May 2002
Volume 66 |
Number 5
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| Use of Handheld
Computers for Resident Education in Anesthesiology |
J. Kent Garman, M.D.
Committee on Electronic Media and Information Technology
A small number of anesthesiology resident training programs
are using handheld computers to deliver both administrative and
clinical resource information to residents and faculty. Stanford
University School of Medicine also has handheld computer support
for its medical students in delivering class schedules and reference
material. Handheld computers work well for this purpose since
large amounts of customized information can be carried in a pocket-size,
easy-to-use computer in the classroom, operating room, clinics
or wards. Also, departmental-specific information such as telephone
lists can be delivered using secure transmission methods if desired.
For a discussion of the factors influencing your choice of which
handheld computer to buy, see my NEWSLETTER article "Handheld
Computers Revisited" in the February 2002 issue at < www.asahq.org/NEWSLETTERS/2002/2_02/whatsnew0202.htm
> .
Since there are two distinctively different and popular handheld
operating systems, Palm OS™ and Windows® CE ("Pocket
PC"), it is desirable to deliver content to both platforms.
At the present time, there is only one method that will automatically
deliver Web-based content to both Palm and Pocket PC handhelds;
AvantGo® is an amazing service (free to users) that places
content of your choice, including news, entertainment and Web
sites, on your handheld computer. All content is updated when
you synchronize your handheld with your desktop (assuming you
have an Internet connection during the synchronization). As an
example, I have the daily New York Times and Wall Street Journal
on my handheld via AvantGo. If I synchronize once daily, they
are always up to date.
Until March 2002, AvantGo was a free service to both users and
providers. It is still free to end-users (that means only yourself),
but now carries a charge for commercial providers who deliver
content to more than eight users. Yearly fees are: 0-8 users,
free; 9-99 users, $1,000; 100-499 users, $2,000; 500-1,000 users,
$8,000.
The good news is that AvantGo has softened its policy regarding
payment, so it will allow most noncommercial educational sites
with less than 1,000 users to continue to use the service for
free. This is its current policy from its Web site:
"Access to Custom Channels (i.e., domains) will NOT be blocked
based solely on the number of subscribers; we will focus more
closely on the nature of the use. In addition, we have created
exceptions for certain types of domains. These domains are public-facing
government Web sites and certain sites that host individual Web
sites. If you previously were using one of these channels and
found you were unable to access it, please try syncing again.
"AvantGo will now monitor Custom Channels for use inconsistent
with its policy (i.e., use of the Custom Channel function to distribute
content, goods and/or services by actively soliciting AMI subscribers).
AvantGo will also now look at how demand for a Custom Channel
is generated. If it is organic user demand, as opposed to a third-party
soliciting subscribers to use the service, AvantGo will weigh
this factor favorably before deciding to limit access to a channel."
There are two other methods of providing the same service as
AvantGo to Palm handhelds but not to Windows CE (Pocket PC) handhelds.
They are Pendragon™ Browser < www.pendragonsoftware.com/browser/index.html
> and iSilo™ . They both work well and are
either free or low cost. The two serious problems with them are
that they do not support the increasingly popular Pocket PC handhelds,
and they are not as widely understood, easy to use or easily available
as AvantGo.
Since I have whetted your appetite, take a look at some of the
sites. All the sites mentioned below have instructions on how
to subscribe on their homepage. There are protected areas that
you will be unable to see, but you can get a good idea of what
these sites can do by putting them on your handheld.
For those who do not already have a free AvantGo account, you
will have to sign up for one the first time you add a channel
(site) to your handheld. After that, use the same username and
password to enter your account on AvantGo.
I will apologize in advance if I have omitted some departmental
sites, but these are the ones that I know about. (The Web site's
creator appears in parentheses.)
Departmental Educational Handheld Web Sites
• Stanford University Department of Anesthesia Handheld Computer
Support (J. Kent Garman, M.D.) < anesthesia.stanford.edu/kentgarman/handheld.htm
>
• University of North Carolina Anesthesia Handheld Site (Ravindra
V. Prasad, M.D.) < www.unc.edu/~rvp/
RP_Anesthesia >
• Maine Medical Center Anesthesia Resources for the Palm
Pilot (Thomas R. Verlee, M.D.)
• Virginia Mason Department of Anesthesiology Handheld Site
(Hugh Allen, M.D.) < home.attbi.com/
~hughallen/ >
• University of Virginia Department of Anesthesiology Handheld
Anesthesia Reference (Paul Ting, M.D.) < www.faculty.virginia.edu/pting/palmsite
>
Other Educational Handheld Web Sites
You can also add the sites below to your handheld. For example,
you can get regularly updated abstracts from Anesthesiology and
New England Journal of Medicine. We have made the entire contents
of the ASA NEWSLETTER, updated monthly, available on handhelds.
All these sites use AvantGo as a conduit. Now take a look at the
large number of sites available for Palms on the "MedPilot
WebRing."
• The journal Anesthesiology monthly abstracts
• The ASA NEWSLETTER (Full text and illustrations monthly)
< www.ASAhq.org/NEWSLETTER
>
• The Answer Page (Anesthesiology)
• AnesthesiaLinx • New England
Journal of Medicine weekly abstracts < content.nejm.org/current.shtml
>
• The MedPilot Webring (a large listing of Palm-compatible
Web sites) < w.webring.com/hub?ring=medpilot
>
How can a department build one of these Web sites? I suggest
having your departmental Webmaster look at the source code from
the departmental sites above. We have all learned and "stolen"
ideas from each other. The Webmaster also should read the current
AvantGo developer documentation (available on the AvantGo Web
site). It is easier than you might think (for anyone who wears
a pocket protector and who knows what a slide rule is). The biggest
problem is the time involved with keeping the site current and
fresh.
There is one other method of distributing information to handheld
computers that must be mentioned: beaming stations. These are
small, infrared transmitting units that attach to any PC. They
are designed to continually search for the infrared emissions
of a handheld computer seeking to receive a "beamed"
file. All one has to do is point the handheld computer at one
of these "beaming stations," and it will immediately
send the handheld the file it contains. Transmission usually takes
less than 15 seconds. This file can be a single file or a series
of files depending on the actual unit's capabilities. These units
are just entering the market, and anyone wishing to purchase one
is urged to do some research before buying. Try the following
sites for information: (which features the
EthIR LAN multiport) and (which features a new,
cutting-edge mobile caching server). As these products mature,
I can conceive of an anesthesiology department owning one of them
and updating everyone's handheld as they walk by the library.
The EthIR LAN works with all Palm and Pocket PC handhelds.
The ASA Committee on Electronic Media and Information Technology
used a EthIR LAN beaming station at the 2001 Annual Meeting and
had a large number of files sent to handheld computers, including
meeting schedules and practice parameters. This first use was
an experiment, but it passed the test of usability. At the 2002
Annual Meeting, beaming stations will again be used to send complete
meeting schedules and information to anyone with a handheld computer.
So bring your handheld to the meeting!
As you can see, handheld computers can be used to enhance the
educational experience using simple and free tools. Give these
sites and techniques a try.
I wish to give thanks to Ravindra V. Prasad, M.D., University
of North Carolina; Thomas R. Verlee, M.D., Maine Medical Center;
and Hugh W. Allen, M.D., Virginia Mason, Seattle, Washington,
for information that assisted in the writing of this article.
Editor's Note: The mention of certain brand-name products is not
intended to be construed as an endorsement by ASA and is essentially
the personal preference of the author.
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J.
Kent Garman, M.D., is Associate Professor of Anesthesia, Stanford
University School of Medicine, Stanford, California. |
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