ISN Informatics Commission, NKF cyberNephrology in the Context of cyberMedicine Moscow Nephrology Up

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ISN Informatics Commission,NKF cyberNephrology
in the Context of cyberMedicine Moscow
Nephrology Update Course May 31, 2002

• Kim Solez, M.D.

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NKF cyberNephrology/Informatics - A remarkable
NKF/ISN innovation!

• In 1996 an NKF think tank recommended the
  creation of NKF cyberNephrology, initiated in
  April 1997. ISN Informatics Commission May 97.
  
• Remarkably insightful, no other voluntary heath
  organization has had similar technology impact.
  Earlier Internet initiatives in other health
  disciplines - dermatology, anesthesiology, and
  nursing - were individual or institutional
  efforts.
• Now as a consequence of this NKF/ISN initiative,
  nephrology has caught up to and surpassed these
  other disciplines, now has Internet resources
  superior to those in any other area!

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NKF cyberNephrology/Informatics - A remarkable
NKF/ISN innovation!

• Foreign language content now in French, Spanish,
  and Arabic.
  
• Would like as a consequence of this meeting to
  also create similar high quality Internet
  resources in Russian.
  
• Educational content also available on CD-ROM for
  physicians with low bandwidth Internet
  connections.

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All the More Remarkable Considering Nephrologys
size vs. all of Medicine

• There are more than 800,000 physicians in the US
  and only about 5,000 are practicing renal
  medicine, so nephrologists represents only about
  0.6 of total US physicians.
• On the other hand, the cost of end stage kidney
  disease care is very high 18 billion US dollars
  per annum in public and private money (source
  USRDS). This is nearly 2 of the 1 trillion
  dollar total annual health care budget of the US
  and rising rapidly.

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Surprising that Nephrology is Ahead of Much
Larger Disciplines, e.g. Cardiology

• Topol text on Heart.org has cumbersome
  registration process, is old (1998), and is
  mostly just visually uninteresting text on a
  page, Schrier Atlas http//www.kidneyatlas.org
  is made for web presentation, virtually identical
  to 2001 text, has powerpoint files for each
  chapter, every page visually interesting, no
  registration process!
• Heart.org weekly update inferior to and goes to
  fewer people than HDCN weekly update.
  
• JointandBone.org similarly inferior to Schrier
  Atlas and other nephrology resources.
  

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NKF New Technologies Division / ISN webpage
redesign

• Beautiful new redesign of NKF kidney.org page for
  2002!
  
• Chronic kidney disease guidelines now available
  electronically through efforts of NKF
  cyberNephrology.
  
• Redesign of ISN website underway
  http//www.isn-online.org
  

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Extending Internet knowledge from nephrology to
medicine in general!

• cyberMedicine - New Medicine http//www.cyber-medi
  cine.org
  
• Discipline upgrade from other areas which can
  learn from nephrology - Critical Care Medicine
  
• cyberMedicine as part of the technology future -
  search strategies - efficient information
  retrieval.

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Most physicians are learning about the Internet
and new technology on the fly.

• Inefficient, unpredictable, leaves gaps.

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A short 2-3 hour period of formal teaching with
mixed didactic/interactive format and hands on
experience can provide enormous benefit.

• That is the plan of the computer workshops at
  this meeting.

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Ray Kurzweil

• "Technology is the continuation of evolution by
  other means....
  
• It is in the nature of exponential growth that
  events develop extremely slowly for extremely
  long periods of time, but as one glides through
  the knee of the curve, events erupt at an
  increasingly furious pace. And that is what we
  will experience as we enter the twenty-first
  century."
• -- Ray Kurzweil - The Age of Spiritual Machines,
  When Computers Exceed Human Intelligence

• When computers exceed human intelligence - 2020
• When computers and humans become
  indistinguishable from each - 2099

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Arthur C. Clarke

• "When a scientist states that something is
  possible, he is almost certainly right.
  
• When he states that something is impossible, he
  is very probably wrong.
  
• The only way of discovering the limits of the
  possible is to venture a little way past them
  into the impossible.
  
• Any sufficiently advanced technology is
  indistinguishable from magic."
  
• -- Arthur C. Clarke's three laws of technology

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First Phase of ISN Informatics/NKF
cyberNephrology 1997-2002

• Many accomplishments
• Email discussion groups - NEPHROL, NEPHDEVEL,
  NEPHKIDS and progeny
  
• WWW sites - virtual attendance at meetings
• AJKD Forum http//www.ajkd.org
• Schrier Atlas http//www.kidneyatlas.org
• Renal-Tech computer donation project
• Internet videoconferencing, wireless
  connectivity, panoramas. French, Spanish.
  
