The majority of electronic patient-reported outcome data (ePRO) in the pharmaceutical industry, we would venture, are collected on devices and software running on Palm. That’s a reflection of the industry’s assessment of Palm’s superior design. They are superbly easy devices to use. With the tap of a stylus or finger, Palm makes any patient’s record-keeping as pleasant as possible.

So when we began to chat with Eddie Davis, a developer at etrials, we were a bit skeptical. He was standing in front of a table loaded with Windows devices.

Full disclosure: Your correspondent keeps a Palm Treo no more than two feet away from his body at all times. But Davis immediately put us at ease, fishing his own Palm out of a pocket. He understands the Palm fanatic thing. We know: just like Mr. Spock, we use a special tricorder to detect such individuals. It was flashing orange (the affirmative signal) during our entire interview.

Palm, Reconsidered

As Davis ruefully explained, it’s not clear to him that Palm’s popularity is deserved. Or in the interest of any sponsor of clinical trials planning to use Palms over the next few years. Palm has no built-in WiFi, he notes. Palm supports the older version of Bluetooth. It runs an antiquated web browser. “It’s frustrating for me as a user,” says Davis.

Then he reminded us that the destinies of Palm’s hardware and software divisions have become a botched fugue, with different melodies and harmonies diverging and converging in unexpected and unpredicted ways.

A little history—just a little—may be helpful. For its early years, Palm hardware and software were controlled by the same people. That has not been the case since 2005, when Access of Japan bought the Palm operating system. That allowed Palm’s hardware division to do a deal with Microsoft. Windows does run on a few Palm devices, which have been scorned by longtime Palm users.


Since December 2006, the Japanese owners of the software side of Palm have been in receipt of $44 million from the U.S. part of Palm. That allowed the U.S. part of Palm to license back part of the Palm operating system that had previously been auctioned to the Japanese. Why in heaven would such a flip-flop be necessary?

Because work on the next Palm operating system did not blossom. (We could give you the names of the doomed operating systems, but why bother? They’ll change.) An effort to use the Linux operating system (yes, you read that right) on Palm handhelds is ongoing, but far from complete. It’s about now, that the birth of Windows Vista looks punctual. But we’re getting ahead of ourselves.

Reading Palms

The bottom line: the stability and freshness of the Palm platform is open to question. It happens to the best technology firms.

Palm has made great devices in the past and may figure out a way to seamlessly remarry its hardware and software. But its present disarray is a worrisome thing for those planning clinical trials in 2008 or 2009. Indeed, as we have been reading up on Palm’s recent history, it’s not clear whether or when the current Palm operating system will be updated, and what that means for anything in Palm’s product line that is not a phone. People who check out Palm’s press releases will be more confused about the future, not less.

Back at etrials, Davis is a software guy. He’s an engineer’s engineer. And as much as a Palm keeps him organized personally, there are things that the Palm platform cannot do in the ePRO realm.

For starters, there is really just one Palm form factor, the usual PDA screen. Windows devices come in many more sizes, with both tablets and screens sized halfway between a PDA and a small laptop. That makes it easy for etrials to match rivals that offer larger-screen devices to be used in the clinic by nurses and doctors (not patients). A profusion of hardware suppliers on the Windows side of the question also keeps hardware costs down.


Then there’s the matter of more than one application running at once. Palm can’t do it. Windows can. etrials uses that to launch a communications program and other ePRO tools at the same time. “We don’t have to shut down one or the other,” says Davis.

Says Davis: “The Palm operating system, it frustrates me. Palm is pretty much a stagnant platform. I want the expandability. On Windows, we can plug in anything we want. We can plug in a module, a wireless modem. Global positioning.”

Truth be told, we recall PHT and invivodata, dedicated exclusively to ePRO, can also harness Palms to peripheral diagnostic equipment such as glucose meters and spirometers, and have been doing it for some time. So the absence of WiFi is not a dealbreaker if your peripheral can be connected with a cable or Bluetooth.

Fallback Options

Still, Davis suggests it’s an open secret that Palm is faltering, and that some companies supporting clinical trials are quietly developing Windows-based alternatives.

“Palm doesn’t have the horsepower to do the studies we’re doing,” says Davis. etrials says it recently shipped the largest order for handheld diaries in any industry, ordering 4,700 Windows devices for an unnamed customer running a large global clinical trial.

Davis allows that it is possible Palm has lately rolled up its sleeves on a new attempt to update its operating system. But even that delays the development of applications for some additional period of time.

He’s also dubious about Palm’s ability to match the labors of the open source community and Microsoft. “The amount of work to catch up with Windows or Linux will be tremendous,” Davis says.

A Tortoise In Redmond

Microsoft, Davis concedes, may have started out behind. Dell recently stopped selling handhelds. The road has been bumpy. Just keeping track of what Microsoft calls its mobile offerings requires a cheat sheet.

But Davis says Microsoft has doggedly closed the gap with Palm: “Microsoft has continued to evolve the Pocket PC and Windows Mobile. They continue to branch out in new areas, and we find out ways to use the new branches.” One example: Microsoft’s Origami, a low-power version of its mobile operating system.

Beyond that, Davis complains that for all its visual elegance, the Palm platform lacks the scalable fonts that could help elderly and pediatric patients see their patient diaries more readily. Microsoft also makes liberal use of XML on its handheld platform. That XML makes it easier for etrials to integrate ePRO data from its handheld devices with its other e-clinical systems.

Palm v. Bill ... Guess Who Wins

Microsoft seems to be providing more for etrials to work with. Says Davis: “With Microsoft, they are updating the operating system and the development tools. Visual Studio with .Net is an immensely powerful tool for creating mobile applications. The tool that Palm is using is decent but not nearly as powerful. The number of software development kits, the support you get from Microsoft, the development mailings, everything is more rich and robust from Microsoft. The Palm OS is a legacy operating system. I don’t see it moving forward.”

For etrials, it appears, Microsoft has supported clinical trials just by slowly and steadily improving its mobile platform. “Microsoft has the money, time and patience to keep pushing and pushing it until the company gets the market share they’re happy with,” notes Davis. “Palm has innovated almost nothing.”