Newton MessagePad 2000

I bought a MessagePad 2000 in April, and I have to say that all the hype is true. It is a fantastic machine, as much a leap forward in hardware as Newton OS 2.0 was in software.

Others have discussed the numerous advantages of the MP2K, but I'd like to mention just a few. One is that the added heap and speed make running some larger packages much more practical. I have found that DateMan, from Stand Alone Software, to be an invaluable aid to tracking my schedule and scut list. This package allows links between most of the built-in Newton applications, so I can keep my continuity clinic patients in the Names application and connect them with progress notes in the Notepad and to do items and appointments in DateMan. Using Names, Notepad, and DateMan I find that I still don't need a patient management package.

While you're at the Stand Alone site, you should also check out Super NotePad. It adds a number of useful extensions to the built-in Notepad that I've found extraordinarily useful on the wards.

One of my favorite references has always been the LexiComp Drug Information Handbook. K2 Consultants recently released an updated version that takes advantage of the MP2K's increased screen real estate, and it is awesome.

One of the best features of the MP2K is IrDA printing, but you'll need a software update from Newton Inc. to make it work. One of the worst features is that you need a special dongle to connect your 2K to an AppleTalk network, the PrintPack, or a keyboard. This is a pain, as forgetting or losing the tiny dongle can make your MessagePad almost unusable. At about $20 each, they aren't cheap enough to just keep a few around. (The new connector on the MP2K will eventually support extra serial and audio i/o ports, but for now it's just a hassle.)

A few months back, someone browsing my website asked about the MP2K. By the time I finished saying what I thought of it, I had quite a document composed. I've included it here as my personal take on this new Newton product:

Date: Sun, 25 May 1997 13:56:12 -0800
To: Brian Christopher Misiaszek 
From: Ron Risley 
Subject: Re: Newton, MP2K, and Long Term Usefulness

At 12:10 -0800 5/20/97, Brian Christopher Misiaszek wrote:
>  Firstly, comments by my friend.  He said that he was at first
>exhilarated at having the Newton for doing ward duties, showing off to
>friends, bragging at it's prowess.  Over the long haul, he began to have
>doubts, qualms and misgivings.  He felt that compared to paper notes,
>that the Newton was too heavy, bulky, and slow to operate (much to the
>very vocal annoyance of his upper year residents who sneered at what
>they called his "toy").

As far as being heavy and bulky, my Newton contains the complete DSM-IV,
the Five Minute Clinical Consult, most of the Chan Current Clinical
Strategies series, three years' collection of clinical pearls, Ferri,
copies of all the H&Ps for any patient I've seen within the past three
months (can you say "bounce"?), current information on over 1,000
pharmaceuticals (including information on dosing, interactions, and costs),
beeper numbers for all residents and faculty in two departments, floor
extension numbers, clinic referral numbers, hospital formulary info, and
copies of all the current progress notes on my active patients. The same
material on paper would require a small wheelbarrow to cart around, and
*all* of it has proven useful time and again. I wear it in a fanny pack,
and can work the medicine wards without a white coat if I choose 'cause I
don't need all those pockets full of reference cards and pocket books, and
I seldom have to wait on hold for an operator to look up an extension or
pager number for me.

>It was also commented that "real doctors" keep
>all their facts in their head, giving rise to the more macho image of
>relying on memory for coming up with admission orders, post-op orders,
>etc.

That is a sad, sad commentary on the state of medicine and medical
education. By relying on rote memory in favor of teaching providers how to
use modern (meaning post-19th century) reference techniques, we've created
a cult of cowboy practitioners who rely on inaccurate, out of date, and
often just plain wrong memories instead of using fingertip access accurate,
up-to-date information. Once I had the Newton in my hands, I began to
discover that most practitioners (residents as well as attendings) often
make inappropriate drug choices because they stick with the agents they
know instead of consulting current literature. They often adhere to
outdated practices because it takes far too much time and energy to visit a
library to double-check their facts. With the MP-2000, I can even jump on
the Net and get up-to-the *minute* references if the case warrants (though
they rarely do).  And, yes, having that information at hand sometimes
intimidates folks who are not used to having their dogma instantly refuted
by published data, so one must tread very gently when doing so or risk that
co-workers will resort to ridicule as a defense mechanism against a
threatening technology.

I found that the MP-120 was right at the threshold for being fast enough.
By using a number of tricks (including avoiding patient management software
packages) to eke out the highest possible speed I was able to get by pretty
well. I once contended that looking things up on the Newton was faster than
on paper but just *appeared* slower since there wasn't the distraction of
watching someone flip through a book or deck of cards. I got challenged to
an informal showdown, and we came out about dead even (assuming the
paper-user had the right book at hand). With the MP-2000, though, there's
no contest -- it achieves nearly an order of magnitude improvement in speed
in the areas that really count.

>He did admit that his notes on the Newton, albeit slower to input,
>were much more legible afterwards.  But he had a damned hard time trying
>to find hospital printers for output his Virtual Intern documents and
>the like.

Slower to input? I don't know. Using the simple templates I've developed, I
can crank out a *decent* H&P faster than I could by hand. The only folks I
know who can get a note in the chart faster do really sub-standard (and/or
totally illegible) work. (NB. Some folks have intimated that I'm a bit on
the compulsive side.)

I don't have an all-encompassing answer to the printing problems, but I do
have an array of solutions which, when taken together, allow me to get by.
First, on some services I still hand write notes. The MP-2000 beats the
pants off index cards for storing patient data, and is still useful for
printing H&P's and the like, but if you're on a service where it's
important to get the notes actually in the chart -- as opposed to being
written but pending printing -- as early as possible then it's best to just
scribble them down. Even when I hand write notes, having the MP available
for printing sign-out sheets is invaluable, as this can often happen at the
end of a 36-hour day when having to remember what's important for each
patient and write it legibly on a card can seem like a nightmare.
Cross-covers really like thorough, typewritten sign outs.