• WWW site http//www.cybernephrology.org

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Support of ISN Programs

• COMGAN
• RENAL-TECH Computer Donation Project
• Video Legacy Project
• ISN Archive
• Sister Centers Program
• Teaching Resources
• Discussion Groups
• Assistance to National Societies

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Making Full Use of the Favorable Local
Environment in Canada

• Canada is way ahead of the U.S. in the deployment
  and adoption of next-generation broadband
  services The cross-Canada high-speed network
  backbone, CAnet3, is the world's first national
  optical research network.
• In 2002 17 of Canadian on-line homes have a
  broadband connection compared to 8.6 in the U.S.
  Prime Minister Jean Cretien dedicated to making
  Canadians the most connected people on earth!.
• Internet2 Initiative provides enormous dedicated
  bandwidth between educational institutions for
  video conferencing etc.

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New Operating Systems, DataTransmission Formats,
Artificial Intelligence

• Palm computing platform
• Macintosh OS 10
• Wireless transmission - AirPort hub
• XML document presentation
• Artificial Intelligence, Robotics

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The Great Internet Paradox!

• The Internet is everywhere and nowhere. It has
  become mainstream in everyday life in first world
  countries, and reaches virtually every nation on
  earth.
• On the other hand, just as half the world has yet
  to make their first phone call, the Internet has
  not touched the lives of the vast majority of
  people living on this planet. Only 5 percent of
  the worlds population is actively using the
  Internet.

