as good for acclimating users to their handheld as more intimidating medical applications. Eventually, if handheld computers really are all we say they’re cracked up to be, they will win over your slow adopters and nonadopters.
Wonderful Training Tip #2
Let users play games on their handhelds. Encourage slow and nonadopters to use medical applications but wean them from their 3-by-5 cards slowly.
You can please all the slow adopters some of the time, And you can please some of the early adopters all of the time, But you can’t please most of the nonadopters most of the time, Unless you wait a long time.
Give up your handheld training program if you meet resistance.
By the way, all these tips and examples are based on real people and cir- cumstances. One physician all but left her Palm OS handheld in the box for 2 years. It took about a year more for her to master her appointment calendar, and now she’s using ePocrates and loving it. It’s a happy tale of a nonadopter turned enthusiast; admittedly, a particularly long tale, but a happy one. There is reason for hope—most people come around. Thus we come to Huge Mistake #3 and Wonderful Training Tip #3.
Huge Mistake #3
Wonderful Training Tip #3 (paraphrased from Abraham Lincoln’s original treatise on handheld computing)
Formal training definitely has its place in the world of handheld com- puters. Just don’t forget the importance of hands-on and peer-to-peer train- ing, and consciously incorporate these aspects into your training plan. Busy health care providers, particularly physicians, respond best to training that they believe will directly improve their quality of care. For many, especially those wary of technology, this belief is best gained by peer-to-peer demon- stration over time.
Table 20.1 summarizes teaching approaches for different types of hand- held adopters. As for training content, we believe this book serves as an excellent outline. Begin with the basics. Go on to specific medical applica- tions. And give people time before fully incorporating handheld-only solu- tions into your organization.
What follows are several tutorials on using alternative training tools, emulators and others, that allow you to project an image of a functioning handheld device onto a large screen. This ability becomes important for teaching larger groups for two reasons. First, as it turns out, the average handheld screen is too small to effectively train more than two or three people at a time. Second, when you demonstrate using a projected hand- held image, students can easily follow along using their own handheld device simultaneously. You get to “see one” and “do one” at the same time—it’s perfect!
Installing and Using the Palm OS Emulator for Presentations
Have you ever wanted to show your colleagues a great program for the Palm, but were limited by its small screen? Well, there is a way to project all your “killer apps” onto a screen so that everyone can share in your
Table 20.1. Approaches to teaching handheld computing.
Type of handheld user Teaching tips
Early adopter Hands-on, self-directed training
Formal training courses to introduce a wide range of medical applications early and speed progress
Get them devices early; let them help direct further training for slow and nonadopters
Slow adopter Encourage hands-on experimentation
Encourage discussion with early adopters to pique interest and increase confidence (small group discussions)
Offer incentives to use medical applications; measure rates of utilization and relative outcomes (charge capture, etc.)
Nonadopter One-on-one training
Require users to bring handheld devices to certain events (small group discussions, training courses, etc.)
Be patient; recurrent one-on-one training
wealth of knowledge, but it takes a little bit of effort to install the program and run it. The effort will be well worth it, however, as your colleagues
“ooh” and “aah” at all the incredible programs you show them for their handheld computers.
The program is called an emulator, and can be downloaded from the Palm Web site and installed on your computer. To project it, you also need to install a “ROM Image,” a process that I will describe in laymen’s terms (it took me several months to figure this one out using the tech manuals for the emulator). Then, you need to install your Palm programs onto the emu- lator, which is a little simpler. Finally, a good LCD projector will be needed to show these images to your eager colleagues. Please note that you cannot change the emulator from computer to computer without installing the ROM image on that computer as well (unless you save it as a self- executable file). The easiest way to avoid any trouble is to install the emu- lator and the ROM image on your laptop and use that computer for the presentation.
So Where Do You Get This Emulator?
HANDS-ON EXERCISE 20.1. DOWNLOADING THE EMULATOR
The emulator can be downloaded from the Palm website at http://www.palmos.com/dev/tools/emulator. Download the most current emulator and skins (graphical images of Palm handheld computers) from the section entitled “Download the Emulator.”
What Do I Do with This Emulator Once It Is Downloaded?
HANDS-ON EXERCISE 20.2. INSTALLING THE EMULATOR
After you have downloaded the emulator, you can disconnect from the Internet and begin the installation process. The file needs to be “unzipped”
using a decompression utility like Winzip (available at www.winzip.com;
select the “download evaluation version” for a free trial). If you need more help with decompression and using Winzip, please see Chapter 3, where we have a great hands-on exercise that describes this process. Make sure you pay attention to where the file is decompressed. In my case, it sets up a default location called “c:\unzipped\emulator.” When you open up Winzip and click “Unzip now,” it will tell you which directory is the target for the decompressed file. You will also need to unzip the “skins” file and locate it in the same folder as the emulator. All the skins need to be placed in a folder called “skins,” which you will have to rename using Windows (Figure 20.1a).
