Pearls

Name-brand practice-management software can cost hundreds or even thousands of dollars-no small expense, especially for a new practice. Still, you and your staff need the word processing, spreadsheet, documentation, patient tracking, and appointment-scheduling capabilities these programs provide.

Open-source and general public licensing (GPL) software titles-available free or at minimal cost-may offer a budget-friendly alternative.

Open-source versus GPL

There are two types of “free” software:

• “free” as in no charge for its use. For example, Steve Gibson of Speeding up your Web search,” Psyber Psychiatry, May 2003). Use key words such as “freeware,” “free,” or “open source” in conjunction with the type of program (eg, “document” or “database”).
  Many open-source or GPL projects are centrally stored at two sites, SourceForge and Freshmeat. Browse the categories for the type of program you need, such as databases, utilities, firewalls, etc. These sites offer source code and version information for programmers as well as precompiled software for the public.
  Table Relevant open-source and GPL software titles

  Type	Software	URL
  Office document	OpenOffice *	www.openoffice.org
  Instant messaging	GAIM *	http://gaim.sourceforge.net
  Web browser	Firefox *	www.mozilla.org/products/firefox/
  Database	Firebird *	http://firebird.sourceforge.net
  Application server	Zope *	www.zope.org
  Practice management	FreeMED	www.freemed.org
  Clinical database	SQL Clinic	www.sqlclinic.net
  Electronic Medical Record	Open EMR	www.openemr.net
  * available in binary format and ready to use

  Related Resources (accessed Feb. 20, 2004) GNU Project. GNU General Public License (example of free-distribution license). http://www.gnu.org/copyleft/gpl.html
  GNU Project. Various licenses and comments about them. http://www.gnu.org/licenses/license-list.html.
  GNU Project. Terms and conditions for copying, distribution, and modification http://www.gnu.org/copyleft/gpl.html#SEC3
  Open Source Initiative. The open source definition. http://www.opensource.org/docs/definition.php
  If you have questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.
  Disclosure Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Name-brand practice-management software can cost hundreds or even thousands of dollars-no small expense, especially for a new practice. Still, you and your staff need the word processing, spreadsheet, documentation, patient tracking, and appointment-scheduling capabilities these programs provide.

Open-source and general public licensing (GPL) software titles-available free or at minimal cost-may offer a budget-friendly alternative.

Open-source versus GPL

There are two types of “free” software:

• “free” as in no charge for its use. For example, Steve Gibson of Speeding up your Web search,” Psyber Psychiatry, May 2003). Use key words such as “freeware,” “free,” or “open source” in conjunction with the type of program (eg, “document” or “database”).
  Many open-source or GPL projects are centrally stored at two sites, SourceForge and Freshmeat. Browse the categories for the type of program you need, such as databases, utilities, firewalls, etc. These sites offer source code and version information for programmers as well as precompiled software for the public.
  Table Relevant open-source and GPL software titles

  Type	Software	URL
  Office document	OpenOffice *	www.openoffice.org
  Instant messaging	GAIM *	http://gaim.sourceforge.net
  Web browser	Firefox *	www.mozilla.org/products/firefox/
  Database	Firebird *	http://firebird.sourceforge.net
  Application server	Zope *	www.zope.org
  Practice management	FreeMED	www.freemed.org
  Clinical database	SQL Clinic	www.sqlclinic.net
  Electronic Medical Record	Open EMR	www.openemr.net
  * available in binary format and ready to use

  Related Resources (accessed Feb. 20, 2004) GNU Project. GNU General Public License (example of free-distribution license). http://www.gnu.org/copyleft/gpl.html
  GNU Project. Various licenses and comments about them. http://www.gnu.org/licenses/license-list.html.
  GNU Project. Terms and conditions for copying, distribution, and modification http://www.gnu.org/copyleft/gpl.html#SEC3
  Open Source Initiative. The open source definition. http://www.opensource.org/docs/definition.php
  If you have questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.
  Disclosure Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Name-brand practice-management software can cost hundreds or even thousands of dollars-no small expense, especially for a new practice. Still, you and your staff need the word processing, spreadsheet, documentation, patient tracking, and appointment-scheduling capabilities these programs provide.

Open-source and general public licensing (GPL) software titles-available free or at minimal cost-may offer a budget-friendly alternative.

Open-source versus GPL

There are two types of “free” software:

• “free” as in no charge for its use. For example, Steve Gibson of Speeding up your Web search,” Psyber Psychiatry, May 2003). Use key words such as “freeware,” “free,” or “open source” in conjunction with the type of program (eg, “document” or “database”).
  Many open-source or GPL projects are centrally stored at two sites, SourceForge and Freshmeat. Browse the categories for the type of program you need, such as databases, utilities, firewalls, etc. These sites offer source code and version information for programmers as well as precompiled software for the public.
  Table Relevant open-source and GPL software titles

  Type	Software	URL
  Office document	OpenOffice *	www.openoffice.org
  Instant messaging	GAIM *	http://gaim.sourceforge.net
  Web browser	Firefox *	www.mozilla.org/products/firefox/
  Database	Firebird *	http://firebird.sourceforge.net
  Application server	Zope *	www.zope.org
  Practice management	FreeMED	www.freemed.org
  Clinical database	SQL Clinic	www.sqlclinic.net
  Electronic Medical Record	Open EMR	www.openemr.net
  * available in binary format and ready to use

  Related Resources (accessed Feb. 20, 2004) GNU Project. GNU General Public License (example of free-distribution license). http://www.gnu.org/copyleft/gpl.html
  GNU Project. Various licenses and comments about them. http://www.gnu.org/licenses/license-list.html.
  GNU Project. Terms and conditions for copying, distribution, and modification http://www.gnu.org/copyleft/gpl.html#SEC3
  Open Source Initiative. The open source definition. http://www.opensource.org/docs/definition.php
  If you have questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.
  Disclosure Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Knowing each patient’s problems and life situation is critical to conducting an effective follow-up examination. But with limits on your time and patients often changing psychiatrists, keeping track can be challenging.

A multiaxial problem (MAP) list, which we devised based on clinical experience, can help you organize key symptoms and remember which issues to address during repeat visits. It can quickly get you up to speed with a patient who:

• has multiple disorders or symptoms
• is treatment-resistant
• has not been seen in months or years
• is a candidate for a change in treatment
• or was treated by another psychiatrist.

Table

Sample multiaxial problem (MAP) list

Creating the list

The MAP list can be compiled from information obtained by:

• asking the patient to list complaints
• reviewing the patient’s chart
• interviewing family members
• or talking with other care team members.

On a blank sheet of paper, write at the top the patient’s name, age, race/sex (for fast identification), and age at onset of symptoms (to differentiate between chronic, episodic, and recent onset).

Then draw four quadrants and organize the information as follows (Table):

• Axis A—symptoms and issues addressed by the psychiatrist
• Axis B—behavior patterns and attitudes that might affect treatment. Also include intellectual limitations. A behavior attributed to a personality disorder (such as selfmutilation) falls under Axis A because the psychiatrist would treat it directly.
• Axis C—physical symptoms or disorders to be addressed by another physician
• Axis D—psychosocial, physical, and other patient stressors. A physical illness may fall under both Axes C and D if the stress is significant.

Pertinent negatives such as “No suicide attempt” may be recorded on Axis A or C, psychological strengths/coping skills on Axis B, and supportive persons and factors (such as “Mother helps financially”) on Axis D.

Using the list

Keep the MAP list handy while seeing the patient. Start by going through the symptoms/problems listed under Axis A. Review the patterns noted under Axis B and look for ways to promote insight and coping by reflecting those patterns back to the patient. For the hypothetical patient illustrated in the Table, we would prescribe a medication, then tell her, “We’ve discussed your pattern of stopping medications because you’re afraid of becoming dependent on them. We need to discuss this further so that you can keep taking this medication regularly.”

Next, check the physical conditions under Axis C before choosing a medication to avoid possible drug-drug interactions or side effects. We find that Axis C also helps us ensure that the patient seeks appropriate medical care from another physician. Finally, Axis D reminds us to be empathic toward patients who report psychosocial stressors and to intervene where appropriate.

Remember that the MAP list is not a substitute for taking a full history and physical.

MAP maintenance

Revise the MAP list after each visit as the patient responds to treatment or as his or her life changes. For example, a psychosocial stressor that has been resolved should be struck, although some cases call for leaving the item in and noting “resolved” or “in remission” after it. For example, even if a patient was no longer being physically abused by her spouse, we would not delete the problem because we would want to keep monitoring it.

Include only relevant data on the list or it will become unwieldy. Add diagnoses only if they are certain.

Knowing each patient’s problems and life situation is critical to conducting an effective follow-up examination. But with limits on your time and patients often changing psychiatrists, keeping track can be challenging.

A multiaxial problem (MAP) list, which we devised based on clinical experience, can help you organize key symptoms and remember which issues to address during repeat visits. It can quickly get you up to speed with a patient who:

• has multiple disorders or symptoms
• is treatment-resistant
• has not been seen in months or years
• is a candidate for a change in treatment
• or was treated by another psychiatrist.

Table

Sample multiaxial problem (MAP) list

Creating the list

The MAP list can be compiled from information obtained by:

• asking the patient to list complaints
• reviewing the patient’s chart
• interviewing family members
• or talking with other care team members.