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Internet use becomes mainstream in 2002
- even in the Russia! 1. Most health care wor
kers using the Internet. 2. Access becoming fast
er, cheaper.3. Computers themselves
inexpensive.4. No longer necessary to type.
Voice recognition reaches 98 accuracy and still
improving!
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The World is Changing - Now!
September 26, 2000 New Hewlett Packard CEO
Carly Fiorina stated that the world is
now entering the "renaissance of the
information age" -- a time when emerging
technologies and an "always-on Internet"
could transform human experience and
entire industries. "This world is clearly
emerging before our eyes," "The shifts ahead,
the opportunities ahead are massive."
February 2, 2001 Cars that alert their owners
when stolen, tracking thief location. (CNN)
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The World is Changing - Now!
February 1, 2001 The Media Development Loan Fund,
backed by some of the wor
ld's largest philanthropies including the MacArth
ur and Soros foundations, lends money at low
interest rates to news organizations in
developing countries and helps them use
technology to facilitate the flow of
information. Rather than beam their reports via
satellite, the stations
transmit audio and text files via the Internet,
creating a network that covers most of the
country. http//www.cnn.com/2001/TECH/computin
g/02/01/media.activists.idg/index.html
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The World is Changing - Now! ... continued
November 21, 1999 Clinton Calls for Widespread
Internet Access - The New York Times
FLORENCE, Italy -- President
Clinton called Sunday for developed nations to e
nsure their citizens have access to the Internet
"as complete as telephone access," saying tha
t would dramatically reduce the income gap
between rich and poor.
November 21, 1999 Clinton Calls for Widespread
Internet Access - The New York Times
FLORENCE, Italy -- President
Clinton called Sunday for developed nations to e
nsure their citizens have access to the Internet
"as complete as telephone access,"
saying that would dramatically reduce the income
gap between rich and poor.
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The World is Changing - Now! continued - The
Digital Divide
November 21, 1999 Clinton Calls for Widespread
Internet Access - The New York Times
FLORENCE, Italy -- President
Clinton called Sunday for developed nations to e
nsure their citizens have access to the Internet
"as complete as telephone access,"
saying that would dramatically reduce the income
gap between rich and poor.
At a gathering of world leaders who adhere
to "third way" politics, Clinton said one of
the greatest domestic problems facing
developed countries is the "digital divide"
that gives those who have computers an
enormous advantage over those who do not.
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The World is Changing - Now! Solutions to Who
has time!
Feb. 2001 Former Labor Secretary Robert Reich
The Future of Success . Quit job when youngest
son asked wake me up when you get home no mat
ter what time it is so I know you are there.
Internet driven economy, frenzied lives, less
security race without a finish line. Digital
age allows you more time to yourself, more
work can be done at home. Digital butler or
agent www.autonomy.com performs searches for you
at night learning from what you liked in previou
s searches. Personalized newspaper in the morni
ng.
November 21, 1999 Clinton Calls for Widespread
Internet Access - The New York Times
FLORENCE, Italy -- President
Clinton called Sunday for developed nations to e
nsure their citizens have access to the Internet
"as complete as telephone access,"
saying that would dramatically reduce the income
gap between rich and poor.
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The Internet in Europe, Asia, and the Middle
East - including Russia
Up until now there have been three main barriers
to Internet use in Europe, Asia, and Middle East
1. Cost (Much higher than in North America a
nd quite heterogeneous) 2. Lack of high speed Int
ernet access (Often nothing faster than standard
modem or ISDN) 3. Language (because most Inter
net activity is in English it may seem like a ve
ry foreign and not-very-attractive culture)
November 21, 1999 Clinton Calls for Widespread
Internet Access - The New York Times
FLORENCE, Italy -- President
Clinton called Sunday for developed nations to e
nsure their citizens have access to the Internet
"as complete as telephone access,"
saying that would dramatically reduce the income
gap between rich and poor.
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The Internet in Europe, Asia, and the Middle
East - Solutions!
November 21, 1999 Clinton Calls for Widespread
Internet Access - The New York Times
FLORENCE, Italy -- President
Clinton called Sunday for developed nations to e
nsure their citizens have access to the Internet
"as complete as telephone access,"
saying that would dramatically reduce the income
gap between rich and poor.
1. Cost - Communications reform. Flat rate.
2. High speed Internet access DSL
and cable modem coming, faster
than ISDN and cheaper! 3. Language - Increasing
success with non-English resources on the Inter
net.
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Bandwidth considerations
The Internet in high bandwidth environments
Only 35 of human communication is words. Wi
th Internet video conferencing can capture
gestures, body language, inflections of the
voice, facial expression etc. plus share
images, documents, software applications
with "shared white board" or complete
remote control of other computer!
Requres 56 K modem or faster connection.
Allows telemedicine/telepathology.
November 21, 1999 Clinton Calls for Widespread
Internet Access - The New York Times
FLORENCE, Italy -- President
Clinton called Sunday for developed nations to e
nsure their citizens have access to the Internet
"as complete as telephone access,"
saying that would dramatically reduce the income
gap between rich and poor.
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Bandwidth considerations
The Internet in low bandwidth situations W
eb site educational content can be placed
on CD-ROMs cheaply and easily so sites
can be accessed without going to the
World Wide Web. Email-based low
bandwidth discussion has been
enormously successful in nephrology and
transplantation while WWW-based
discussion has not. So potentially
everyone has access to the Internet
resources that have proven most valuable.
November 21, 1999 Clinton Calls for Widespread
Internet Access - The New York Times
FLORENCE, Italy -- President
Clinton called Sunday for developed nations to e
nsure their citizens have access to the Internet
"as complete as telephone access,"
saying that would dramatically reduce the income
gap between rich and poor.
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Few Countries Out of Reach!
Almost all countries can benefit from Intern
et-based discussion. Email connectivity has rea
ched almost everywhere. Very few exceptions
Countries lacking Internet access include
only Afghanistan , Angola, Cape Verde,
the Comoros Islands, Equatorial Guinea,
Libya, Mauritania, São Tome and Principe,
Somalia and Western Sahara.
November 21, 1999 Clinton Calls for Widespread
Internet Access - The New York Times
FLORENCE, Italy -- President
Clinton called Sunday for developed nations to e
nsure their citizens have access to the Internet
"as complete as telephone access,"
saying that would dramatically reduce the income
gap between rich and poor.
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"We strongly believe that better
telecommunications will enhance our ability to d
eliver improved quality of life, electronic heal
th and learning services to previously disadvant
aged areas in the continent". President Nels
on Mandela in an address to the
Africa TELECOM 98 Exhibition and
Forum Johannesburg 4-9 May 1998
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Factors Influencing Second Phase of ISN NKF
cyberNephrology 2002 - onward

• Digital photography now inexpensive and
  superior/equal to film photography.
  
• Video panoramas, 3D panoramas
• Virtual microscope panoramas
• Books with digital paper pages
• Circuits that combine digital and analog
  signaling just as the human brain does
  
• Human-centered rather than machine-centered
  computing, near perfect voice recognition

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Factors Influencing Second Phase of ISN/NKF
cyberNephrology - Continued

• Gene chip DNA Microarrays for instant genetic
  diagnosis
  
• The wearable computer, digital clothing
• The bioartificial kidney
• Evolution of new ethical standards for e-health
• Quantum computing
• Optical switching/Optical Internet
• Nanomachines/near molecular level organ repair in
  disease

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Why not talk about distant future of
technology/cyberNephrology?

• Because if Ray Kurzweil is right and people and
  machines will be indistinguishable from each
  other in 2099, what will be the relevance of
  nephrology then?
• Machines/computers dont have kidneys !

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So follow our progress and remember Any
sufficiently advanced technology is
indistinguishable from magic.