The Meaning of Information Technology (IT) Mobile Devices to Me, the Infectious Disease Physician

The first smartphone was produced in 1992, but it took 10 years before it could properly perform the functions of a mobile PC [1]. The Blackberry was launched in 2002, Windows Mobile in 2006, and the first-generation iPhone was launched in 2007. In Korea, the iPhone and Android phones were introduced in 2009, starting the smartphone generation.

In 2010, the iPad was launched, which activated the tablet PC market; the Galaxy tablet and others were also successively launched, and mobile IT devices were further universalized. These devices combine with clouding and various applications (apps) to become very useful.

When a smartphone or tablet PC comes into one's possession, the first concern will be "Where will I use this?" The bottom line is as follows: we have to select whether the purpose of the device in our hands will be for 'production' or 'consumption'.

We are familiar with the use of the PC; therefore, in principle we pursue 'production', but these IT devices are somewhat uncomfortable for 'production' purposes due to problems such as the lack of a keyboard or their small size.

However, from the perspective of Apple, the smartphone (iPhone) and tablet PC (iPad) are primarily made for the purpose of 'consumption'. As far as this goes, 'production' is the responsibility of a PC. However, this is not an absolute rule. For example, Samsung, the self-proclaimed rival of Apple, has 'creativity' as the motto for its Android phone (the Galaxy Note). For this reason, they brought out the stylus pen and are now emphasizing that 'creation' is achieved by drawing and working with this pen. However, despite the argument that using a pen is 'production', there are opposing views stating that it signifies a type of 'regression' of the IT device interface.

Also, if the desktop is used as the center of production and IT devices are used as means for gathering resources for production, then it has the purpose of 'production'.

In an analogy, the PC is the aircraft carrier and the smartphone or iPad roam the surrounding areas and collect materials for the carrier. The medium for the process of using the gathered materials for production is Cloud technology (Fig. 1).

Figure 1
Life with information technology (IT) device and cloud.

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In conclusion, the primary purpose of an IT device for ID physicians is 'preparation for production.'

The first step in this case is to install and use an app with the function of an eBook reader. These reader apps do not stop at simply viewing PDF files but make it possible to underline, highlight, or annotate text. Another small advantage is that the font can be enlarged, making it beneficial for old aged readers. Popular reading apps are GoodReader and iAnnotate.

Also, the concept of 'synchronizing' the IT device and the PC is very important. To do this, a Cloud service or apps are utilized. As a Cloud service, Dropbox is most popular, while SkyDrive connects with Windows 8 and Google provides GDrive. In Korea, Naver nDrive, Daum Cloud, uCloud, and others are in service.

For example, if Dropbox is installed on my PC and IT device, the data in both devices are synchronized (Fig. 2). This enables me to view and use materials anywhere without any type of media, such as a USB device or CD. Also, folders can be shared with others, so I share a research data folder with my colleagues to establish a group work structure. This Cloud service is available also in nDrive, Daum Cloud, uCloud, Google drive, and SkyDrive.

Figure 2
Synchronized data manipulation via cloud service (Dropbox).

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This can be utilized further when apps supported by these types of Cloud services are used in combination.

For example, GoodReader can be connected to various Cloud services. Using the 'connect to servers' menu, I can register my primary Cloud server; in subsequent connections PDF files to be read can be downloaded into my GoodReader. I can also upload edited PDF files (Fig. 3).

Figure 3
An example of ebook reader (Goodreader®) of author itself.

Anyone can register their favorite Cloud server and either download or upload articles.

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In addition, editors and online clipboards (e.g., Evernote), which can be installed on both a PC and an IT device as a Cloud service, can be used with a connection to the Reader. For example, the important sections of articles in PDF that we read through GoodReader can be accumulated in Evernote through copying and pasting, and a presentation can easily be prepared with materials and information saved in the Evernote and PowerPoint software installed on the PC (Fig. 4).

Figure 4
Synchronization of three different software in three different devices via cloud service.

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In these days, society has changed from communicating face to face to an era in which communication can be achieved from long distances. This can be utilized not only for personal interrelationships but as a means of official interactions as well. For a physician, it can be utilized for consultations and discussions and exchanges of professional knowledge. In my case, I created a non-disclosed infectious disease forum on Facebook and registered professors of infectious disease at university hospitals all over the country. This resource is used for the purpose of online consultations, discussions, and mini-lectures when there are difficult cases (Fig. 5). In the past, I agonized without the thought of consulting professors from other hospitals. Even during consultations, actual visits were difficult, and it was inconvenient to call up them. Thus, it is such a convenient and efficient system that offers space for various specialists from around the country to participate and share opinions in a short time.

Figure 5
An example of on-line consultation and discussion in the closed forum of my Facebook.

Real image (wirtten as Korean) on Facebook is shown in Supplementary Fig. 1.

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Another example of utilizing SNS is through chatting apps. I usually use KakaoTalk, which is the most popular app in Korea. When I am out of the hospital, I frequently receive consultation calls from house staffs. When KakaoTalk is used, text messages and various image data regarding the patient can be provided, allowing more detailed advice to be given.

On holidays or when I am off duty, I use KakaoTalk effectively to manage tasks with the house staff (Fig. 6).

Figure 6
An example of on-line discussion using chatting app: On the weekend at home, I received this consultation message including image data from a housestaff in my hospital. We established an initial management plan via online-discussion on time.

Real image (wirtten as Korean) on smartphone is showin in Supplementary Fig. 2.

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Teamviewer is the most common example; it is installed on both desktop PCs in the hospital and mobile devices, allowing the use of hospital PCs from outside with the mobile device through remote access.

