What’s New in cyberNephrology ISN Dubai Update, Feb. 6, 2001

1. What’s New incyberNephrology ISN Dubai Update, Feb. 6, 2001 Kim Solez, M.D.

2. Most physicians are learning about the Internet and new technology “on the fly”. Inefficient, unpredictable, leaves gaps.

3. 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.

4. Key Points • ISN Informatics Commission/NKF cyberNephrology partnership • New Technologies Division of NKF - Gary Green • History, Nephrology born of technology. • ISN Informatics/NKF cyberNephrology 1997-2001 • ISN Informatics/NKF cyberNephrology beyond 2001

5. 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

6. 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

7. First Phase of ISN Informatics/NKF cyberNephrology 1997-2000 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. • WWW site http://www.cybernephrology.org

8. Support of NKF and ISN Programs. Furthering of new technologies. WWW sites: http://www.cybernephrology.org http://www.isn-online.org http://www.kidney.org

9. 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

10. Support of NKF Programs • KEEP, RISE • K/DOQI • PARADE • People like Us • Spring Clinical Meeting , ASN • Publications • Donor Families, Donor Quilt • Transplant Games

11. 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, CA*net3, is the world's first national optical research network. • By the end of this year nearly 17% of Canadian on-line homes will have a broadband connection compared to 8.6% in the U.S. • Expect to have 100 MB/sec. connectivity from University of Alberta to College Plaza cyberNephrology complex by March 2001.

12. New Operating Systems and Electronic Data Transmission Formats • Palm computing platform • Macintosh OS 10 • Wireless transmission - AirPort hub • XML document presentation

13. The hand held device • 1971 Hoff - Microprocessor • 1972 Alan Kay - PARC - Dynabook • 1993 Newton MessagePad • 2001 – palm OS – fastest growing platform in history

14. Internet use becomes “mainstream” in 2001 - even in the Middle East! 1. Most health care workers using the Internet. 2. Access becoming faster, cheaper.3. Computers themselves inexpensive.4. No longer necessary to type. Voice recognition reaches 98% accuracy and still improving!

15. 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)

16. The World is Changing - Now! February 1, 2001 The Media Development Loan Fund, backed by some of the world's largest philanthropies including the MacArthur 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/computing/02/01/media.activists.idg/index.html

17. 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 ensure their citizens have access to the Internet "as complete as telephone access," saying that 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 ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor.

18. 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 ensure 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.

19. The Internet in Europe, Asia, and the Middle East - including UAE 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 and quite heterogeneous) 2. Lack of high speed Internet access (Often nothing faster than standard modem or ISDN) 3. Language (because most Internet activity is in English it may seem like a very 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 ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor.

20. 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 ensure 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 Internet.

21. Bandwidth considerations The Internet in high bandwidth environments: Only 35% of human communication is words. With 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 ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor.

22. Bandwidth considerations The Internet in low bandwidth situations: Web 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 ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor.

23. Few Countries Out of Reach! Almost all countries can benefit from Internet-based discussion. Email connectivity has reached 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 ensure their citizens have access to the Internet "as complete as telephone access," saying that would dramatically reduce the income gap between rich and poor.

24. "We strongly believe that better telecommunications will enhance our ability to deliver improved quality of life, electronic health and learning services to previously disadvantaged areas in the continent". President Nelson Mandela in an address to the Africa TELECOM 98 Exhibition and Forum Johannesburg 4-9 May 1998

25. Factors Influencing Second Phase of NKF cyberNephrology 2000 - 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

26. Factors Influencing Second Phase of 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

27. 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 don’t have kidneys !

28. So follow our progress and remember: “Any sufficiently advanced technology is indistinguishable from magic.”