After you have unzipped the file, a window will open up with the files contained in the zip file. Alternatively, if you have to open it up later, just remember where it was unzipped. If you begin working on it right away, you will double-click on the file called “emulator.exe,” which will have an icon of a Palm with a pilot’s cap on it (Figure 20.1b). You will be asked if you want to add the emulator to the Start menu configuration, to which you can reply either “Yes” or “No.”
Next, you will be brought to a box entitled “Palm OS Emulator.” It will have the choices of “New,” “Open,” “Download,” or “Exit” (Figure 20.2).
To start a new session, just tap on “New.” You can select which device you Figure 20.1a. Emulator folder with skins renamed. (Reprinted with permission from Microsoft Corporation.)
Figure 20.1b. Icon for Palm emulator. (Reprinted with permission from Microsoft Corporation.)
want from the “Device select” drop-down menu (choices include all the various Palm and Palm OS models). You can also select the “skin” or look of the Palm Pilot for your presentation (I would recommend the “generic”
setting). Finally, you can select the RAM size. It is to your advantage to select the largest amount of RAM (i.e., 16384 K), as this will allow you to install more Palm programs later (Figure 20.3).
But wait, you aren’t ready to run the emulator yet! The next step involves transferring the ROM image, and then you will be ready to project your emulator on any conference screen you choose.
HANDS-ON EXERCISE 20.3. INSTALLING THE ROM IMAGE
The first step of this process is to find the file “ROM transfer.prc” that came with your original emulator. It should be in the unzipped file that you stored earlier when you decompressed the entire “emulator.zip” file. When you Figure 20.2. Starting an emulator session. (Reprinted with permission from palmOne, Inc.)
Figure 20.3. Selecting the attributes of the emulator. (Reprinted with permission from palmOne, Inc.)
open the unzipped file, you should find this Palm program that is installed in the usual manner (see Chapter 3 for details on Palm program installa- tion). Just double-click on the program and it should automatically go into your Palm Install tool.
The computer you are using must have the Palm Desktop software installed and configured correctly and needs to synchronize via a cradle with your handheld. After you have installed the “ROM transfer” file to your Palm Pilot, open up the emulator and click the “Download” button (see Figure 20.2). You need to have the handheld hooked up and in the cradle. You will also need to disable the HotSync program by “right- clicking” on the icon of the blue and red arrows in the lower-right-hand corner of your computer’s start bar, and hitting “Exit.” A box will appear that asks you if you are sure you want to exit this program, and you should hit the “Yes” button. Now, hit “Download” and “Begin.”
You will need to place your handheld in the cradle, turn it on, and open the “ROM transfer” program located under utilities. Press “Begin transfer”
on the handheld, and then you will have to hit the “Begin” button on the computer to which you are transferring the ROM image. This process should take a few minutes, but a “progress bar” should come up immedi- ately if you have followed the steps correctly so far.
You will be prompted to save the ROM files. Give them a meaningful name and remember where they are saved.
Now you can begin your first emulator session by tapping on the emula- tor and selecting “New” (see Figure 20.2). You can select the device, skin, and RAM size and when you will need to hit the “Browse” button and iden- tify where you just saved the ROM files (see Figure 20.3).
HANDS-ON EXERCISE 20.4. AN ALTERNATIVE METHOD TO INSTALL THE ROM IMAGE
Another way to install the ROM image is to download it from the Palm site. You will need to register as a developer at http://www.palmos.com/
dev/programs/pdp/join.html. This site can be accessed from the main Web site we told you about earlier. After registering, access the page for down- loading ROM images to get your file. It will need to be decompressed, and after you have done this, you will just hit “Browse” to show where the ROM image is when you go to start your first emulator session.
HANDS-ON EXERCISE 20.5. INSTALLING PROGRAMS ONCE THE EMULATOR IS RUNNING
When you get the emulator to work, a large Palm clone will appear on your main computer that is about half the size of the screen (Figure 20.4). All the preinstalled programs on the Palm will be there. To show your col- leagues a medical application, right-click on the screen, and select “Install Application/Database.” Select “Other” from the menu that comes up to the
right of that selection, and you will be taken to a file selection box. You can then grab any application on your hard drive (for example, in your Palm backup file located at C:\Palm\your user name\Backup) and install it on the emulator (Figures 20.5, 20.6).
Once you have saved all the programs you want on your emulator, you can right-click on the emulator screen and save the emulator under a certain name for that demonstration or particular lecture. Remember that you will only be able to install 16 MB of programs, so you may need multiple emu- lators if you have a lot of programs to show off.
Pocket PC Emulators
There is only one way to get a true Pocket PC emulator, and that is to install embedded Visual Basic, embedded Visual C, or the .Net Compact Frame- work on a Windows 2000 or Windows NT desktop computer. Unfortunately, older versions of Windows do not support the emulator. On the bright side, the eVB programming environment is free (www.microsoft.com/pocketpc), Figure 20.4. Emulator Palm clone. (Reprinted with permission from palmOne, Inc.)
