NKF cyberNephrology: Fostering Kidney Medicine’s Embrace of Technology in 2005 and Beyond!

1. NKF cyberNephrology: Fostering Kidney Medicine’s Embrace of Technology in 2005 and Beyond! Kim Solez, M.D.

2. Every Audience Now Diverse! Because the Internet is now mainstream, many of you have already solved most of the Internet related problems in your professional life. You already know the basics of creating web, email, and chat resources. Nevertheless there are still many positive surprises, technology advances which can greatly enhance your professional activities which you may not be are aware of, video conferencing, cell phone based resources. So this presentation will have something for everyone!

3. NKF cyberNephrology -Human Centered Computing Fostering nephrology’s embrace of the Internet and new technology since 1994 with Email and web resources. Websites which allow virtual attendance at meetings, education. www.cybernephrology.org www.cyber-medicine.org

4. Resources 45 Email discussion groups reaching some 5000 subscribers, with offerings for physicians, other nephrology professionals, patients, and patients’ families. Numerous websites with educational and meeting-related content. Workshops on telemedicine and evidence based nephrology, e.g. recently presented in Karachi and Dubai.

5. Evidence-Based Medicine Sir Austin Bradford Hill, British Researcher: "All scientific work is incomplete- whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. This does not confer upon a freedom to ignore the knowledge we already have, or to postpone the action that it appears to demand at a given time. Who knows, asked Robert Browning, but that the world may end tonight? True, but on available evidence most of us make ready to commute on the 8:30 next day."

6. NKF cyberNephrology provides: Electronic/Internet versions of 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, and technology vision for the future. It is the embodiment of kidney medicine’s embrace of technology. A wealth of offerings for physicians, other nephrology professionals, and patients and families at: www.cybernephrology.org

7. NKF cyberNephrology can assist with: • Creation of web, email, cell phone (MMS), and chat resources (AIM and MSN messenger like, or IRC) • Recommending links for nephrology resources. http://www.cybernephrology.org/education/eduPhysicians.htm • Recommending searching resources on your web site. • Promotion of the resources you create. www.cybernephrology.org

8. But putting matters more simply… The use of computers and the Internet should be enjoyable, practical, and productive. Web, email, chat resources should be easy to create. If you need help we are there to provide assistance. You can send us questions at the “contact us” link on www.cybernephrology.org or at the following Email addresses: Janice McDonald jm5@ualberta.ca Michele Hales Michele.Hales@UAlberta.CA Kim Solez, M.D. Kim.Solez@UAlberta.CA We can help you create Internet resources specific to the local language and culture of your own region.

9. NKF cyberNephrology - A remarkable NKF innovation! • In 1996 an NKF think tank recommended the creation of NKF cyberNephrology, initiated in April 1997. • 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 initiative, nephrology has caught up to and surpassed these other disciplines, now has Internet resources superior to those in any other area!

10. 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.

11. Unique Resources for Patients Not Found In other Specialties • NEPHKIDS - For parents of children with renal disease, moderated by pediatric nephrologist. • KIDNEYDISEASE - For adult patients with kidney disease, moderated by 10 nephrologists all over the world! 45 Email discussion groups in all connecting more than 5000 health professionals , patients, and patient’s families.

12. Email Discussion Groups

13. Email - Best Communication for Low Bandwidth Situations

14. Schrier Atlas of Diseases of the Kidney 66 chapters covering all areas of kidney medicine, completely searchable, with outstanding graphics, preformed Powerpoint files for each chapter are an excellent resource for teaching! http://www.kidneyatlas.org Accessed by more people per month than the total number of US nephrologists!

21. NKF New Technologies Division • Directed by Gary Green. • Beautiful new redesign of NKF kidney.org page! • Chronic kidney disease K/DOQI guidelines now available electronically through efforts of NKF cyberNephrology

22. New Technologies Division NKF (New York team) (800) 622-9010 Gary Green garyg@kidney.org Anthony Della Camera anthonyd@kidney.org Brian Robilotta brianr@kidney.org Gordon Brown gordonb@kidney.org Dawn Maruna dawnm@kidney.org

24. 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 - search strategies - efficient information retrieval, future of technology and the human spirit.

28. Using Internet videoconferencing, other informatics tools to enhance communications.

29. Video conferencing/ The near future of medical education and practice! To be demonstrated at Singapore World Congress of Nephrology. 2 ways: Dedicated videoconf. equipment from Internet2/Abilene “research” Internet with guaranteed bandwidth. Access Grid, H323. Desktop videoconferencing using iSight and iChatAV on Macintosh G4 or G5 , ViGO (VCON) , MSN, Yahoo messenger system on PCs.