On a blank sheet of paper, write at the top the patient’s name, age, race/sex (for fast identification), and age at onset of symptoms (to differentiate between chronic, episodic, and recent onset).

Then draw four quadrants and organize the information as follows (Table):

• Axis A—symptoms and issues addressed by the psychiatrist
• Axis B—behavior patterns and attitudes that might affect treatment. Also include intellectual limitations. A behavior attributed to a personality disorder (such as selfmutilation) falls under Axis A because the psychiatrist would treat it directly.
• Axis C—physical symptoms or disorders to be addressed by another physician
• Axis D—psychosocial, physical, and other patient stressors. A physical illness may fall under both Axes C and D if the stress is significant.

Pertinent negatives such as “No suicide attempt” may be recorded on Axis A or C, psychological strengths/coping skills on Axis B, and supportive persons and factors (such as “Mother helps financially”) on Axis D.

Using the list

Keep the MAP list handy while seeing the patient. Start by going through the symptoms/problems listed under Axis A. Review the patterns noted under Axis B and look for ways to promote insight and coping by reflecting those patterns back to the patient. For the hypothetical patient illustrated in the Table, we would prescribe a medication, then tell her, “We’ve discussed your pattern of stopping medications because you’re afraid of becoming dependent on them. We need to discuss this further so that you can keep taking this medication regularly.”

Next, check the physical conditions under Axis C before choosing a medication to avoid possible drug-drug interactions or side effects. We find that Axis C also helps us ensure that the patient seeks appropriate medical care from another physician. Finally, Axis D reminds us to be empathic toward patients who report psychosocial stressors and to intervene where appropriate.

Remember that the MAP list is not a substitute for taking a full history and physical.

MAP maintenance

Revise the MAP list after each visit as the patient responds to treatment or as his or her life changes. For example, a psychosocial stressor that has been resolved should be struck, although some cases call for leaving the item in and noting “resolved” or “in remission” after it. For example, even if a patient was no longer being physically abused by her spouse, we would not delete the problem because we would want to keep monitoring it.

Include only relevant data on the list or it will become unwieldy. Add diagnoses only if they are certain.

Knowing each patient’s problems and life situation is critical to conducting an effective follow-up examination. But with limits on your time and patients often changing psychiatrists, keeping track can be challenging.

A multiaxial problem (MAP) list, which we devised based on clinical experience, can help you organize key symptoms and remember which issues to address during repeat visits. It can quickly get you up to speed with a patient who:

• has multiple disorders or symptoms
• is treatment-resistant
• has not been seen in months or years
• is a candidate for a change in treatment
• or was treated by another psychiatrist.

Table

Sample multiaxial problem (MAP) list

Creating the list

The MAP list can be compiled from information obtained by:

• asking the patient to list complaints
• reviewing the patient’s chart
• interviewing family members
• or talking with other care team members.

On a blank sheet of paper, write at the top the patient’s name, age, race/sex (for fast identification), and age at onset of symptoms (to differentiate between chronic, episodic, and recent onset).

Then draw four quadrants and organize the information as follows (Table):

• Axis A—symptoms and issues addressed by the psychiatrist
• Axis B—behavior patterns and attitudes that might affect treatment. Also include intellectual limitations. A behavior attributed to a personality disorder (such as selfmutilation) falls under Axis A because the psychiatrist would treat it directly.
• Axis C—physical symptoms or disorders to be addressed by another physician
• Axis D—psychosocial, physical, and other patient stressors. A physical illness may fall under both Axes C and D if the stress is significant.

Pertinent negatives such as “No suicide attempt” may be recorded on Axis A or C, psychological strengths/coping skills on Axis B, and supportive persons and factors (such as “Mother helps financially”) on Axis D.

Using the list

Keep the MAP list handy while seeing the patient. Start by going through the symptoms/problems listed under Axis A. Review the patterns noted under Axis B and look for ways to promote insight and coping by reflecting those patterns back to the patient. For the hypothetical patient illustrated in the Table, we would prescribe a medication, then tell her, “We’ve discussed your pattern of stopping medications because you’re afraid of becoming dependent on them. We need to discuss this further so that you can keep taking this medication regularly.”

Next, check the physical conditions under Axis C before choosing a medication to avoid possible drug-drug interactions or side effects. We find that Axis C also helps us ensure that the patient seeks appropriate medical care from another physician. Finally, Axis D reminds us to be empathic toward patients who report psychosocial stressors and to intervene where appropriate.

Remember that the MAP list is not a substitute for taking a full history and physical.

MAP maintenance

Revise the MAP list after each visit as the patient responds to treatment or as his or her life changes. For example, a psychosocial stressor that has been resolved should be struck, although some cases call for leaving the item in and noting “resolved” or “in remission” after it. For example, even if a patient was no longer being physically abused by her spouse, we would not delete the problem because we would want to keep monitoring it.

Include only relevant data on the list or it will become unwieldy. Add diagnoses only if they are certain.

The SAD PERSONS scale, an acronym based on 10 suicide risk factors,¹ has found widespread acceptance in assessing the likelihood of a suicide attempt. It also has been adapted for use with children.²

However, a major risk factor omitted from the scale is the availability of a lethal means for suicide, such as a firearm, stockpiled medication, or other potentially lethal item. In particular, where firearm ownership levels are higher, a disproportionately higher number of people die from suicide.³

Include ‘Availability of lethal means’

SAD PERSONS can be modified to “SAD PERSONAS” to remedy this omission, with the second ‘A’ representing “Availability of lethal means” (Table). This modification reminds the clinician to ask about lethal means when assessing suicidality. If lethal means are available, the clinician can then take whatever action is reasonably indicated to reduce the likelihood of a suicide.

Eliminate scoring

Because the listed risk factors are not equivalent with regard to suicide potential, a second modification is to eliminate scoring.

In SAD PERSONS, one point is scored for each risk factor. Consider these two patients:

• a man who is depressed and has an organized plan to shoot himself with his handgun
• an elderly widower who has dementia and is physically ill.

Both men would score a 4, but the risk of suicide would be substantially greater in the first case. Suicide risk factors are qualitative—not quantitative—measures and should be considered within the overall context of the clinical presentation.

Table

Modified SAD PERSONAS scale

The SAD PERSONS scale, an acronym based on 10 suicide risk factors,¹ has found widespread acceptance in assessing the likelihood of a suicide attempt. It also has been adapted for use with children.²

However, a major risk factor omitted from the scale is the availability of a lethal means for suicide, such as a firearm, stockpiled medication, or other potentially lethal item. In particular, where firearm ownership levels are higher, a disproportionately higher number of people die from suicide.³

Include ‘Availability of lethal means’

SAD PERSONS can be modified to “SAD PERSONAS” to remedy this omission, with the second ‘A’ representing “Availability of lethal means” (Table). This modification reminds the clinician to ask about lethal means when assessing suicidality. If lethal means are available, the clinician can then take whatever action is reasonably indicated to reduce the likelihood of a suicide.

Eliminate scoring

Because the listed risk factors are not equivalent with regard to suicide potential, a second modification is to eliminate scoring.

In SAD PERSONS, one point is scored for each risk factor. Consider these two patients:

• a man who is depressed and has an organized plan to shoot himself with his handgun
• an elderly widower who has dementia and is physically ill.

Both men would score a 4, but the risk of suicide would be substantially greater in the first case. Suicide risk factors are qualitative—not quantitative—measures and should be considered within the overall context of the clinical presentation.

Table

Modified SAD PERSONAS scale

The SAD PERSONS scale, an acronym based on 10 suicide risk factors,¹ has found widespread acceptance in assessing the likelihood of a suicide attempt. It also has been adapted for use with children.²

However, a major risk factor omitted from the scale is the availability of a lethal means for suicide, such as a firearm, stockpiled medication, or other potentially lethal item. In particular, where firearm ownership levels are higher, a disproportionately higher number of people die from suicide.³

Include ‘Availability of lethal means’

SAD PERSONS can be modified to “SAD PERSONAS” to remedy this omission, with the second ‘A’ representing “Availability of lethal means” (Table). This modification reminds the clinician to ask about lethal means when assessing suicidality. If lethal means are available, the clinician can then take whatever action is reasonably indicated to reduce the likelihood of a suicide.

Eliminate scoring

Because the listed risk factors are not equivalent with regard to suicide potential, a second modification is to eliminate scoring.

In SAD PERSONS, one point is scored for each risk factor. Consider these two patients:

• a man who is depressed and has an organized plan to shoot himself with his handgun
• an elderly widower who has dementia and is physically ill.

Both men would score a 4, but the risk of suicide would be substantially greater in the first case. Suicide risk factors are qualitative—not quantitative—measures and should be considered within the overall context of the clinical presentation.

Table

Modified SAD PERSONAS scale

Next time you meet someone at a clinical conference, don’t just hand that person a business card.

Instead, invite the colleague to join your online social network. Within days, your new acquaintance will have access to hundreds of potential business contacts-an ever-expanding network that otherwise would have taken years to build.

How online networks work

In the Internet age, people connect by meeting online in chat forums devoted to a favorite subject, exchanging e-mails after reading a mailing list or Web log, or finding relevant Web sites.

