ACP-ASIM Online - American College of Physicians-American Society of Internal Medicine

The operating system debate: Pocket PC vs. Palm

Do you want a miniature version of your desktop computer—or something faster?

Copyright © 2002 by the American College of Physicians-American Society of Internal Medicine.

By Bryan Walpert

In the world of handhelds, you won't find a more heated debate than the one over a PDA's operating system (OS), the software that runs the machine.

The PDA market is dominated by two platforms: the Palm OS (from Palm Inc.) and the Pocket PC (from Microsoft). Each side has its vocal converts-and its critics.

Take Thomas G. McLeod, FACP, an internist at the Mayo Clinic in Rochester, Minn. He has had five different models of the Palm, which he insists is "just easier" and more "intuitive" than Pocket PC-based handhelds.

By contrast, Patricia L. Hale, ACP-ASIM Member, an internist with Fort Edward Internal Medicine in Saratoga Springs, N.Y., said she has "graduated" from the Palm system to the Pocket PC-based iPAQ, which has a larger screen for easier reading.

This is no esoteric debate. The operating system determines the type of model you can choose—and the software you can use.

Palm's system works not only on its own devices, such as the Palm m500, but on popular models like the Handspring Visor and the Sony CLIÉ. The Pocket PC system, on the other hand, runs on another set of hardware, such as the popular Compaq iPAQ and HP Jornada. Some software is available for only one type of operating system.

Moreover, each set of devices has its advantages and drawbacks, including size, screen look, programs to capture handwritten notes and the way you navigate among applications. The choice is similar to the decision you make when you decide between a personal computer and a Macintosh.

Fortunately, many of the differences between these operating systems are disappearing as new models come on the market. Palm-based devices, for example, are now available with expansion slots for additional memory, initially an advantage held by only Pocket PC devices.

Screen quality has improved on Palm-based PDAs thanks to the higher-resolution screens on recent versions of the Sony CLIÉ. And while Palm OS remains a leader in medical software applications—something that has given the system an early advantage—vendors are developing a growing number of programs for the Pocket PC.

In the end, the choice comes down to personal preference and factors like size, screen quality, applications you intend to run and what your colleagues are using.

"If you were to ask me which PDA to get, I would say the least expensive one you're comfortable with," said Kevin B. Johnson, MD, a pediatrician and vice chair for the department of medical informatics at Vanderbilt University Medical Center in Nashville.

Here is what physician users had to say about both operating systems.

Size and screen

Pocket PC devices typically offer a larger screen area, which is an important feature for quicker reading. Their 320 by 240 pixel screens offer higher resolution than Palm-based devices, which typically have 160 by 160 pixel screens.

(The Sony CLIÉ PEG-NR70, however, runs on the Palm operating system and offers a 320 by 480 pixel screen. It's a good example of how differences between the two are gradually fading.)

Screen quality mattered to Dr. Hale. She started four or five years ago with a Palm, but she became frustrated after a couple of years with the screen quality and bought a Pocket PC device.

Later, looking for a new device that would support more software, she thought about getting a Palm OS-based Sony CLIÉ. With its color screen and backlighting, it made reading text easier than older Palm models.

Ultimately, however, the screen was still too small because the area reserved for handwritten notes takes up too much of what is usable screen on the Pocket PC machines. "You lose too much of the screen," Dr. Hale said. So, when she was ready for a new PDA, she bought a Compaq iPAQ, a Pocket PC device.

While Pocket PC devices tend to offer larger screens, the flip side is that Palm-based devices are generally smaller and weigh less. Kenneth J. Maxwell, ACP-ASIM Member, who uses a Palm m500, experimented in the fall of 2001 with an iPAQ.

"It was heavy and almost had too many gizmos on it," said Dr. Maxwell, a gastroenterologist with Internal Medical Associates in Omaha, Neb. "I want something I can stick in my pocket that is not bulgy and heavy."

Ease of use

Physicians also base their operating system choice on ease of use. Even that, however, is in the eye of the beholder.

Pocket PC devices work much like scaled-down versions of your desktop personal computer and have similar ways of navigating among programs. That's precisely why Dr. McLeod prefers the Palm.

He can assign any of the applications on his Palm m515 to one of the four buttons at the bottom of the device. He doesn't have to maneuver through menus to reach a favorite application. Instead, he can quickly see his clinical drug database with the push of one button.

"I think it's easier to organize in a fashion that works well with your brainwave pattern, something that suits your tastes functionally and aesthetically," Dr. McLeod said of the Palm.

While Pocket PC devices may have faster processors, Palm OS fans say their devices were designed to be more efficient and don't need that much power. They insist that a faster processor does not necessarily mean a faster response at the bedside—and that's where speed really counts.

Charles F. Shaefer, FACP, an internist with University Medical Associates in Augusta, Ga., tried a Jornada, but found that speed was a non-issue. "I was able to work through to my end result applications quicker on the Palm than on the Jornada," he said.

"I view the Jornada as a min-computer," he added. "I'm not trying to do mini-computing. I'm trying to get rapid access to information."

It is exactly the "mini-computer" aspect of the Pocket PC system, however, that supporters appreciate. The Pocket PC's faster processors can run multiple applications, allowing physicians to multi-task. The devices can run an e-prescription program, for example, while a medical dictionary and drug reference are both running.