Other than purchasing and using such apps, a virtual private network (VPN) ID can be received from the hospital to allow secure logins to the hospital network through the Internet from outside the hospital to manage tasks such as emergency consultations.

Nowadays, there are various ways to conduct an online presentation through the Internet without bringing a file in a USB device. The most common means is Prezi, while a type of Mindmap software, Thinkwise, also operates other online presentation arena [4, 5].

On these sites, not only presentations but also sharing through the Cloud and collaborations with colleagues are possible.

Prezi effectively uses a close-up effect and therefore has considerable strength in ensuring concentration by the audience. On the other hand, Mindmap is a map of thoughts and is more helpful for reviewing after the presentation. Prezi is a type of animation, so controllability is not always satisfactory. Therefore, it is difficult to perform selective reviews, as in Mindmap.

Prezi and Mindmap both have good connectivity through social networking service (SNS) (Fig. 7).

Figure 7
Tools of online presentation: Prezi and Mindmap.

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There is a continuous development of apps, which suggests that the smartphone can be used as a tool to supplement medical devices. A very typical example is the recently developed iStethoscope, which uses the microphone function of the iPhone to auscultate and record. It is of course difficult to consider it as an official medical device, and the developer also emphasizes that it is for entertainment and not for medical purposes. However, this app is significant in that it suggests that the smartphone can be utilized as a tool capable of replacing medical devices to a certain degree in the near future. Aside from this, apps which measure the blood pressure or blood glucose are available for purchase.

Apps useful for ID physicians are antibiotics reference apps, medical utilities (e.g., calculators, and TDM apps) as well as literature search apps that find reference guides and review materials. News apps are also useful (e.g., epidemiology and outbreak news) [6, 7].

1. Skyscape application and Omnio

The Skyscape application unites the apps listed above into a single application (Fig. 8). It has Archimedes as a medical calculator, RxDrugs as a drug reference guide, and Outlines in Clinical Medicine as a reference of clinical information on numerous diseases. MedAlert provides updated medical information such as the latest trial results, clinical news, and drug alerts [8].

Figure 8
Skyscape and Omnio.

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These are free applications, and useful apps can be purchased additionally according to need. Paid apps useful for physicians are as follows: The 5 Minute Infectious Diseases Consult, The Washington Manual Infectious Diseases Subspecialty Consult, Cochrane Reviews in HIV/AIDS, Cochrane Reviews in Infectious Diseases, The Pocket Guide to Fungal Infection, Journal Watch Infectious Diseases, etc.

Omnio is an iPad version of Skyscape. It provides the same free resources available from Skyscape. Also, direct connection to the IDSA homepage is possible in the app.

2. Antimicrobial reference apps

1) Sanford Guide

The Sanford Guide will be more familiar to physicians as a paperback manual. This guide was developed from the web edition and converted into a smartphone application to provide services (Fig. 9A). It has earned great confidence due to the sound content that has accumulated over a long period, but personally I have a single complaint regarding this paperback manual: the font size is too small and in reality I am reluctant to open the manual. Thus, the app version which can be enlarged is a very welcome development. The Sanford Guide app provides detailed information of nearly all antimicrobials, including HIV guidance, immunizations, infection in the special situation (e.g. pregnancy or post-transplantation).

Figure 9
Sanford guide (A) and Johns Hopkins antibiotics guide (B).

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The subscription is renewed every year.

2) Johns Hopkins ABX Guide

This app provides detailed information pertaining to antimicrobials and related knowledge (Fig. 9B). However, it is a textbook-like reference and thus utilities such as built-in calculator are not provided. Like the Sanford guide, it is renewed every year.

3) Epocrates

This is an application from the Palmtop period. It has substantial content but is made for nearly all healthcare professionals. It has a drug interaction tool (InteractionCheck), a pill identification tool (with photos), and the MedMath calculator as built-in utilities.

4) CDC antibiotics

This is an app provided by the Centers for Disease Control (Fig. 10A). Rather than a detailed explanation of antibiotics, this app focuses on various clinical guidelines made by the CDC. This app also has built-in utilities such as a dose calculator.

Figure 10
CDC antibiotics (A) and Micromedex drug information (B).

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5) Micromedex drug information

This app is a favorite for house staffs as it is free and has a relatively simple user interface (Fig. 10B). It is very useful when searching for interactions between drugs, adjusting dosages, and for learning about adverse effects.

6) KIMS for smartphone

KIMS (Korean Index of Medical Specialties) is offered through the Internet. It was developed as a smartphone app starting in 2011 (Fig. 11). It is possible to search in Korean, and in contrast to other overseas apps it has the advantage in that various generic drugs available in Korea can be sought and viewed.

Figure 11
KIMS online app for smartphone.

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7) HIV iChart

This app is a smartphone version of HIV-drug interactions on-line utility in http://www.hiv-druginteractions.org (Fig. 12).

Figure 12
HIV iChart for evaluating the antiretroviral interactions with others.

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5. Journal apps - IDSA journals, New England Journal of Medicine app.

Various journals can also be viewed through apps as well. For example, the Infectious Disease Society of America (IDSA) provides an app to read Clinical Infectious Diseases or the Journal of Infectious Diseases on a smartphone, and the New England Journal of Medicine provides the most current papers every week to read through an app (Fig. 13). However, it is rare for journal apps to provide free articles, and most have to be purchased.

Figure 13
IDSA journals app (A) and New England Journal of Medicine app (B).

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I want to witness the future prospects of IT and its utilization in the medical field from the perspective of an individual physician and as part of a group of physicians.

Supplementary data including two figures can be found with this article online http://www.icjournal.org/src/sm/ic-45-244-s001.pdf.