Online social networking takes this interaction one step further: Users join social networks and then invite others to join, allowing people to meet friends of friends for business or pleasure.

With popular file-sharing networks such as Kazaa and Napster, strangers can share music and other computer files. Online social networking sites work differently, but the idea is the same: to share resources.

For social purposes, these sites let users see lists of other peoples’ contacts, providing an opportunity to make new friends based on common interests. For business, interaction may be done directly by reviewing a profile or indirectly via a chain of mutual contacts in a network. As others on the network keep inviting new members and opening paths to new contact lists, your social and/or professional network will continuously grow.

How online networking can help you

Developing contacts at clinical conferences is crucial to our livelihood, but too often business cards are lost or the contact’s context is forgotten.

By contrast, with online social networking, contacts are developed and stay online. What’s more, the contact’s profile information enhances the context.

This service not only cements existing connections but may open the door to new, more worthwhile contacts. For example, the network may provide:

• a mechanism to discreetly market your services and seek job openings.
• a source of referrals for your patients who are moving to areas where you know few or no physicians. Each contact can check his or her network for area doctors. This could also lead to more patients for a doctor in that area.

Online social networking also can promote an exchange of ideas and expertise. Many large companies use this technology to solicit strategic planning ideas from their workforces. This saves companies the expense of an outside consultant.¹

How to get started

Most social networking sites provide free accounts, using a valid e-mail address as the primary method of contact (Table).

Once you activate your account, you should set up a profile that highlights your interests, specialties, and types of offers you wish to receive. You are now ready to invite friends to join your network. From there, you can find other members with common interests (eg, colleagues in medical practice).

Most sites let you determine which information to make public or private, such as your e-mail address or phone number. Sites such as LinkedIn give you additional control by blocking communications from sources other than your trusted connections; you can also elect to anonymously decline requests for contact.

Some sites offer premium accounts, which for $5 to $10 a month offer services such as resume management, advanced searches, and information on who has reviewed your profile.

Risks

Some networking sites are not secure.² This may open your social network to spam, or another user might be able to change your information. To prevent this, only use social network providers who implement SSL-level security.

Level of trust from network to network is another issue. For example, if you do not trust one colleague’s opinion, that person’s network may be not worth keeping. You may wish to keep the contact anyway because some knowledge-good or bad-may be better than no information at all.

Table

Online Networking Sites

Related Resources

www.ringo.com. Click on “take a tour” for a quick tutorial on online social networking.

If you have questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to: Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Next time you meet someone at a clinical conference, don’t just hand that person a business card.

Instead, invite the colleague to join your online social network. Within days, your new acquaintance will have access to hundreds of potential business contacts-an ever-expanding network that otherwise would have taken years to build.

How online networks work

In the Internet age, people connect by meeting online in chat forums devoted to a favorite subject, exchanging e-mails after reading a mailing list or Web log, or finding relevant Web sites.

Online social networking takes this interaction one step further: Users join social networks and then invite others to join, allowing people to meet friends of friends for business or pleasure.

With popular file-sharing networks such as Kazaa and Napster, strangers can share music and other computer files. Online social networking sites work differently, but the idea is the same: to share resources.

For social purposes, these sites let users see lists of other peoples’ contacts, providing an opportunity to make new friends based on common interests. For business, interaction may be done directly by reviewing a profile or indirectly via a chain of mutual contacts in a network. As others on the network keep inviting new members and opening paths to new contact lists, your social and/or professional network will continuously grow.

How online networking can help you

Developing contacts at clinical conferences is crucial to our livelihood, but too often business cards are lost or the contact’s context is forgotten.

By contrast, with online social networking, contacts are developed and stay online. What’s more, the contact’s profile information enhances the context.

This service not only cements existing connections but may open the door to new, more worthwhile contacts. For example, the network may provide:

• a mechanism to discreetly market your services and seek job openings.
• a source of referrals for your patients who are moving to areas where you know few or no physicians. Each contact can check his or her network for area doctors. This could also lead to more patients for a doctor in that area.

Online social networking also can promote an exchange of ideas and expertise. Many large companies use this technology to solicit strategic planning ideas from their workforces. This saves companies the expense of an outside consultant.¹

How to get started

Most social networking sites provide free accounts, using a valid e-mail address as the primary method of contact (Table).

Once you activate your account, you should set up a profile that highlights your interests, specialties, and types of offers you wish to receive. You are now ready to invite friends to join your network. From there, you can find other members with common interests (eg, colleagues in medical practice).

Most sites let you determine which information to make public or private, such as your e-mail address or phone number. Sites such as LinkedIn give you additional control by blocking communications from sources other than your trusted connections; you can also elect to anonymously decline requests for contact.

Some sites offer premium accounts, which for $5 to $10 a month offer services such as resume management, advanced searches, and information on who has reviewed your profile.

Risks

Some networking sites are not secure.² This may open your social network to spam, or another user might be able to change your information. To prevent this, only use social network providers who implement SSL-level security.

Level of trust from network to network is another issue. For example, if you do not trust one colleague’s opinion, that person’s network may be not worth keeping. You may wish to keep the contact anyway because some knowledge-good or bad-may be better than no information at all.

Table

Online Networking Sites

Related Resources

www.ringo.com. Click on “take a tour” for a quick tutorial on online social networking.

If you have questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to: Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Next time you meet someone at a clinical conference, don’t just hand that person a business card.

Instead, invite the colleague to join your online social network. Within days, your new acquaintance will have access to hundreds of potential business contacts-an ever-expanding network that otherwise would have taken years to build.

How online networks work

In the Internet age, people connect by meeting online in chat forums devoted to a favorite subject, exchanging e-mails after reading a mailing list or Web log, or finding relevant Web sites.

Online social networking takes this interaction one step further: Users join social networks and then invite others to join, allowing people to meet friends of friends for business or pleasure.

With popular file-sharing networks such as Kazaa and Napster, strangers can share music and other computer files. Online social networking sites work differently, but the idea is the same: to share resources.

For social purposes, these sites let users see lists of other peoples’ contacts, providing an opportunity to make new friends based on common interests. For business, interaction may be done directly by reviewing a profile or indirectly via a chain of mutual contacts in a network. As others on the network keep inviting new members and opening paths to new contact lists, your social and/or professional network will continuously grow.

How online networking can help you

Developing contacts at clinical conferences is crucial to our livelihood, but too often business cards are lost or the contact’s context is forgotten.

By contrast, with online social networking, contacts are developed and stay online. What’s more, the contact’s profile information enhances the context.

This service not only cements existing connections but may open the door to new, more worthwhile contacts. For example, the network may provide:

• a mechanism to discreetly market your services and seek job openings.
• a source of referrals for your patients who are moving to areas where you know few or no physicians. Each contact can check his or her network for area doctors. This could also lead to more patients for a doctor in that area.

Online social networking also can promote an exchange of ideas and expertise. Many large companies use this technology to solicit strategic planning ideas from their workforces. This saves companies the expense of an outside consultant.¹

How to get started

Most social networking sites provide free accounts, using a valid e-mail address as the primary method of contact (Table).

Once you activate your account, you should set up a profile that highlights your interests, specialties, and types of offers you wish to receive. You are now ready to invite friends to join your network. From there, you can find other members with common interests (eg, colleagues in medical practice).

Most sites let you determine which information to make public or private, such as your e-mail address or phone number. Sites such as LinkedIn give you additional control by blocking communications from sources other than your trusted connections; you can also elect to anonymously decline requests for contact.

Some sites offer premium accounts, which for $5 to $10 a month offer services such as resume management, advanced searches, and information on who has reviewed your profile.

Risks

Some networking sites are not secure.² This may open your social network to spam, or another user might be able to change your information. To prevent this, only use social network providers who implement SSL-level security.

Level of trust from network to network is another issue. For example, if you do not trust one colleague’s opinion, that person’s network may be not worth keeping. You may wish to keep the contact anyway because some knowledge-good or bad-may be better than no information at all.

Table

Online Networking Sites

Related Resources

www.ringo.com. Click on “take a tour” for a quick tutorial on online social networking.

If you have questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to: Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

If you cannot get to a phone and you need to make immediate contact, instant messaging (IM) may be the right call.

IM, the equivalent of ‘instant e-mail,’ allows almost real-time communication and exchange of information over the Internet. IM is most popular among teenagers and college students, but medical providers and other professionals have begun to recognize its potential for speeding communication.

How IM started

Before the World Wide Web existed, electronic bulletin boards (BBS) were a popular mode of communication. Users would log in and browse various message topics, posting comments and questions for others to answer. Users also could check who was logged into the BBS and post messages to one or more of those contacts. This was done in a Telnet session, which is a method for connecting to another computer on the Internet. Telnet sessions hark back to mainframe computing, when computer terminals without processing power provided access to the central computer.

In 1996, Mirabilis released ICQ, which enabled Internet users to locate each other on the Internet without connecting to a BBS-by creating direct peer-to-peer communication channels. Companies such as America On Line, Microsoft, and Yahoo! also developed IM systems, but none could connect with one another because there is no common standard. AOL later purchased Mirabilis and incorporated its technology into the AOL Instant Messenger (AIM).

