INTRODUCTION
At Campus Bio-Medico University of Rome we introduced at the beginning of 2003 wireless networks and portable devices starting a number of projects for assessing the use of this technology. One of them is the HISS project, which was funded by HP Applied Mobile Technology Solutions in Learning Environments - 2003 Grant Initiative. It was the only Italian project in a list of forty worldwide ones. It was presented in HP Labs at Palo Alto, California in September 2003 by the two main investigators: prof. Giulio Iannello and prof. Michele Crudele (see Project Proposal). We installed wireless devices so that from every room of all the wards a connection could be set to a separate LAN, different from the Hospital Information System one, for security reasons. Each student participating in the project, during training sessions was equipped with a wireless LAN enabled HP iPAQ 5500capable of fingerprint authentication. Some of them, especially the teachers (nurses and physicians) used a HP Tablet PC.

	Learning on the job Learning on the job has always been considered a basic methodology for medical related professions. An important part of the teaching is accomplished in the wards, while visiting patients.   The typical way of memorizing what is said or done by the teachers, nurses or physicians is to take a written note on an exercise book. This leads to unstructured data and makes it difficult to rapidly access specific information. Postproduction is usually needed to reorganize the notes in a practical way for easy recovery of any part of it.
Top PROJECT
	Learning and working We used the students’ feedback to develop new approaches for a real operational Hospital Information System for handheld computers Too difficult to achieve We were interested in examining whether the students using handheld computers were achieving better results in their examinations. We soon realized that this last goal was too complex to accomplish because too many factors are involved in the learning phase.
Phases 1. Sep-Dec 2003: development of a simulated Hospital Information System restricted to clinical information, leaving aside all the administrative modules and some specialized areas (radiology, laboratory etc.) 2. Jan-Mar 2004: first users’ trial; analyses of the first results and of students’ feedback 3. Apr-May 2004: development of a new version of HISS 4. Jun-Jul 2004: second testing phase and gathering of proposals for the implementation of a Mobile Hospital Information System
	We held periodical meetings with teachers, tutors, physicians, nurses and dieticians in charge of their departments.  We also followed the daily hospital activity of the three main groups of actors: physicians, nurses and dieticians. We concentrated on the tasks that may require a mobile device: we selected all the information that they usually write at the bedside, therefore excluding other longer data, for example the patient’s entrance and exit letter which can be better written on a desktop computer.
EXAMPLE: XML data entry visualized on the palm computer   After designing the actors and the use cases, the main problem was content adaptation depending on mobile devices features and the frequent changes in the interface definition. We were aware that the development process in writing the software had to be adaptive, because the students would discover new solutions and redefine the structure many times. he web-based application, accessible through a wireless LAN, included both generic and specific data entry masks. By using XML we built thirty different masks simply combining a few tags: <Section>, <Title>, <Voice>, <VoiceName>, <Value> for the different structural parts; <SmallText>, <MediumText> and <BroadText> for data input; <Drop> corresponding to the object DropDownList in ASP.NET and <Check> corresponding to CheckBoxList in ASP.NET Technicalities and Freedom Since we were not bound to real production and we had no strict deadlines, we were free to try different solutions: - on-line and off-line - XML and relational database - access through WLAN, GPRS, UMTS - interface adaptation for pocket and desktop PC’s Top ARCHITECTURE Actually we based our system on ASP.NET, C#, XML and SQL Server Top
CONTENTS MANAGEMENT After authentication, students can choose the floor and the bed of the patient. They collect different data according to their role
Medicine students' bedside activities - anamnesis (family, personal, physiological, pathological) - general health conditions examination - request for radiological, chemical, endoscope examinations and surgical intervention - drugs prescription and administration
	Nursing students collecting records - entrance evaluation - medical diagnosis - collaboration problems -  nursing diagnosis - calculation of entrance and exit fluids