Figure 20.5. Installing an application to the Palm emulator. (Reprinted with permission from palmOne, Inc.)
Figure 20.6. Selecting “Other” to install programs to the emulator. (Reprinted with permission from palmOne, Inc.)
but on the not-so-bright side it is a bit of a waste to install 40 MB of files just to get an emulator! Also, the emulator is very clumsy to work with, and is really only a tool for programmers to test their software, rather than a way to demonstrate Pocket PCs in a presentation.
So what should you do if you want to demonstrate how to use a Pocket PC to a roomful of eager learners (all your learners are eager, aren’t they?) Not to worry—several free or inexpensive utilities are available that let you connect your Pocket PC to a laptop, connect the laptop to a projector, and then project the Pocket PC’s screen through your laptop onto the screen.
Then, anything you do on the Pocket PC is visible to your learners on the screen.
It’s easy to set this up. Just go to http://www.microsoft.com/pocketpc, and click on the “Downloads” link. Then download the “Remote Display Adapter,” one of the PowerToys that Microsoft has kindly made available at no charge. Make sure your device is in its cradle and synchronized, and then run the setup program (the icon is shown in Figure 20.7, the initial setup program screen is shown in Figure 20.8). The setup program will install a small program to your desktop or laptop computer and another to your Pocket PC.
When you are done installing, go to the Start menu under Windows and select “Remote Display Control” from the Programs menu.
Next, go to your Pocket PC, select Programs from the Start menu, and then select the cryptically named “cerdisp” from that folder (Figure 20.9).
You will see the screen shown in Figure 20.10. Select “Connect” and you will see the screen shown in Figure 20.11.
Just agree—that tells it to use the “Peer to Peer Protocol” as a transport.
There are other options, but I’ve never known anyone who had to use them.
Figure 20.7. Icon for Remote Display. (Reprinted with permission from Microsoft Corporation.)
Figure 20.8. Initial setup program screen for Remote Display. (Reprinted with permission from Microsoft Corporation.)
Figure 20.9. Locating the Remote Display program on your Pocket PC. (Reprinted with permission from Microsoft Corporation.)
Figure 20.10. Opening Remote Display on your Pocket PC. (Reprinted with permission from Microsoft Corporation.)
After you select “OK,” wait a few seconds, and you should see the Pocket PC’s screen appear on your desktop or laptop computer (Figure 20.12a).
One nice option is the ability to “Zoom” the screen. You can increase to two or even three times normal size. This is great when you have a laptop with a high-resolution screen and want the Pocket PC to take up most of it when you project it on a screen.
That’s it. This free and easy-to-use software means that you can demon- strate anything on your Pocket PC for any size audience. The only down- side is a slight “lag time” between when you enter your command on the Pocket PC and when you see the response on screen. You can also set the Remote Display program to send mouse moves from your laptop screen to the Pocket PC, but this just slows it down even further and isn’t recom- mended. Another program that is commercially available (Pocket Con- troller, www.soti.net, $24.99) displays the actual device that you choose in addition to the Pocket PC screen (Figure 20.12b).
Now You’re Ready
After all this hard work, the fun is about to begin. All you have to do is locate an LCD projector to plug into your laptop or computer, and run the emulator program to show your collection of Palm or Pocket PC applica- Figure 20.11. Connection type in Remote Diplay program. (Reprinted with permission from Microsoft Corporation.)
tions. Be prepared for some astonished faces as you show fellow physicians how to conquer everyday tasks such as inpatient billing, looking up drug doses, checking your schedule, and oh yes, playing a game when you have a minute to take a breather!
Another Way to Present: An ELMO Unit
As you can probably gather, the emulator is a cheap way to demonstrate Palm programs, but maybe not the easiest. It works fine for many people, but if you have access to an ELMO unit, otherwise known as a video pre- senter (Figure 20.13), it provides a great alternative (ELMO was one of the first manufacturers of this type of technology, although others are now available). The ELMO unit has the advantage of presenting whatever you currently have installed on your Palm, Pocket PC, or whatever you are trying to show (including finger animals). The disadvantage is that it merely Figure 20.12a. Remote Display screen on your
desktop or laptop computer. (Reprinted with permission from Microsoft Corporation.)
Figure 20.12b. Pocket controller with Toshiba e740 device. (Reprinted with permission from SOTI, Inc.)
projects the images, but cannot be used to capture screenshots as we did in this book. All the screenshots shown were captured using either the Palm emulator or its Pocket PC brother that cones with eVB.
ELMO units come in various shapes and sizes, and also have varying price tags. Many academic centers and conference rooms already have them installed, or can get them set up through audio-visual support. Just check before your presentation. One disadvantage I have noticed when using one is that you usually have to sit down to use this type of technology.
Figure 20.13. Video presenter.