"Physicians literally think at light speed," said Ahmad Hashem, MD, global health care industry manager for Microsoft Corp. in Seattle. The Pocket PC, he argued, does not "restrict physicians from doing one thing and waiting until that thing is completely done before moving on to the next."

Because Pocket PC devices can run multiple programs, some physicians think Palm devices are ultimately faster. "Doctors' offices are extremely busy," said Alec Cooper, MD, a family physician in Quebec City, Quebec, who has a Palm m515. "You don't want those four- or five-second waits when you're trying to call up a file. It may not seem like very long to wait, but it makes a huge difference when data is available instantaneously."

Another consideration: Because Pocket PC devices typically have faster processors and larger screens, some (depending on the model) need more frequent recharging than Palm-based PDAs.

"If you have a Palm, you don't worry about batteries at all," acknowledged Dr. Hale, who is Chair of the College's Medical Informatics Subcommittee. "When you have a Pocket PC, you worry about it more."

Still, Dr. Hale said she hasn't had any problems and has learned to recharge her iPAQ every night. "It requires different habits," she explained.


While the above considerations are important, the biggest single factor when choosing a PDA platform should be the applications you want to run. Even diehard Pocket PC users admit that there are still more medical applications available for the Palm OS, including a trove of shareware and freeware created by physician users.

One of the biggest draws for Palm-based devices, according to a number of physicians, is ePocrates. The free program, which lets you check drug dosages, interactions and prices, is available only for the Palm OS. While the software has more than 250,000 physician users, a company spokeswoman said there is no Pocket PC version being developed.

While there are still more medical titles for Palm devices, the gap is narrowing quickly.

Even Palm aficionados, however, agree the software gap is narrowing as more and more applications are written for Pocket PCs. While you can't run ePocrates on a Pocket PC device, you can run mobilePDR, a free handheld version of the Physicians Desk Reference.

There are still more Palm-based applications "in terms of numbers," acknowledged Dr. Hashem of Microsoft. But in terms of categories of applications, "there is no category of application that's not also supported by Pocket PC," he said. "I don't know if a physician needs 25 applications for drug reference. One is probably enough, and there is more than one on the Pocket PC platform."

The availability of software titles is no longer a concern for Nirav R. Shah, ACP-ASIM Associate, a Robert Wood Johnson clinical scholar and clinical epidemiology fellow at the University of California, Los Angeles, and a member of the College's Medical Informatics Subcommittee. After using a Palm device for several years, he switched this spring to a Pocket PC-based Audiovox Maestro.

"Initially," he said, "Palm had so much medical software. But now with Skyscape and other software providers providing the same software for the Pocket PC platform, it's made the Pocket PC just as medically friendly as the Palm used to be."

One Pocket PC advantage, according to its supporters, is that it easily runs familiar Windows applications such as Word, Excel and PowerPoint. It is true that physicians with Palm-based devices can use a program like Documents To Go to convert and use documents created on these Microsoft programs. But Microsoft's Dr. Hashem insisted that sophisticated documents that contain charts, for example, can sometimes lose their formatting during conversion.

Dr. Shah agreed that converting documents from desktop computers to Palm devices is too difficult, even using specially designed conversion programs. "I used it once and said, 'Forget it,' " he said. Now that he has switched to the Pocket PC platform, he can easily edit documents in programs like Microsoft Word and PowerPoint while commuting to work.

Tom H. Karson, FACP, a cardiologist and associate chief of clinical informatics for Mount Sinai Medical Center in New York, said he has found a richer array of charge capture applications available for the Pocket PC. This software permits physicians to easily enter and maintain records of charges for services made when they enter a hospital. Many physicians now write those charges on notecards or scraps of paper that are easily lost.

"The majority of what I would consider better solutions are all written for the Pocket PC," Dr. Karson said.

The crowd

Overall, the best advice for now—especially if you're a novice user—is to choose a device that your colleagues are using. "Pick one everybody else is comfortable with around you," said Dr. Johnson from Vanderbilt. "You'll have people to answer questions and opportunities to benefit from colleagues."

Palm devices, by all accounts, have more physician users at the moment, presenting certain advantages to newcomers who want to share programs, swap advice and get help. But Cambridge, Mass.-based Forrester Research Inc. predicts that Microsoft's market share will grow. The Pocket PC already appears to be gaining a stronger foothold among large users such as hospitals, universities and clinics that set up local area networks for access to the Web and patient information.

That's important to individual physicians because Pocket PC devices can typically support radio frequency-based communication on local area networks with little modification, Dr. Johnson said. To connect a Palm, you'll have to do a little more work. And because larger groups tend to use the Pocket PC device, you may not have access to as much help from your institution as you would like, Dr. Johnson said.

"If hospitals are doing wireless work with PDAs, they're probably using Pocket PCs," Dr. Johnson added.

Still, if you're having trouble choosing, you'll have plenty of time to change your mind. After a year or so, Dr. Johnson said, you'll be able to make a better decision about whether to keep the operating system you've chosen or try another. And, with more sophisticated devices and more complex applications coming on the market all the time, you might be looking to switch or upgrade sooner than you think.

"You ought to be looking at these devices as disposable," advised Dr. Karson, who has had four PDAs. "If you think you'll be running the same device 18 months from now, you're wrong."