All the hospitals I'm currently working in (a university medical center, a
county mental health facility, a private HMO hospital, a VA psychiatry
ward, and two private general hospitals) all have plain-paper fax machines
on every floor. I can just pull the modular plug out of the wall and fax
directly to the machine without even using a phone line, though it's not
terribly fast (and doesn't work with all fax modems).

I work weekends on a psychiatric consult service, and there I find it
worthwhile to actually carry a Newton keyboard and a DeskJet 340 printer
around with me. These psych workups can run 6-7 typed pages, and I probably
save upwards of 45 minutes on each consult by typing rather than writing.
In the bargain, the notes are not only more legible, but quite a bit more
thorough. Since I don't have to carry around stethoscopes, hammers, gloves,
and the like, it's a reasonable trade-off.

Obviously, on locations where I do most of my work in an office (psychiatry
and clinics) I just take the DeskJet to work and leave it on my desk during
the day. It prints about 100 pages on a charge, so you'd have to be
considerably more loquatious than I to use up the batteries.

One warning: though the MP-2000 claims to support IrDA printing, it doesn't
really work. There's a bug in Apple's implementation of the protocol that
can slow printing to 5-10 minutes per page! That's sad, because
IrDA-equipped printers are starting to crop up around the medical center
here.

[The IrDA printing problem has since been fixed. Download the HP IrDA Printers extension from the Newton Inc. website.]

>While having such software as Onion's MEDICAL PEARLS, and
>drug information software was useful, he would have much preferred
>something such as Harrison's, or the Washington Manual (for he still had
>his lab coat pockets weighed down with assorted pocketbooks).

All internists seem to dream of having Harrison's available on the wards,
except when it actually *is*. (There's a copy on the medicine floor of
UCDMC, and it's lost on a high shelf covered with a thick layer of dust.)
It's not much good for real clinical medicine -- the times when you need
Harrison's you can afford to go and get it. As for a pocket clinical
manual, I've always preferred Ferri [Fred Ferri's Practical Care of the
Medical Patient] over the Washington Manual and, happily, Ferri is now
available in Newton format. Oh, yes. It's wonderful. And don't forget the
Five Minute Clinical Consult, a textbook-sized tome you can now drop in a
fanny pack, thanks to Newton technology.

I still carry a Tarascon Pocket Pharmacopeia (low-tech done right) and a
dozen or so 3x5's in case I have to hand information to someone else. Both
these items fit quite comfortably in the same fanny pack as the Newton (an
Eagle Creek pack I bought from REI).

> Finally,
>he said that while he could back-up his Newton on his home PC, it did so
>in an archived format that he couldn't alter on his home computer, not
>allowing him to change Newton notes, or even input his own version of
>the little black book.

Newton Connection Utilities (included with the MP-2000) lets you
synchronize with personal organizer data on the desktop and enter data
directly on the Newton using a desktop's keyboard, though this remains one
of the weakest areas of Newton technology. I've never wanted to use my
desktop as an organizer after getting the Newton, so I'm not terribly
bothered by these weaknesses.

>In the end, he even stopped carrying it around
>for addresses and telephone numbers, leaving it at home now for such
>purposes (he admits, though, a holster or bag may have been useful).

Yes, I find my fanny pack indispensable. I'm so scatter-brained when I'm
sleep deprived that I probably would long ago have left the Newton at some
nurse's station if I didn't have the pack. As it is, I take my Newton
practically *everywhere*. I suppose it's gained the status of a
transitional object for me. I felt naked when taking the USMLE Step III
because, of course, they wouldn't let me carry it in for the exam.
(Remember, it's more important to be 45% accurate by memory than 98%
accurate using real-world reference tools.)

>Also, because he doesn't use it now, he's embarrased at all his initial
>bragging about the usefullness of the Newton.

That's understandable. As I've said, it took some effort for me to make the
MP-120 practical, and having a dozen years of engineering experience
probably helped. The MP-2000 is a quantum leap forward, though.

>  In the light of my friend's comments, has the new MP2K overcome these
>difficulties?  Has utility and speed increased all that much for the
>Newton to be a utilatarian product?  Is it worth $1275 Canadian (about
>$900 US) for the base unit, or would I be happier with a US Robotics
>Palm Pilot?

The Pilot and the MessagePad are two entirely different animals. The Pilot
would be something you'd probably want to carry in addition to all your
reference books, your patient cards, and (maybe) your peripheral brain,
perhaps instead of just a name and address book. The MessagePad can
effectively replace all those, but of course requires a much larger
investment of money and, to some extent, time (though the time investment,
at least for me, is really paying dividends every day I use the Newton).

>Does the initial enthusiasm for the unit fade over time as
>other matters in medicine become more important (ie. I notice that your
>last significant update on your homepage for the Newton is about a year
>old).

Six months, but who's counting. :-) No, if anything I become more attached
to my Newton every day. Alas, one's intern year is not the time to try to
become an award-winning webmaster. I have a whole list of comments and
features I'd very much like to add to the site, but instead I fritter away
my hours on silly pursuits such as sleeping or obtaining food, clothing,
and shelter.

>[Is] it a tool as useful as a stethoscope, or is it still a "toy",
>that comes close to, but misses the mark?

For me? Given a choice between the Newton and a stethoscope (and I own
several fine ones), I'd take the Newton every time. Bear in mind, though,
that I've been a wirehead since the 1970's. Your mileage may certainly vary.

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