Doing IM: What you need

To do instant messaging, you need an Internet connection and the appropriate client. Keep in mind that your client should be:

• compatible with several systems
• or the same client that your messaging partner uses. New users typically choose an IM system that a friend or colleague is using.

Choosing an IM client is a matter of preference because all systems offer similar features (E-therapy: Alerting patients to the benefits, risks,“ November 2002).

Because IM is a direct communication channel with visual references to previous dialogue, it creates the environment of an active conversation. One drawback is that a participant’s typing speed typically limits the conversation’s pace. Using the voice feature overcomes this limitation, but this feature will not work properly without a broadband Internet connection, such as over a cable modem or digital subscriber line.

Risks of IM-based therapy

The IM communication channel’s lack of security poses a significant risk, particularly when used for psychotherapy. This active connection broadcasts its availability over the Internet, making it vulnerable to hackers. What’s more, the IM client may change your security settings for your Web browser¹ or allow remote access to your computer by a hacker.²

Making your IM system secure

On the corporate level, vendors such as Yahoo!, Microsoft, AOL and others have created products to secure public IM systems, such as Akonix and Endeavors Technology. These products are gateways that maintain corporate data within the company network, encrypt information, specify and limit certain features, and log conversations. This level of security does not exist over major public IM networks for individual users.

Secure Shuttle Transport, DBabble, and PSST provide encrypted communication to individual users.

Table

Instant messaging clients

If you have questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or e-mail him at: Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

If you cannot get to a phone and you need to make immediate contact, instant messaging (IM) may be the right call.

IM, the equivalent of ‘instant e-mail,’ allows almost real-time communication and exchange of information over the Internet. IM is most popular among teenagers and college students, but medical providers and other professionals have begun to recognize its potential for speeding communication.

How IM started

Before the World Wide Web existed, electronic bulletin boards (BBS) were a popular mode of communication. Users would log in and browse various message topics, posting comments and questions for others to answer. Users also could check who was logged into the BBS and post messages to one or more of those contacts. This was done in a Telnet session, which is a method for connecting to another computer on the Internet. Telnet sessions hark back to mainframe computing, when computer terminals without processing power provided access to the central computer.

In 1996, Mirabilis released ICQ, which enabled Internet users to locate each other on the Internet without connecting to a BBS-by creating direct peer-to-peer communication channels. Companies such as America On Line, Microsoft, and Yahoo! also developed IM systems, but none could connect with one another because there is no common standard. AOL later purchased Mirabilis and incorporated its technology into the AOL Instant Messenger (AIM).

Doing IM: What you need

To do instant messaging, you need an Internet connection and the appropriate client. Keep in mind that your client should be:

• compatible with several systems
• or the same client that your messaging partner uses. New users typically choose an IM system that a friend or colleague is using.

Choosing an IM client is a matter of preference because all systems offer similar features (E-therapy: Alerting patients to the benefits, risks,“ November 2002).

Because IM is a direct communication channel with visual references to previous dialogue, it creates the environment of an active conversation. One drawback is that a participant’s typing speed typically limits the conversation’s pace. Using the voice feature overcomes this limitation, but this feature will not work properly without a broadband Internet connection, such as over a cable modem or digital subscriber line.

Risks of IM-based therapy

The IM communication channel’s lack of security poses a significant risk, particularly when used for psychotherapy. This active connection broadcasts its availability over the Internet, making it vulnerable to hackers. What’s more, the IM client may change your security settings for your Web browser¹ or allow remote access to your computer by a hacker.²

Making your IM system secure

On the corporate level, vendors such as Yahoo!, Microsoft, AOL and others have created products to secure public IM systems, such as Akonix and Endeavors Technology. These products are gateways that maintain corporate data within the company network, encrypt information, specify and limit certain features, and log conversations. This level of security does not exist over major public IM networks for individual users.

Secure Shuttle Transport, DBabble, and PSST provide encrypted communication to individual users.

Table

Instant messaging clients

If you have questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or e-mail him at: Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

If you cannot get to a phone and you need to make immediate contact, instant messaging (IM) may be the right call.

IM, the equivalent of ‘instant e-mail,’ allows almost real-time communication and exchange of information over the Internet. IM is most popular among teenagers and college students, but medical providers and other professionals have begun to recognize its potential for speeding communication.

How IM started

Before the World Wide Web existed, electronic bulletin boards (BBS) were a popular mode of communication. Users would log in and browse various message topics, posting comments and questions for others to answer. Users also could check who was logged into the BBS and post messages to one or more of those contacts. This was done in a Telnet session, which is a method for connecting to another computer on the Internet. Telnet sessions hark back to mainframe computing, when computer terminals without processing power provided access to the central computer.

In 1996, Mirabilis released ICQ, which enabled Internet users to locate each other on the Internet without connecting to a BBS-by creating direct peer-to-peer communication channels. Companies such as America On Line, Microsoft, and Yahoo! also developed IM systems, but none could connect with one another because there is no common standard. AOL later purchased Mirabilis and incorporated its technology into the AOL Instant Messenger (AIM).

Doing IM: What you need

To do instant messaging, you need an Internet connection and the appropriate client. Keep in mind that your client should be:

• compatible with several systems
• or the same client that your messaging partner uses. New users typically choose an IM system that a friend or colleague is using.

Choosing an IM client is a matter of preference because all systems offer similar features (E-therapy: Alerting patients to the benefits, risks,“ November 2002).

Because IM is a direct communication channel with visual references to previous dialogue, it creates the environment of an active conversation. One drawback is that a participant’s typing speed typically limits the conversation’s pace. Using the voice feature overcomes this limitation, but this feature will not work properly without a broadband Internet connection, such as over a cable modem or digital subscriber line.

Risks of IM-based therapy

The IM communication channel’s lack of security poses a significant risk, particularly when used for psychotherapy. This active connection broadcasts its availability over the Internet, making it vulnerable to hackers. What’s more, the IM client may change your security settings for your Web browser¹ or allow remote access to your computer by a hacker.²

Making your IM system secure

On the corporate level, vendors such as Yahoo!, Microsoft, AOL and others have created products to secure public IM systems, such as Akonix and Endeavors Technology. These products are gateways that maintain corporate data within the company network, encrypt information, specify and limit certain features, and log conversations. This level of security does not exist over major public IM networks for individual users.

Secure Shuttle Transport, DBabble, and PSST provide encrypted communication to individual users.

Table

Instant messaging clients

If you have questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or e-mail him at: Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Many patients who request a benzodiazepine dose increase need more medication to manage their anxiety or panic disorder. Some patients, however, are misusing or abusing the drug.

How can you tell when to stop a benzodiazepine prescription? Consider these cases:

Case 1

Mr. A says a 1-week trial of diazepam, 5 mg tid, has alleviated his anxiety “a little” but adds that he has to “double-up” to get complete relief.

Is Mr. A being honest? Probably, because he is volunteering the information. Remember that diazepam, 10 mg every 4 hours, is within the agent’s therapeutic range for severe anxiety.

Recommendation: Increase diazepam to 10 mg tid and continue monitoring use. Expect that the patient may need additional doses during periods of greater stress.

Case 2

Three days after his last visit, Mr. B says he lost his clonazepam or it was stolen.

Is Mr. B being honest? Possibly not. Patients who abuse their prescriptions often make this claim.

Recommendation: Admonish Mr. B that clonazepam is a controlled substance. Tell him you will terminate the prescription if he cannot keep it secure.

Schedule a follow-up appointment. At that visit, order a toxicology screen and remind the patient that he must manage his prescription.

Case 3

Mr. C—who has been taking lorazepam, 5 mg tid to qid, for 1 year—mentions that he recently had a drink at a party. During his initial evaluation, he denied alcohol use. Upon further questioning, he admits that he drinks “socially” 4 to 6 times per year but never has more than a second drink on any occasion.

Is Mr. C being honest? Probably. Patients who drink minimally commonly deny alcohol use.

Recommendation: Explain the need to avoid alcohol when taking benzodiazepines but do not give the impression that an occasional drink will lead to serious harm or death.

Also find out how much and how often your patient drinks. Make sure “a drink now and then” is not in fact a few drinks 2 or 3 nights a week.

Case 4

Ms. D says her diazepam use has escalated to 40 to 60 mg/d, depending on her anxiety level. One day she calls to reschedule her appointment; her speech sounds slightly slurred.

Is Ms. D being honest? Probably, but she may be misusing diazepam or abusing another substance.

Recommendation: See the patient ASAP. Order urine and serum toxicology and a breath alcohol test. Consider inpatient detoxification. Also consider switching anxiolytics, as benzodiazepine abusers often crave one agent but not another.

Case 5

A new patient—Ms. E, age 70—says she has been taking diazepam, 5 mg qid, for 35 years.

Recommendation: Continue the prescription. Stopping diazepam for fear of long-term adverse effects could cause an upheaval for this patient.

Many patients who request a benzodiazepine dose increase need more medication to manage their anxiety or panic disorder. Some patients, however, are misusing or abusing the drug.

How can you tell when to stop a benzodiazepine prescription? Consider these cases:

Case 1

Mr. A says a 1-week trial of diazepam, 5 mg tid, has alleviated his anxiety “a little” but adds that he has to “double-up” to get complete relief.

