Telemedicine Nephrology and Renal Pathology Kim Solez M

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Telemedicine, Nephrology, and Renal Pathology Kim Solez, M. D. Kim. Solez@UAlberta. CA

Telemedicine, Nephrology, and Renal Pathology Kim Solez, M. D. Kim. [email protected] CA

A transition: Telemedicine, telehealth, e-health The primary care physician of the future is the

A transition: Telemedicine, telehealth, e-health The primary care physician of the future is the patient (or parent) !

e-health Consumer-driven Telemedicine and Telehealth Provider-driven The public will tell us what they want

e-health Consumer-driven Telemedicine and Telehealth Provider-driven The public will tell us what they want in e-health. Providers no longer dictate but become partners with patient or parent.

4 Telemedicine - The Past, the Future In the past meant mainly phone based

4 Telemedicine - The Past, the Future In the past meant mainly phone based videoconferencing using phone lines or dedicated ISDN lines, largely impractical for developing countries. In the future, Internet based using such programs as Microsoft Netmeeting and Class. Point, practical for developing countries.

5 Telepathology - The Past, the Future In the past meant mainly real time

5 Telepathology - The Past, the Future In the past meant mainly real time robotic stage connection using dedicated ISDN lines, largely impractical for developing countries. In the future, Internet based using static images from inexpensive digital cameras, practical for developing countries.

6 Internet technologies the ideal way to build consensus Three examples: ISN Disaster Relief

6 Internet technologies the ideal way to build consensus Three examples: ISN Disaster Relief Task Force ISN Consensus Conferences - COMGAN Banff conferences on allograft pathology

7 Banff Classification Internationally agreed upon classification First developed in 1991, meetings every two

7 Banff Classification Internationally agreed upon classification First developed in 1991, meetings every two years. Published in KI in 1993 and 1999. Employs lesion quantitation g, I, t, v, ah cg, ci, ct, cv, mm and standard diagnostic categories.

8 Banff Classification Inflammation does not equal rejection. Tubulitis suggests rejection, intimal arteritis diagnostic

8 Banff Classification Inflammation does not equal rejection. Tubulitis suggests rejection, intimal arteritis diagnostic of rejection. Three histologic forms, tubulointerstitial, vascular, and transmural.

9 Banff Classification Anyone can participate in the Banff meetings, on site or remotely.

9 Banff Classification Anyone can participate in the Banff meetings, on site or remotely. Next meeting April 21 -28, 2001 Important breakthroughs expected in 2001. Chronic rejection classification. EM and C 4 D findings specific for chronic rejectiion, antibody mediated rejection. Donor biopsy classification.

10 Communications for Banff Face to face meetings. Letters, faxes, phone calls. Expensive, cumbersome,

10 Communications for Banff Face to face meetings. Letters, faxes, phone calls. Expensive, cumbersome, slow. Since 1994 the Internet has been the main means of communication for this and other projects.

11 Origins of cyber. Nephrology In 1994 Michele Hales and I created the WWW

11 Origins of cyber. Nephrology In 1994 Michele Hales and I created the WWW page for ISN and RPS, and the NEPHROL discussion group. In 1995 we sent first renal biopsy images over the Internet and has the first international medical meeting that one could virtually attend via Internet and CD-ROM, and in 1996 created the first nephrology Internet teleconference (Edmonton-Milan)

12 First Phase of NKF cyber. Nephrology 1997 -2000 Many accomplishments Email discussion groups

12 First Phase of NKF cyber. Nephrology 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

Support of ISN and NKF Programs. Furthering of new technologies. WWW sites: http: //www.

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

14 Support of NKF Programs n KEEP, RISE n K/DOQI n PARADE n People

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

15 Support of ISN Programs n COMGAN n RENAL-TECH Computer Donation Project n Video

15 Support of ISN Programs n COMGAN n RENAL-TECH Computer Donation Project n Video Legacy Project n ISN Archive n Sister Centers Program n Teaching Resources n Discussion Groups n Assistance to National Societies

16 Making Full Use of the Favorable Local Environment in Canada is way ahead

16 Making Full Use of the Favorable Local Environment in Canada is way ahead of the U. S. in the deployment and adoption of next-generation broadband services: The cross-Canada highspeed network backbone, CA*net 3, is the world's first national optical research network. n 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. n Living example of the success of wireless connectivity! From University of Alberta to College Plaza cyber. Nephrology complex.

17 New Operating Systems and Electronic Publishing Formats n Palm computing platform n Macintosh

17 New Operating Systems and Electronic Publishing Formats n Palm computing platform n Macintosh OS 10 n Linux n XML document presentation

18 Internet use becomes “mainstream” in 2000 - even in Africa! 1. Most health

18 Internet use becomes “mainstream” in 2000 - even in Africa! 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!

19 Internet Users Worldwide June 1999 - Nua Internet Surveys n World Total n

19 Internet Users Worldwide June 1999 - Nua Internet Surveys n World Total n Africa n Asia/Pacific n Europe n Middle East n Canada and USA n Latin America 179. 00 million 1. 14 million 26. 97 million 42. 69 million 0. 88 million 102. 03 million 5. 29 million

20 The World is Changing - Now! September 26, 2001 New Hewlett Packard CEO

20 The World is Changing - Now! September 26, 2001 New Hewlett Packard CEO Carly Fiorina said Tuesday 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. " September 28, 2001 Major advance in quantum computing announced.

21 The World is Changing - Now!. . . continued November 21, 1999 Clinton

21 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.

22 The World is Changing - Now! … continued - The “Digital Divide” At

22 The World is Changing - Now! … continued - The “Digital Divide” 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.

23 The Internet in Europe, Asia, and Africa - including Kenya Up until now

23 The Internet in Europe, Asia, and Africa - including Kenya Up until now there have been three main barriers to Internet use in Europe, Asia, and Africa: 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)

24 The Internet in Europe, Asia, and Africa - including Kenya - Solutions! 1.

24 The Internet in Europe, Asia, and Africa - including Kenya - Solutions! 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.

25 Bandwidth considerations The Internet in high bandwidth environments: Only 35% of human communication

25 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.

26 Bandwidth considerations The Internet in low bandwidth situations: Web site educational content can

26 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.

27 Few Countries Out of Reach! Almost all countries can benefit from Internet-based discussion.

27 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.

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28 "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

Contact Kim. Solez@UAlberta. CA To subscribe to NEPHROL and/or NEPHDEVEL send Email to majordomo@Ualberta.

Contact Kim. [email protected] CA To subscribe to NEPHROL and/or NEPHDEVEL send Email to [email protected] CA with the message subscribe nephrol subscribe nephdevel