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How to Develop a Low Cost, In-House Distance Learning Center for Continuing Medial Education

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How to Develop a Low Cost, In-House Distance Learning Center for Continuing Medial Education HOW TO DEVELOP A LOW COST, IN-HOUSE DISTANCE Lanza V. How to develop a low cost, in-house distance learning center for continuing medial education. Part II. LEARNING CENTER FOR CONTINUING MEDICAL J Clin Monit 2002; 17: 421^426 EDUCATION ABSTRACT. The¢rstpartofthispaperdiscussedtheadvantages Part II and communication tools needed to create a Distance Learn- Vincenzo Lanza, MD ing Center for continuing medical education by using an Intranet or the Internet. This part continues with an explan- ation of the hardware, software (largely free) and human resources needed for videoconferencing as well as the costs. Suitable even for small hospitals Distance Learning Centers can be of higher quality than traditional methods of continu- ing medical education. KEY WORDS. Continuing medical education, CME, video- conferencing, distance learning, intranet, internet, local area network. VIDEOCONFERENCING SERVERS Interactivity between all users is not always necessary because the primary function of a distance learning center (DLC) is communication between one presenter and the other participants. This is especially true for medical videoconferences where the interactivity is in the form of participant questions answered by the presenter at the end of the presentation. However, in a live videoconference it is important to allow as many participantsaspossibletoavoidtheneedtorepeatthe presentation several times. It is possible to use the same networking technology, where several computers are able to download data from a single server, to build a videoconferencing system. This concept is illustrated in Figure 1. The speaker uses a videocamera connected to a com- puter, in which an audio card has also been installed. A program is launched to capture the video images and From the Department of Anesthesia, Ospedale Buccheri La Ferla Fatebenefrateli, Palermo, Italy. Received July 23, 2003. Accepted for publication July 23, 2003. Address correspondence to V. Lanza, Chief of Anesthesia Department, Ospedale Buccheri La Ferla Fatebenefratelli, Via M. Marine 197, 90123-Palermo, Italy. E-mail: [email protected] Fig. 1. Illustration of a simple videoconferencing system in a network. Journal of Clinical Monitoring and Computing 17: 421^426, 2002. ß 2003 KluwerAcademic Publishers. Printed in the Netherlands. 422 Journal of Clinical Monitoring and Computing Vol 17 Nos 7^8 2002 the audio recorded via microphone, and compresses the data (encoding).The resulting ¢le is transmitted to a web server computer in which a streaming program will store the ¢les on its hard disk temporarily. This server allows participants on distant computers with a decoder program connected to the network to access the videoconference ¢les at a synchronized speed for accurate motion. Some common programs available are Microsoft Windows Media Technologies and RealNet- works’tools.Thelattero¡ersacompletepackageof programs free on the Internet (for limited participants in a live broadcast) and is independent of the Operating System. MicrosoftWindows MediaTechnologies Fig. 2. MicrosoftWindows MediaTools software. The package of Windows media programs for video- conferencing (http://www.microsoft.com/windows/ windowsmedia/9series/server/helpdocs.aspx) consists created, or by using Windows Media Player with the of 3 programs: path (server address and conference directory). A) Windows Media Encoder C) Windows Media Player It is used to capture and compress audio and video input This program is included in Windows 98 and later from the speaker. The compressed content is then sent versions of Windows. There are two ways to access a to a server. The encoder is available in two versions: 9 videoconference using Windows Media Player: for Windows 2000/XP and 7.1 for Windows 98. The earlier version is not suitable to capture digital video à Via Internet browser directly through a ¢rewire port, but is capable of You visit a web site, ¢nd the relative web page and by capturing video from many analog-digital cards. The clicking on a link you open the videoconference resulting ¢le is in mpeg format. The average size of a streaming ¢le which automatically launches Win- one-hour videoconference is approximately 120 Mbytes dows Media Player to view the video. with highest quality Multiple bit rates video and Multi- ple bit rates audio (CBR) which means 282 Kbps bit à By launchingWindows Media Player rate, 30 frame rate and video size 320 Â 240. The You insert the complete path of the videoconference encoder can produce output ¢les (.wmv) of up to 30 in the ¢le menu and the videoconference will appear GB. If the output exceeds 4 GB, you must use an in the program window without any need to launch NTFS-formatted hard disk partition. the Internet Browser. B) Windows Media Server Windows Media Server allows you to save a live video- Windows Media Server is included in the Windows conference as an .AVI ¢le while streaming to partici- 2000 server OS as well as in the Windows 2003 OS. pants, and such ¢les can be edited by most video editing A version for Windows NT 4.0 is downloadable from programs. The disk space necessary is approximately the Microsoft web site. This program functions in the 2 MB per minute of video with the following common background on the server computer receiving the ¢les characteristics: compressed by the Encoder and stores them in a Hard Disk directory you select. The participants connect to ^ Window size: 240 Â 180 pixels; Windows Media Server and may access the videocon- ^ Colors: 24 bit (16 million); ference ¢le being stored on the server’s selected direc- ^ Speed: 10 frames per second; tory and it is presented at the beginning regardless of ^Audio:11Hz8bitmono. other participants already viewing, and at the proper synchronized speed. The connection may be via an HTML link on the web page which the server has Lanza: How to Develop a Low Cost, In-House Distance Learning Center for Continuing Medical Education. Part II 423 ¢leshaveasizeof1.1Mbytes/minwhenusingthe parameters previously cited in section 1.3.1C. C) RealOne Player This program is used to view live and previously re- corded videoconferences in .rm format on demand. The features are similar to Windows Media Player, but while you may use RealOne Player to view .avi ¢les, Fig. 3. RealNetworks Helix videoconferencing tools. you may not use Windows Media Player to view .rm ¢les. The encoder and the server may be used on the same computer, provided that it has at least a Pentium III 450 HOW TO USE A VIDEOCONFERENCING SERVER FOR CONTINUING MHz with 256 MB of RAM. MEDICAL EDUCATION Such a system is currently in use at Buccheri La Ferla RealNetworks tools Fatebenefratelli Hospital (BLFH) in Palermo, Italy and will be described as a model. The software suite (http://www.realnetworks.com/ resources/documentation/index.html) consists of di¡er- ent programs which function as illustrated in Figure 3. The equipment A) Helix Producer The hardware used to create an in-house videoconferenc- Helix Producer is the encoder to compress video and ingcenterconsistsofseveralcommonandinexpensive audio ¢les. The program is compatible with many devices. operating systems, analogical/digital cards and direct digital input also. The resulting ¢les are in a Real Net- The network work proprietary format. There is a free downloadable The local area network (LAN) in our ICU and anesthe- version (Basic), and an a¡ordable advanced version sia department adopted TCP/IP to become an Intranet. (Plus). An Intranet web server was established using Windows 2000 Server on a computer in the network. Proxy A1) PresenterOne server software (Microsoft) was also installed in the After the slideshow has been prepared (e.g. with Power- server computer to allow all computers on our LAN to Point) PresenterOne is used to synchronize the speaker’s connect to the Internet, and as security to prevent any audio and video with the slides which are converted to intruders on our LAN from the Internet. The server JPEG images. computer is connected to a free Internet Service Pro- vider (University of Palermo) via an ADSL router.The B) Helix Universal Server Internet connection is obviously necessary to allow The Helix Universal Server is compatible with most participants outside the hospital to view your video- server operating systems (e.g. Windows NT 4.0, Win- conference. dows 2000, Linux, etc.), and requires a minimum pro- cessor speed of 500 MHz (with Intel Pentium). The The speaker’s tools Helix server is available in a free Basic version and a Plus In the conference room a speaker gives his presentation version. The Helix Basic is su⁄cient for videocon- using a unidirectional microphone (to avoid back- ferencing but has a maximum of 1 megabit per second ground noise) and a videocamera to record audio and bandwidth. The software allows storage of the video- videoonacomputerconnectedtotheIntranet.A conference on hard disk for future viewing. To access multimedia projector may also be used to project en- the live videoconference you may enter the address larged images of the computer video content. directly in RealOne Player (described below), or the server may create an HTML page with a link to the live à Using RealNetworks tools videoconference. The ¢les thus created by the Helix Helix Producer software is used to present a speaker’s server are in a proprietary format (.rm) which cannot audio and video, or video demonstrations. be edited by common video editing programs. The To present a speaker and clear slide images at the same 424 Journal of Clinical Monitoring and Computing Vol17 Nos 7^8 2002 time PresenterOne software is needed, as well as The encoded content may be streamed in two ways: Helix Universal Basic Server installed on the same ‘‘Push‘‘ the encoded content to a Windows Media Server, computer or another computer on the network. or ‘‘Pull’’ the encoded content from the encoder. To ‘‘Push’’ you obviously need Windows Media Server 9 à UsingWindows tools (included in Windows 2003) but this allows you to Windows Media Encoder 9 Series enables the speaker divide the work between two computers and accom- to broadcast audio and video or video demonstra- modate more participants.When you ‘‘Pull,’’ your com- tions.
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