Is Mr. A being honest? Probably, because he is volunteering the information. Remember that diazepam, 10 mg every 4 hours, is within the agent’s therapeutic range for severe anxiety.

Recommendation: Increase diazepam to 10 mg tid and continue monitoring use. Expect that the patient may need additional doses during periods of greater stress.

Case 2

Three days after his last visit, Mr. B says he lost his clonazepam or it was stolen.

Is Mr. B being honest? Possibly not. Patients who abuse their prescriptions often make this claim.

Recommendation: Admonish Mr. B that clonazepam is a controlled substance. Tell him you will terminate the prescription if he cannot keep it secure.

Schedule a follow-up appointment. At that visit, order a toxicology screen and remind the patient that he must manage his prescription.

Case 3

Mr. C—who has been taking lorazepam, 5 mg tid to qid, for 1 year—mentions that he recently had a drink at a party. During his initial evaluation, he denied alcohol use. Upon further questioning, he admits that he drinks “socially” 4 to 6 times per year but never has more than a second drink on any occasion.

Is Mr. C being honest? Probably. Patients who drink minimally commonly deny alcohol use.

Recommendation: Explain the need to avoid alcohol when taking benzodiazepines but do not give the impression that an occasional drink will lead to serious harm or death.

Also find out how much and how often your patient drinks. Make sure “a drink now and then” is not in fact a few drinks 2 or 3 nights a week.

Case 4

Ms. D says her diazepam use has escalated to 40 to 60 mg/d, depending on her anxiety level. One day she calls to reschedule her appointment; her speech sounds slightly slurred.

Is Ms. D being honest? Probably, but she may be misusing diazepam or abusing another substance.

Recommendation: See the patient ASAP. Order urine and serum toxicology and a breath alcohol test. Consider inpatient detoxification. Also consider switching anxiolytics, as benzodiazepine abusers often crave one agent but not another.

Case 5

A new patient—Ms. E, age 70—says she has been taking diazepam, 5 mg qid, for 35 years.

Recommendation: Continue the prescription. Stopping diazepam for fear of long-term adverse effects could cause an upheaval for this patient.

Many patients who request a benzodiazepine dose increase need more medication to manage their anxiety or panic disorder. Some patients, however, are misusing or abusing the drug.

How can you tell when to stop a benzodiazepine prescription? Consider these cases:

Case 1

Mr. A says a 1-week trial of diazepam, 5 mg tid, has alleviated his anxiety “a little” but adds that he has to “double-up” to get complete relief.

Is Mr. A being honest? Probably, because he is volunteering the information. Remember that diazepam, 10 mg every 4 hours, is within the agent’s therapeutic range for severe anxiety.

Recommendation: Increase diazepam to 10 mg tid and continue monitoring use. Expect that the patient may need additional doses during periods of greater stress.

Case 2

Three days after his last visit, Mr. B says he lost his clonazepam or it was stolen.

Is Mr. B being honest? Possibly not. Patients who abuse their prescriptions often make this claim.

Recommendation: Admonish Mr. B that clonazepam is a controlled substance. Tell him you will terminate the prescription if he cannot keep it secure.

Schedule a follow-up appointment. At that visit, order a toxicology screen and remind the patient that he must manage his prescription.

Case 3

Mr. C—who has been taking lorazepam, 5 mg tid to qid, for 1 year—mentions that he recently had a drink at a party. During his initial evaluation, he denied alcohol use. Upon further questioning, he admits that he drinks “socially” 4 to 6 times per year but never has more than a second drink on any occasion.

Is Mr. C being honest? Probably. Patients who drink minimally commonly deny alcohol use.

Recommendation: Explain the need to avoid alcohol when taking benzodiazepines but do not give the impression that an occasional drink will lead to serious harm or death.

Also find out how much and how often your patient drinks. Make sure “a drink now and then” is not in fact a few drinks 2 or 3 nights a week.

Case 4

Ms. D says her diazepam use has escalated to 40 to 60 mg/d, depending on her anxiety level. One day she calls to reschedule her appointment; her speech sounds slightly slurred.

Is Ms. D being honest? Probably, but she may be misusing diazepam or abusing another substance.

Recommendation: See the patient ASAP. Order urine and serum toxicology and a breath alcohol test. Consider inpatient detoxification. Also consider switching anxiolytics, as benzodiazepine abusers often crave one agent but not another.

Case 5

A new patient—Ms. E, age 70—says she has been taking diazepam, 5 mg qid, for 35 years.

Recommendation: Continue the prescription. Stopping diazepam for fear of long-term adverse effects could cause an upheaval for this patient.

Wireless fidelity, or “Wi-Fi,” is gaining popularity in the medical profession and elsewhere. Some medical professionals are using Wi-Fi’s anytime, anywhere Internet connectivity to access electronic medical information during hospital rounds and to immediately enter demographic information when admitting patients.

What it is-and how it works

Wi-Fi is a certification given by the Wi-Fi Alliance, a nonprofit international trade organization that tests 802.11-based wireless Internet products. The “Wi-Fi Certified” logo signals to purchasers that the product has met rigorous interoperability testing requirements and is compatible with products from different vendors.

Today, the term “Wi-Fi” also commonly describes wireless Internet. Technically speaking, Wi-Fi is the use of radio technology to provide Ethernet connectivity in the unlicensed 2.4 and 5 GHz radio frequencies. By contrast, Internet access provided by wireless modems is based on technology used in cellular phones.

802.11 is the standard protocol ratified by the Institute of Electrical and Electronics Engineers. 802.11b is the most commonly used standard; 802.11a and 802.11g are other options (Table).

Why Wi-Fi?

Wireless Internet access via the 802.11 protocol offers:

• freedom to surf the Internet in your office, back yard, or elsewhere
• the ability to avoid using unsightly wires to connect computers in a local area network (LAN)
• significantly faster access than wireless modems and higher connection speeds than are available via telephone lines or electrical outlets.

Hitting the hot spots

Aside from office and home, Wi-Fi can be used at “hot spots”-public access points at cafes, restaurants, coffee shops, hotels, airports, downtown business districts, malls, and retail stores. Some retailers provide free access to attract business,¹ while others pay to partner with wireless Internet service providers such as T-Mobile ² and Boingo.³

It helps to check online for hot spots before heading out (visit the T- Mobile or Boingo sites or try the Wi-Fi FreeSpot Directory or other Web site guide). Because most network connections are automatic, however, you can turn on your notebook computer anytime and find out in seconds if a wireless Internet service is available. An indication usually appears on the screen if you are connected to a wireless LAN with Windows XP or Mac OS X, but older operating systems may require additional software. A Wi-Fi signal does not guarantee Internet access because many Wi-Fi providers require the user to log in.

An alternative is to look for ‘warchalking’-a series of sidewalk symbols that appear on your screen to indicate nearby wireless access⁴ (click here to view warchalking symbols). Warchalking has raised legal and moral issues, though to my knowledge this tracking method is seldom used.

Getting started

Several components are necessary for wireless Internet in the home or office. First, broadband Internet access via a cable modem, digital subscriber line (DSL), or satellite must be established. Connecting via a dial-up modem is another option, but its connection rate is too slow to be shared among several computers.

A wireless access point, which serves as the ‘base station,’ is then connected to the modem. Access points often are sold in combination with a built-in router, which delivers network information to the appropriate destination.

Each computer connecting to the access point must have a wireless network adapter. For desktop computers, this can either be a peripheral component interconnect (PCI) card or a Universal Serial Bus (USB) device. Many notebook computers come with a built-in wireless network adapter but can also use a PCI card or USB device.

Once these devices are installed, the wireless network must be set up so that each device can communicate. Most network setups are automatically established and require little user intervention; however, the user must decide which wireless channel to use and whether a security key is required.

Security risks

Wireless network use poses one major drawback: lack of security.

All wireless LANs have built-in wired equivalent privacy security, which uses a security key to limit access. In 2001, researchers at the University of California at Berkeley discovered flaws in the encryption algorithm designed to protect wireless LANs.⁵ Software has since been designed to exploit this flaw and identify the security key in the wireless traffic, rendering this level of security useless.⁶

In health care, this risk raises the issue of whether wireless networking is compliant with the Health Insurance Portability and Accountability Act (HIPAA). Medical Records Institute Executive Director C. Peter Waegeman n indicates that access via 802.11b is clearly not HIPAA-compliant⁷ and that other standards such as 802.11a or 802.11g should be used. Most healthcare systems, however, continue to use 802.11b because it is widely available and economical.

Making your network secure

Although the 802.11b standard is extremely insecure, several practical issues ameliorate the security risk. For one, finding the security key provides access to the wireless network but does not guarantee access to private information. Disabling shared access to network computers offers additional security but will eliminate the benefit of sharing information over a network.

Several hardware and software innovations aimed at increasing remote network security are scheduled to be launched in the coming weeks.⁸ Until these products reach the mainstream, you can prevent unauthorized network access by:

• Choosing an access point that restricts media access control (MAC). The MAC address is the hardware address of a node in the network, such as a network adapter. By designating which MAC addresses have wireless access, unauthorized access is eliminated.
• Setting up the access point to stop broadcasting its Service Set Identifier (SSID). The SSID is part of the automated connection process that tells network adapters which 802.11b network it is joining. Only authorized users will know the SSID and security key, which are needed to establish a connection.