31. CA*net 4 Architecture: 22.5 Gbps! CANARIE GigaPOP ORAN DWDM Carrier DWDM Edmonton Saskatoon St. John’s Calgary Regina Quebec Winnipeg Charlottetown Thunder Bay Montreal Victoria Sudbury Ottawa Vancouver Fredericton CANARIE Optical switches Halifax Chicago Seattle New York CA*net 4 node Toronto Possible future CA*net 4 node Windsor

32. In 2003-2004 iSight and iChatAV on Mac G4/G5 computers - practical in most areas of world.

33. iSight/IChatAV Internet Video Conferencing Demo - ChennaiMedical Student Cynthia Luk in Edmonton, Canada discusses ISN Video Legacy Project - Living History Project in Nephrology - one purpose of our travel to Chandigarh - the interview of Prof. Kirpal Chugh.

34. Can send images in iChatAV by just dragging image icon to chat window.

35. ViGO Design Camera (removable) Headset Hook “Designed by a world-class industrial design firm” Speaker Tower (removable) Base Unit

36. ViGO Laptop-based Video Conferencing http://www.vcon.com/solutions/videoconferencing/desktop/index.shtml http://www.vcon.com/solutions/videoconferencing/desktop/ViGO/index.shtml

37. Videoconferencing alternatives to face to face meetings.Do not assume limited utility.Possible to make the videoconferencing experience you think you know easier and richer, more satisfying.By obtaining feedback on success of face to face meetings and videoconferencing can determine ideal formula for proper mix of both.

38. Demo of Richness of Video Conferencing Limited by 640x480 Data ProjectorsMany high end graphics programs and presentation interfaces will only work at 1024x768 or higher. Such high res. data projectors do not cost much more, but most suppliers are clueless with regards to their advantages for presentation effect.

39. Virtual Pathology Slide • http://www.telepathology.dcu.ie/vps02.php3VPS Breast Needle Core Study (JMIR 2003) • http://www.medicine.uiowa.edu/pathology/uarep_histopathology/ Virtual slidebox of histopathology • http://alf3.urz.unibas.ch/patho/pub/2002-11.htmHuman Pathology -- Volume 34, No. 10 (October 2003) -- pages 968-974 Katharina Glatz-Krieger , Dieter Glatz , Michael J. Mihatsch Virtual Slide: high quality demand, physical limitations and affordability. http://vmic.unibas.ch

40. Technology Evolution Need Not be Complex! Machines should serve human beings, making our lives easier. The latest technology in cell phones, the windup charger. Videoconferencing can also be simple like this.

41. Technology Evolution Need Not be Complex! Machines should serve human beings, making our lives easier. Virtual full size keyboards for cell phones and PDAs which project on any surface. Videoconferencing can also be simple like this.

42. The Serious Side of Robotics in Medicine:Irobot Packbot concept Extraction Payload (EP) The Most Heavily Funded Aspect of Telemedicine

43. More Positive Views of Robotics! Thinking of civilian medical uses of robotics/artificial intelligence.

44. Tangible effects of recent Osaka presentation! Host adopts Aibo!

45. Wireless Connectivity - Not Just for Landlubbers Anymore! BALTIC SEA MAKING WAVESNow travelers in the Scandinavian region (which has long been in the forefront of wireless technology) can get wi-fi while crossing the Baltic Sea. Passengers on Silja ferries running between Helsinki, Stockholm and Tallinn, Estonia, log on for free while seated near the bar.

46. Wireless Connectivity - Many applications within hospital practice BOSTON DOCTORS WITHOUT BORDERS Physicians at Beth Israel Deaconess Medical Center in Boston use wireless handhelds and laptops to submit prescriptions, r ead laboratory results and view X rays and ultrasounds. Above, an emergency -room doctor checks a PDA equipped with a plug-in wi-fi card .

47. Wireless Connectivity - An important focus of national connectivity initiatives. KRAKOW HIP TO BE SQUARE For decades, visitors to Krakow's main city square have admired the historic buildings, browsed the souvenir stands and sipped coffee at the many outdoor cafés. This year, for the first time, they get to browse online for free-thanks to a nationwide effort to bring wi-fi to Poland .

48. NKF cyber Nephrology - Visioning the future!

49. Medicine of the FutureNew Medicine - Individualized Medicine

50. But putting matters more simply… The use of computers and the Internet should be enjoyable, practical, and productive. Web, email, chat resources should be easy to create. If you need help we are there to provide assistance. You can send us questions at the “contact us” link on www.cybernephrology.org or at the following Email addresses: Janice McDonald jm5@ualberta.ca Michele Hales Michele.Hales@UAlberta.CA Kim Solez, M.D. Kim.Solez@UAlberta.CA We can help you create Internet resources specific to local needs, language and culture of your own region.