Dietetics students collecting records - anamnesis - patient appreciation of hospital food - daily change of diet for each patient - monitoring of some gastrointestinal - pathologies (Crohn’s disease and chronic ulcerative colitis)
Bioengineering students technical work - follow courses held in the Information Technology Department of Campus Bio-Medico on software and hardware installation - set up the hardware devices in the wards - set up the software prepared by ELIS, main partner in the HISS project - teach medicine, nursing, dietetics students on the use of HP iPaq and applications - monitor usage and collect comments, bug notices, proposals and other information from the users
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Interface User oriented Besides contents adaptation, we carefully studied the way to present them to the users. The design involved ergonomic and technical factors. The interface, very simple at the beginning, was enriched thanks to users’ feedback. The main innovations concerned: - Drop down or check lists - Multiple sections masks - Avoiding long pages - Frequently used options: easily accessible - Additional text boxes: three sizes Top
ACCESS WLAN, GPRS, UMTS, Mobile IPv6 - management of mobility at the network layer, allowing network applications to be unaware of changes in the network - easiness of use and configuration and seamless roaming: the user does not need to change anything moving from local to geographic wireless networks   Numbers  110 students  FOR 30 different tasks  RECORDS: concerning 1500 patients   495 medical records; 243 nursing records; 193 dietetic record (plus 919 by tutors) Feedback Dietetics students positive comments - speed in finding the answers - time spared in the transcription of data from paper to PC - usability: the palm computer does not need a stand and it is not "uncomfortable" Nursing students accuracy - the students using handheld devices for data entry in structured masks were more accurate than those writing on a blank piece of paper - They noticed more things (having different questions to answer) and were more precise Medicine students rejection - First extensive phase Rejection by many students because of rejection by their tutors in data entry  - Second intensive phase Limited to those departments that showed a positive attitude: cardiology and general surgery Top   ISSUES Open issues and future - Enhancing the hospital level of technology by improving the accessibility to the information system at different levels (students, nurses, physicians) through mobile technologies - Improve teaching and learning in the wards through a faster access to clinical data - Designing new interfaces for small devices to collect and examine data at the bedside - A deeper comprehension of security issues - Analysis of geographical mobility needs and performance evaluation Success history - The Dietetics department adopted the interface produced by the students - Some physicians started using the palm devices in their daily work - The Nursing department started a project for the adoption of a nursing record using mobile devices Publications Michele Crudele, Giuio Iannello, HISS - Hospital Information System for Students, Workshop on Ubiquitous and mobile computing for educational communities: enriching and enlarging community spaces - Amsterdam, 19/9/2003 Paper Filippo Cacace, Maria Cinque, Michele Crudele, Giulio Iannello, Marco Venditti, The impact of innovation in medical and nursing training: a Hospital Information System for Students accessible through mobile devices, Bracciano, Proceedings of MLEARN 2004, Bracciano - Italy, 5-6 July, 2004 Paper Presentation Massimo Bernaschi, Filippo Cacace, Maria Cinque, Michele Crudele, Giulio Iannello, Marco Venditti, Interface design and mobility in ubiquitous access to HIS, Proceedings of Medicon 2004, Ischia - Italy, July 31-August 5, 2004 Paper Presentation Maria Cinque, Michele Crudele, Giulio Iannello The Results of the HISS Project: an Upside-Down Revolution Workshop on “Learning Communities in the era of Ubiquitous Computing” Milan - Italy, June 13, 2005 Paper Maria Cinque, Michele Crudele, Giulio Iannello, Livia Gagliani Caputo PpMC (Pocket PC-mediated communication) in a catering school Workshop on “Learning Communities in the era of Ubiquitous Computing” Milan - Italy, June 13, 2005 Paper 2003 HP Philanthropy and Education Annual Report Partnering with organizations and communities to improve the quality of life Trasforming Education with Mobile Technology Paper Top Further information & contacts m.crudele@unicampus.it; g.iannello@unicampus.it; m.cinque@unicampus.it Print