Internet communications that implement the secure socket layer (SSL) protocol will be encrypted, thus ensuring that the information is sent, unchanged, only to the intended server. Online shopping sites and banks use SSL technology to safeguard sensitive information.

Table

Current Wi-Fi standards

Related Resources

Wi-Fi Alliance: Wi-Fi Overview. Available at: http://www.weca.net/OpenSection/why_Wi-Fi.asp?TID=2. Accessed Nov. 18, 2003

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Wireless fidelity, or “Wi-Fi,” is gaining popularity in the medical profession and elsewhere. Some medical professionals are using Wi-Fi’s anytime, anywhere Internet connectivity to access electronic medical information during hospital rounds and to immediately enter demographic information when admitting patients.

What it is-and how it works

Wi-Fi is a certification given by the Wi-Fi Alliance, a nonprofit international trade organization that tests 802.11-based wireless Internet products. The “Wi-Fi Certified” logo signals to purchasers that the product has met rigorous interoperability testing requirements and is compatible with products from different vendors.

Today, the term “Wi-Fi” also commonly describes wireless Internet. Technically speaking, Wi-Fi is the use of radio technology to provide Ethernet connectivity in the unlicensed 2.4 and 5 GHz radio frequencies. By contrast, Internet access provided by wireless modems is based on technology used in cellular phones.

802.11 is the standard protocol ratified by the Institute of Electrical and Electronics Engineers. 802.11b is the most commonly used standard; 802.11a and 802.11g are other options (Table).

Why Wi-Fi?

Wireless Internet access via the 802.11 protocol offers:

• freedom to surf the Internet in your office, back yard, or elsewhere
• the ability to avoid using unsightly wires to connect computers in a local area network (LAN)
• significantly faster access than wireless modems and higher connection speeds than are available via telephone lines or electrical outlets.

Hitting the hot spots

Aside from office and home, Wi-Fi can be used at “hot spots”-public access points at cafes, restaurants, coffee shops, hotels, airports, downtown business districts, malls, and retail stores. Some retailers provide free access to attract business,¹ while others pay to partner with wireless Internet service providers such as T-Mobile ² and Boingo.³

It helps to check online for hot spots before heading out (visit the T- Mobile or Boingo sites or try the Wi-Fi FreeSpot Directory or other Web site guide). Because most network connections are automatic, however, you can turn on your notebook computer anytime and find out in seconds if a wireless Internet service is available. An indication usually appears on the screen if you are connected to a wireless LAN with Windows XP or Mac OS X, but older operating systems may require additional software. A Wi-Fi signal does not guarantee Internet access because many Wi-Fi providers require the user to log in.

An alternative is to look for ‘warchalking’-a series of sidewalk symbols that appear on your screen to indicate nearby wireless access⁴ (click here to view warchalking symbols). Warchalking has raised legal and moral issues, though to my knowledge this tracking method is seldom used.

Getting started

Several components are necessary for wireless Internet in the home or office. First, broadband Internet access via a cable modem, digital subscriber line (DSL), or satellite must be established. Connecting via a dial-up modem is another option, but its connection rate is too slow to be shared among several computers.

A wireless access point, which serves as the ‘base station,’ is then connected to the modem. Access points often are sold in combination with a built-in router, which delivers network information to the appropriate destination.

Each computer connecting to the access point must have a wireless network adapter. For desktop computers, this can either be a peripheral component interconnect (PCI) card or a Universal Serial Bus (USB) device. Many notebook computers come with a built-in wireless network adapter but can also use a PCI card or USB device.

Once these devices are installed, the wireless network must be set up so that each device can communicate. Most network setups are automatically established and require little user intervention; however, the user must decide which wireless channel to use and whether a security key is required.

Security risks

Wireless network use poses one major drawback: lack of security.

All wireless LANs have built-in wired equivalent privacy security, which uses a security key to limit access. In 2001, researchers at the University of California at Berkeley discovered flaws in the encryption algorithm designed to protect wireless LANs.⁵ Software has since been designed to exploit this flaw and identify the security key in the wireless traffic, rendering this level of security useless.⁶

In health care, this risk raises the issue of whether wireless networking is compliant with the Health Insurance Portability and Accountability Act (HIPAA). Medical Records Institute Executive Director C. Peter Waegeman n indicates that access via 802.11b is clearly not HIPAA-compliant⁷ and that other standards such as 802.11a or 802.11g should be used. Most healthcare systems, however, continue to use 802.11b because it is widely available and economical.

Making your network secure

Although the 802.11b standard is extremely insecure, several practical issues ameliorate the security risk. For one, finding the security key provides access to the wireless network but does not guarantee access to private information. Disabling shared access to network computers offers additional security but will eliminate the benefit of sharing information over a network.

Several hardware and software innovations aimed at increasing remote network security are scheduled to be launched in the coming weeks.⁸ Until these products reach the mainstream, you can prevent unauthorized network access by:

• Choosing an access point that restricts media access control (MAC). The MAC address is the hardware address of a node in the network, such as a network adapter. By designating which MAC addresses have wireless access, unauthorized access is eliminated.
• Setting up the access point to stop broadcasting its Service Set Identifier (SSID). The SSID is part of the automated connection process that tells network adapters which 802.11b network it is joining. Only authorized users will know the SSID and security key, which are needed to establish a connection.

Internet communications that implement the secure socket layer (SSL) protocol will be encrypted, thus ensuring that the information is sent, unchanged, only to the intended server. Online shopping sites and banks use SSL technology to safeguard sensitive information.

Table

Current Wi-Fi standards

Related Resources

Wi-Fi Alliance: Wi-Fi Overview. Available at: http://www.weca.net/OpenSection/why_Wi-Fi.asp?TID=2. Accessed Nov. 18, 2003

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Wireless fidelity, or “Wi-Fi,” is gaining popularity in the medical profession and elsewhere. Some medical professionals are using Wi-Fi’s anytime, anywhere Internet connectivity to access electronic medical information during hospital rounds and to immediately enter demographic information when admitting patients.

What it is-and how it works

Wi-Fi is a certification given by the Wi-Fi Alliance, a nonprofit international trade organization that tests 802.11-based wireless Internet products. The “Wi-Fi Certified” logo signals to purchasers that the product has met rigorous interoperability testing requirements and is compatible with products from different vendors.

Today, the term “Wi-Fi” also commonly describes wireless Internet. Technically speaking, Wi-Fi is the use of radio technology to provide Ethernet connectivity in the unlicensed 2.4 and 5 GHz radio frequencies. By contrast, Internet access provided by wireless modems is based on technology used in cellular phones.

802.11 is the standard protocol ratified by the Institute of Electrical and Electronics Engineers. 802.11b is the most commonly used standard; 802.11a and 802.11g are other options (Table).

Why Wi-Fi?

Wireless Internet access via the 802.11 protocol offers:

• freedom to surf the Internet in your office, back yard, or elsewhere
• the ability to avoid using unsightly wires to connect computers in a local area network (LAN)
• significantly faster access than wireless modems and higher connection speeds than are available via telephone lines or electrical outlets.

Hitting the hot spots

Aside from office and home, Wi-Fi can be used at “hot spots”-public access points at cafes, restaurants, coffee shops, hotels, airports, downtown business districts, malls, and retail stores. Some retailers provide free access to attract business,¹ while others pay to partner with wireless Internet service providers such as T-Mobile ² and Boingo.³

It helps to check online for hot spots before heading out (visit the T- Mobile or Boingo sites or try the Wi-Fi FreeSpot Directory or other Web site guide). Because most network connections are automatic, however, you can turn on your notebook computer anytime and find out in seconds if a wireless Internet service is available. An indication usually appears on the screen if you are connected to a wireless LAN with Windows XP or Mac OS X, but older operating systems may require additional software. A Wi-Fi signal does not guarantee Internet access because many Wi-Fi providers require the user to log in.

An alternative is to look for ‘warchalking’-a series of sidewalk symbols that appear on your screen to indicate nearby wireless access⁴ (click here to view warchalking symbols). Warchalking has raised legal and moral issues, though to my knowledge this tracking method is seldom used.

Getting started

Several components are necessary for wireless Internet in the home or office. First, broadband Internet access via a cable modem, digital subscriber line (DSL), or satellite must be established. Connecting via a dial-up modem is another option, but its connection rate is too slow to be shared among several computers.

A wireless access point, which serves as the ‘base station,’ is then connected to the modem. Access points often are sold in combination with a built-in router, which delivers network information to the appropriate destination.

Each computer connecting to the access point must have a wireless network adapter. For desktop computers, this can either be a peripheral component interconnect (PCI) card or a Universal Serial Bus (USB) device. Many notebook computers come with a built-in wireless network adapter but can also use a PCI card or USB device.

Once these devices are installed, the wireless network must be set up so that each device can communicate. Most network setups are automatically established and require little user intervention; however, the user must decide which wireless channel to use and whether a security key is required.

Security risks

Wireless network use poses one major drawback: lack of security.

