Medical students at The Ohio State University in Columbus are no longer tethered to their desks, thanks to an US$8,000 project that lets them carry a key application with them on hospital floors.
Using plug-in memory cards, a group of medical students have instant access to a set of 11 text-and-image teaching modules. The students can carry the modules on Palm Tungstens and m505 or m515 PDAs. The modules consist of Power Point slides and medical images that formerly were accessible only via PCs reading CD-ROMs or accessing a Web server.
The documents were redesigned specifically for the Palm displays, says Robert McKenney, adjunct instructor for Biomedical Informatics and director of information systems for student educational services. To create responsive user interaction, minimize network download times and free up the Palm's built-in memory, the documents are stored in postage-stamp-sized Secure Digital cards that can store up to 64M bytes of data.
Until this change, the PDAs distributed to 1,600 medical students, residents, physicians and other medical staff have been mainly reference tools: Using a host PC or an infrared port, users could download a limited subset of data via infrared ports at the OSU Medical Center's main sites. The data included a physician desk reference for medications and recent patient census data.
Now instructional material can be adapted from PC and Web formats, stored in Secure Digital cards and used by students anywhere. An additional software program lets students fill in some forms that are designed to evaluate the instructional graphical user interface and the interactions. IT staff and professors upload and review these forms.
The initial PDA project, launched in 2001, also included a middleware component, based on AvantGo software, to let users synchronize their handhelds with a number of selected databases. The project won widespread praise: It earned the American Hospital Association's Innovator Award, and the 2001 Elizabeth Davies Award for accomplishments in providing electronic medical records.
In 2002, to make the PDA more valuable, McKenney's staff decided that distributing new content to the handhelds could pay off. They focused initially on third-year medical students, who have to work their way through a heavy load of studying modules, in such areas as drug abuse and obstetrics, while serving "clerkships" at participating hospitals around the state.
Until now, the only way they could access these instructional modules was via a PC, which meant that the clerking students were cut off from a vital source of information for much of the day.
There were some formidable challenges to adapting the documents and their images for the a tiny screen of a mobile device.
McKenney's team created and refined a standard graphical template that showed how the documents' text and graphics would be arranged and displayed. The display format was another standard: PDF files, made possible by installing Adobe Acrobat 2.0 on the PDA. Another variable in deciding to use the Secure Digital cards and in some cases upgrading to Palm's newest model: the Tungsten, with more memory, better screen display and a more powerful processor than the earlier models. McKenney says one Secure Digital card can hold almost as much as a CD-ROM.
"The images were tough," McKenney says. "At first, we thought if we condensed the image, we'd compromise its performance on the device. But in fact, on the Tungsten, we found the image was enriched and quickly manipulated. Acrobat 2.0 lets you magnify the image and zoom in and out."
The images can't be used for detailed diagnostic work on patients, but for students and professors, the images are detailed enough for instructional use. McKenney discovered that working with the most detailed, high-quality image possible is critical for a high-quality display on the Tungsten.
He also discovered the simplest and fastest way to distribute the documents was via the Secure Digital card, a format available now to about 150 medical students. But other PDA users can synchronize their PDAs through their PCs, using the AvantGo middleware, to download the same documents from a Web server. Users click to select the modules they want from a simple, clear list displayed on PDA.
The new handheld format and distribution project has proven to be so successful that other OSU departments, such as engineering and agriculture, are evaluating its use for their students.
The OSU Medical Center is not yet using the PDAs on either wireless LANs or wide-area cellular data networks.
"We're testing some of that," McKenney says. Wireless will bring a number of complex challenges: more drain on the PDA's battery, a new physical infrastructure and security issues, he says.