CyberNephrology and cyberTransplantation

1. CyberNephrology and cyberTransplantation Kim Solez, M.D.

2. Main Transplantation Internet Resources • http://www.unos.org • http://www.transweb.org • http://www.a-s-t.org • http://www.asts.org • http://www.centerspan.org

3. Main Transplantation Internet Resources. cont. • MESOT needs a WWW page! • Centerspan-l is an Email discussion group for transplant physicians and surgeons. A substantial number of Centerspan-l messages are forwarded from NEPHROL, the main cyberNephrology Email discussion group. NEPHROL messages with a TX prefix are automatically forwarded to Centerspan-l.

4. NKF cyberNephrology/ISN Informatics - Remarkable innovations! • In 1996 an NKF think tank recommended the creation of NKF cyberNephrology, initiated in April 1997. ISN informatics began May 1997. • Remarkably insightful, no other voluntary heath organizations have had similar technology impacts. 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!

5. All the More Remarkable Considering Nephrology’s 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.

6. 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.

15. cyberNephrology and Pakistan Three .pk subscribers to NEPHROL wahmed@brain.net.pk (Dr.Waqar Ahmed) rnaqvi@super.net.pk drtahir@cyber.net.pk One to NEPHDEVEL No .pk subscribers to ARABNEPHROL Substantial possibilities of sustained interaction after this meeting!

16. cyberNephrology and Other Middle East Countries Few Middle East subscribers to NEPHROL or NEPHDEVEL. 141 subscribers to ARABNEPHROL, NEPHROL has 1500, 10+ fold larger. Substantial possibilities of sustained interaction after this meeting!

17. Extending Internet knowledge from nephrology to medicine in general! • cyberMedicine - New Medicine http://www.cyber-medicine.org • Discipline upgrade from other areas which can learn from nephrology - Critical Care Medicine • cyberMedicine as part of the technology future.

20. Choosing the right technologies! • One of the challenges of ISN Informatics/NKF cyberNephrology is to make the right choices in exploring new technologies. In this respect our decision to demonstrate Apple's AirPort wireless 802.11b Internet connectivity between the ISN and NKF booths at the 2000 ASN meeting in Toronto was a prophetic choice, as this type of connection is emerging as the dark horse favorite in wireless connection protocols .

21. Is that all there is to cyberNephrology/ISN Informatics? • Electronic/Internet versions of ISN/NKF publications, professional and patient education and peer support over the Internet using Email and web resources, medical textbooks online, hands on workshops, symposia, videoconferencing , keeping abreast of new technology.

22. Different challenges entirely!

23. The Middle East • The cradle of civilization, “but then something happened”.

24. Psychology and Changing Times! • Perhaps one of the most difficult tasks in the post 9/11 climate has been getting the psychology right, and avoiding inflammatory nonmedical discussions while not rigidly controlling Email discussion group activities.

25. Psychology and Changing Times, cont.! • At the height of the Middle East tensions in the last year 8 people were removed from Email groups (four on each side of the conflict) for grossly inappropriate conduct. Many of these people were prominent nephrologists . In a difficult exercise of healing, I am meeting with these individuals this year, not to try to change them, but to try to understand how future similar situations could be better handled in an increasingly complex but interconnected world. • Just yesterday we were forced to make NEPHROL a moderated group temporarily.

26. Instilling Confidence in the Future our Most Important Role! • “If you want something done you have to start doing it, then when others see you have done that ,they will help you.” Dr. Salma Sulieman, Khartoum, Sudan • The same lofty goals to aspire to that existed before 9/11/2001 exist today. We must avoid the infectious lowering of expectations that seems to be sweeping the planet. All the things that were good to do, all innovations and initiatives, all the goals to aspire to that were there before are still there today. If we give up our hopes and dreams we had before September 11th, then we accept defeat and that must never happen.