All wireless LANs have built-in wired equivalent privacy security, which uses a security key to limit access. In 2001, researchers at the University of California at Berkeley discovered flaws in the encryption algorithm designed to protect wireless LANs.⁵ Software has since been designed to exploit this flaw and identify the security key in the wireless traffic, rendering this level of security useless.⁶

In health care, this risk raises the issue of whether wireless networking is compliant with the Health Insurance Portability and Accountability Act (HIPAA). Medical Records Institute Executive Director C. Peter Waegeman n indicates that access via 802.11b is clearly not HIPAA-compliant⁷ and that other standards such as 802.11a or 802.11g should be used. Most healthcare systems, however, continue to use 802.11b because it is widely available and economical.

Making your network secure

Although the 802.11b standard is extremely insecure, several practical issues ameliorate the security risk. For one, finding the security key provides access to the wireless network but does not guarantee access to private information. Disabling shared access to network computers offers additional security but will eliminate the benefit of sharing information over a network.

Several hardware and software innovations aimed at increasing remote network security are scheduled to be launched in the coming weeks.⁸ Until these products reach the mainstream, you can prevent unauthorized network access by:

• Choosing an access point that restricts media access control (MAC). The MAC address is the hardware address of a node in the network, such as a network adapter. By designating which MAC addresses have wireless access, unauthorized access is eliminated.
• Setting up the access point to stop broadcasting its Service Set Identifier (SSID). The SSID is part of the automated connection process that tells network adapters which 802.11b network it is joining. Only authorized users will know the SSID and security key, which are needed to establish a connection.

Internet communications that implement the secure socket layer (SSL) protocol will be encrypted, thus ensuring that the information is sent, unchanged, only to the intended server. Online shopping sites and banks use SSL technology to safeguard sensitive information.

Table

Current Wi-Fi standards

Related Resources

Wi-Fi Alliance: Wi-Fi Overview. Available at: http://www.weca.net/OpenSection/why_Wi-Fi.asp?TID=2. Accessed Nov. 18, 2003

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com.

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Hypersalivation caused by clozapine can lead to sleep deprivation, salivary gland swelling,¹ and aspiration pneumonia.² Its socially stigmatizing effects can also deter patients with psychotic illnesses from taking clozapine.

It is not clear at what dosage clozapine causes sialorrhea, but the higher the dosage the more severe the problem. Hypersalivation usually resolves with continued clozapine therapy. Until that happens, the following agents may help.

Drug management

• Benztropine, an acetylcholine antagonist used in Parkinson’s disease, can be started at 1 mg at night, when hypersalivation is most troublesome. If needed, increase to 2 mg qhs or 1 mg bid. Benztropine can cause dose-dependent anticholinergic effects ranging from peripheral (dry mouth, blurring of vision, tachycardia, urinary retention, constipation) to central (memory disturbance, restlessness, disorientation, delirium).
• Scopolamine, a transdermal used to prevent motion sickness, significantly reduced disabling hypersalivation in patients who wore a 1-mg patch behind the ear for 72 hours.³ The agent may irritate skin, so reserve it for severe cases.
• Terazocin, an alpha 1 receptor antagonist for hypertension, is effective at 2 mg qhs. Because the agent can cause hypotension, start at 1 mg/d for 1 week, then increase the dosage and monitor blood pressure at each visit.

Atropine, ipratropium bromide, and clonidine also have shown benefit in small studies.^4-6

Other strategies

Lowering the clozapine dosage while maintaining its antipsychotic effect may also help reduce salivation. You might also advise the patient to:

• suck or chew sugarless candy or gum to increase swallowing
• place a towel on the pillowcase to prevent soaking the pillow overnight.

Drug brand names

• Benztropine • Cogentin
• Clonidine • Catapres
• Clozapine • Clozaril
• Ipratropium • Atrovent
• Scopolamine • Transderm-Scop

Hypersalivation caused by clozapine can lead to sleep deprivation, salivary gland swelling,¹ and aspiration pneumonia.² Its socially stigmatizing effects can also deter patients with psychotic illnesses from taking clozapine.

It is not clear at what dosage clozapine causes sialorrhea, but the higher the dosage the more severe the problem. Hypersalivation usually resolves with continued clozapine therapy. Until that happens, the following agents may help.

Drug management

• Benztropine, an acetylcholine antagonist used in Parkinson’s disease, can be started at 1 mg at night, when hypersalivation is most troublesome. If needed, increase to 2 mg qhs or 1 mg bid. Benztropine can cause dose-dependent anticholinergic effects ranging from peripheral (dry mouth, blurring of vision, tachycardia, urinary retention, constipation) to central (memory disturbance, restlessness, disorientation, delirium).
• Scopolamine, a transdermal used to prevent motion sickness, significantly reduced disabling hypersalivation in patients who wore a 1-mg patch behind the ear for 72 hours.³ The agent may irritate skin, so reserve it for severe cases.
• Terazocin, an alpha 1 receptor antagonist for hypertension, is effective at 2 mg qhs. Because the agent can cause hypotension, start at 1 mg/d for 1 week, then increase the dosage and monitor blood pressure at each visit.

Atropine, ipratropium bromide, and clonidine also have shown benefit in small studies.^4-6

Other strategies

Lowering the clozapine dosage while maintaining its antipsychotic effect may also help reduce salivation. You might also advise the patient to:

• suck or chew sugarless candy or gum to increase swallowing
• place a towel on the pillowcase to prevent soaking the pillow overnight.

Drug brand names

• Benztropine • Cogentin
• Clonidine • Catapres
• Clozapine • Clozaril
• Ipratropium • Atrovent
• Scopolamine • Transderm-Scop

Hypersalivation caused by clozapine can lead to sleep deprivation, salivary gland swelling,¹ and aspiration pneumonia.² Its socially stigmatizing effects can also deter patients with psychotic illnesses from taking clozapine.

It is not clear at what dosage clozapine causes sialorrhea, but the higher the dosage the more severe the problem. Hypersalivation usually resolves with continued clozapine therapy. Until that happens, the following agents may help.

Drug management

• Benztropine, an acetylcholine antagonist used in Parkinson’s disease, can be started at 1 mg at night, when hypersalivation is most troublesome. If needed, increase to 2 mg qhs or 1 mg bid. Benztropine can cause dose-dependent anticholinergic effects ranging from peripheral (dry mouth, blurring of vision, tachycardia, urinary retention, constipation) to central (memory disturbance, restlessness, disorientation, delirium).
• Scopolamine, a transdermal used to prevent motion sickness, significantly reduced disabling hypersalivation in patients who wore a 1-mg patch behind the ear for 72 hours.³ The agent may irritate skin, so reserve it for severe cases.
• Terazocin, an alpha 1 receptor antagonist for hypertension, is effective at 2 mg qhs. Because the agent can cause hypotension, start at 1 mg/d for 1 week, then increase the dosage and monitor blood pressure at each visit.

Atropine, ipratropium bromide, and clonidine also have shown benefit in small studies.^4-6

Other strategies

Lowering the clozapine dosage while maintaining its antipsychotic effect may also help reduce salivation. You might also advise the patient to:

• suck or chew sugarless candy or gum to increase swallowing
• place a towel on the pillowcase to prevent soaking the pillow overnight.

Drug brand names

• Benztropine • Cogentin
• Clonidine • Catapres
• Clozapine • Clozaril
• Ipratropium • Atrovent
• Scopolamine • Transderm-Scop

Like many doctors, you often feel the need to be two places at once.

The trick is to avoid scheduling two commitments at the same time. Anyone who has had to manage a busy practice schedule and remember his or her child’s soccer practice knows this can be challenging.

If you’re looking to organize your schedule, the Internet or your personal digital assistant (PDA) may hold the answer. This article will review scheduling solutions and help you decide which is right for your practice.

PDA scheduling-pros and cons

Both Palm and Pocket PC devices offer very good scheduling capabilities; your choice of operating system depends upon whether you need to use Microsoft Outlook. In my view, Palm is simpler and more reliable, whereas I have had more trouble connecting a Pocket PC device to my desktop computer.

Keeping a calendar in a handheld computer can be quite handy. Simply pull out the PDA, click once or twice, and view your daily schedule. Used properly, this can help prevent scheduling conflicts.

This feature, however, may be less helpful if your office staff maintains your schedule. For one, no one else can access the PDA while you’re carrying it. Second, if you do not regularly synchronize your PDA to the office computer, the staffer can make in-office schedule changes that are not recorded on the PDA version, possibly leading to double booking.

To prevent such mixups, assign one office assistant to update your schedule, and allow only that staffer to make changes. Also, be sure to double check the schedule before booking an appointment on your own.

Many major personal information managers such as Microsoft Outlook and Lotus Notes can be synchronized to a handheld. This allows your staff to view and simultaneously edit your schedule in the office, which is then synchronized onto the handheld. What’s more, users who cannot access your computer but have the proper privileges to your information can still connect to your schedule.

If a significant other uses a Palm OS device and you need to coordinate your schedule with his or hers, WeSync provides a solution that synchronizes both schedules via an online server and displays them side by side on your Palm OS PDA. Although WeSync no longer provides tech support for it, the software and service (which PalmOne owns) is still available.

Schedule synchronization between Pocket PC users is tricky: It cannot be done via an Internet server because each device has a one-to-one relationship with Microsoft Outlook, the desktop schedule software.

ManyPartners overcomes this limitation by allowing users to connect two Pocket PC devices to the same desktop scheduling software. Both users then must share information on one profile in Microsoft Outlook and must enter information in a way that avoids confusion, such as “John: doctor’s appointment” and “Mary: lecture on Monday.”)

Making your days colorful

Third-party software can make your calendar easier to use by employing color and icons to designate types of appointments (Table). This software also provides quick access to other information, such as task lists and notes.

For Palm OS devices, products such as Agendus, DateBk5, and Beyond Contacts provide a different and enhanced way to view your data. Similar software for the Pocket PC or Windows Mobile 2003 devices include Ulti-Planner, Pocket Informant, and Agenda Fusion and Agenda Today from DeveloperOne.

Some programs use the PDA’s built-in database while others have a proprietary database. This difference is important because it affects your ability to “beam” information from one device to another. For example, a proprietary database can facilitate data exchange, but only if the user to whom you are sending the data also uses a device with a proprietary database.

Online scheduling

Internet-based scheduling programs can also prevent double-booking. The user enters prospective meeting dates into the online form; the software then checks the dates against the calendar for conflicts and selects the best date. These schedules can also be synchronized to a PDA.

One drawback: changes to the online and PDA schedules must be entered separately, creating the potential for double booking. To avoid this:

• assign one staff member to make schedule changes
• or use a wireless PDA or one with a built-in cellular phone to allow instant schedule updates and prevent miscommunication.

Appointmentquest.com and scheduling.com-two services geared toward health care providers-provide online schedules, can handle multiple service locations and personnel, and will generate reminders for patients. Scheduling.com also can track multiple types of insurance and can provide billing systems with patient registration information to generate statements.

Schedule enhancement software options

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com .

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Like many doctors, you often feel the need to be two places at once.

The trick is to avoid scheduling two commitments at the same time. Anyone who has had to manage a busy practice schedule and remember his or her child’s soccer practice knows this can be challenging.

If you’re looking to organize your schedule, the Internet or your personal digital assistant (PDA) may hold the answer. This article will review scheduling solutions and help you decide which is right for your practice.

PDA scheduling-pros and cons

Both Palm and Pocket PC devices offer very good scheduling capabilities; your choice of operating system depends upon whether you need to use Microsoft Outlook. In my view, Palm is simpler and more reliable, whereas I have had more trouble connecting a Pocket PC device to my desktop computer.

Keeping a calendar in a handheld computer can be quite handy. Simply pull out the PDA, click once or twice, and view your daily schedule. Used properly, this can help prevent scheduling conflicts.

This feature, however, may be less helpful if your office staff maintains your schedule. For one, no one else can access the PDA while you’re carrying it. Second, if you do not regularly synchronize your PDA to the office computer, the staffer can make in-office schedule changes that are not recorded on the PDA version, possibly leading to double booking.

To prevent such mixups, assign one office assistant to update your schedule, and allow only that staffer to make changes. Also, be sure to double check the schedule before booking an appointment on your own.

Many major personal information managers such as Microsoft Outlook and Lotus Notes can be synchronized to a handheld. This allows your staff to view and simultaneously edit your schedule in the office, which is then synchronized onto the handheld. What’s more, users who cannot access your computer but have the proper privileges to your information can still connect to your schedule.

If a significant other uses a Palm OS device and you need to coordinate your schedule with his or hers, WeSync provides a solution that synchronizes both schedules via an online server and displays them side by side on your Palm OS PDA. Although WeSync no longer provides tech support for it, the software and service (which PalmOne owns) is still available.

Schedule synchronization between Pocket PC users is tricky: It cannot be done via an Internet server because each device has a one-to-one relationship with Microsoft Outlook, the desktop schedule software.

ManyPartners overcomes this limitation by allowing users to connect two Pocket PC devices to the same desktop scheduling software. Both users then must share information on one profile in Microsoft Outlook and must enter information in a way that avoids confusion, such as “John: doctor’s appointment” and “Mary: lecture on Monday.”)

Making your days colorful

Third-party software can make your calendar easier to use by employing color and icons to designate types of appointments (Table). This software also provides quick access to other information, such as task lists and notes.

For Palm OS devices, products such as Agendus, DateBk5, and Beyond Contacts provide a different and enhanced way to view your data. Similar software for the Pocket PC or Windows Mobile 2003 devices include Ulti-Planner, Pocket Informant, and Agenda Fusion and Agenda Today from DeveloperOne.

Some programs use the PDA’s built-in database while others have a proprietary database. This difference is important because it affects your ability to “beam” information from one device to another. For example, a proprietary database can facilitate data exchange, but only if the user to whom you are sending the data also uses a device with a proprietary database.

Online scheduling

Internet-based scheduling programs can also prevent double-booking. The user enters prospective meeting dates into the online form; the software then checks the dates against the calendar for conflicts and selects the best date. These schedules can also be synchronized to a PDA.

One drawback: changes to the online and PDA schedules must be entered separately, creating the potential for double booking. To avoid this:

• assign one staff member to make schedule changes
• or use a wireless PDA or one with a built-in cellular phone to allow instant schedule updates and prevent miscommunication.

Appointmentquest.com and scheduling.com-two services geared toward health care providers-provide online schedules, can handle multiple service locations and personnel, and will generate reminders for patients. Scheduling.com also can track multiple types of insurance and can provide billing systems with patient registration information to generate statements.

Schedule enhancement software options

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com .

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

Like many doctors, you often feel the need to be two places at once.

The trick is to avoid scheduling two commitments at the same time. Anyone who has had to manage a busy practice schedule and remember his or her child’s soccer practice knows this can be challenging.

If you’re looking to organize your schedule, the Internet or your personal digital assistant (PDA) may hold the answer. This article will review scheduling solutions and help you decide which is right for your practice.

PDA scheduling-pros and cons

Both Palm and Pocket PC devices offer very good scheduling capabilities; your choice of operating system depends upon whether you need to use Microsoft Outlook. In my view, Palm is simpler and more reliable, whereas I have had more trouble connecting a Pocket PC device to my desktop computer.

Keeping a calendar in a handheld computer can be quite handy. Simply pull out the PDA, click once or twice, and view your daily schedule. Used properly, this can help prevent scheduling conflicts.

This feature, however, may be less helpful if your office staff maintains your schedule. For one, no one else can access the PDA while you’re carrying it. Second, if you do not regularly synchronize your PDA to the office computer, the staffer can make in-office schedule changes that are not recorded on the PDA version, possibly leading to double booking.

To prevent such mixups, assign one office assistant to update your schedule, and allow only that staffer to make changes. Also, be sure to double check the schedule before booking an appointment on your own.

Many major personal information managers such as Microsoft Outlook and Lotus Notes can be synchronized to a handheld. This allows your staff to view and simultaneously edit your schedule in the office, which is then synchronized onto the handheld. What’s more, users who cannot access your computer but have the proper privileges to your information can still connect to your schedule.

If a significant other uses a Palm OS device and you need to coordinate your schedule with his or hers, WeSync provides a solution that synchronizes both schedules via an online server and displays them side by side on your Palm OS PDA. Although WeSync no longer provides tech support for it, the software and service (which PalmOne owns) is still available.

Schedule synchronization between Pocket PC users is tricky: It cannot be done via an Internet server because each device has a one-to-one relationship with Microsoft Outlook, the desktop schedule software.

ManyPartners overcomes this limitation by allowing users to connect two Pocket PC devices to the same desktop scheduling software. Both users then must share information on one profile in Microsoft Outlook and must enter information in a way that avoids confusion, such as “John: doctor’s appointment” and “Mary: lecture on Monday.”)

Making your days colorful

Third-party software can make your calendar easier to use by employing color and icons to designate types of appointments (Table). This software also provides quick access to other information, such as task lists and notes.

For Palm OS devices, products such as Agendus, DateBk5, and Beyond Contacts provide a different and enhanced way to view your data. Similar software for the Pocket PC or Windows Mobile 2003 devices include Ulti-Planner, Pocket Informant, and Agenda Fusion and Agenda Today from DeveloperOne.

Some programs use the PDA’s built-in database while others have a proprietary database. This difference is important because it affects your ability to “beam” information from one device to another. For example, a proprietary database can facilitate data exchange, but only if the user to whom you are sending the data also uses a device with a proprietary database.

Online scheduling

Internet-based scheduling programs can also prevent double-booking. The user enters prospective meeting dates into the online form; the software then checks the dates against the calendar for conflicts and selects the best date. These schedules can also be synchronized to a PDA.

One drawback: changes to the online and PDA schedules must be entered separately, creating the potential for double booking. To avoid this:

• assign one staff member to make schedule changes
• or use a wireless PDA or one with a built-in cellular phone to allow instant schedule updates and prevent miscommunication.

Appointmentquest.com and scheduling.com-two services geared toward health care providers-provide online schedules, can handle multiple service locations and personnel, and will generate reminders for patients. Scheduling.com also can track multiple types of insurance and can provide billing systems with patient registration information to generate statements.

Schedule enhancement software options

If you have any questions about these products or comments about Psyber Psychiatry, click here to contact Dr. Luo or send an e-mail to Current.Psychiatry@dowdenhealth.com .

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.