PowerPoint file for presentation given ten years ago at the historic Bellagio Conference "Prevention of Renal Diseases in the Emerging World:Toward Global Health Equity" 16-18 March, 2004, Bellagio Study and Conference Center Lake Como, Italy see http://www.cybernephrology.ualberta.ca/COMGAN/Bellagio/ Sound files: http://www.cybernephrology.ualberta.ca/COMGAN/Bellagio/Pres/Solez/SolezA.wav http://www.cybernephrology.ualberta.ca/COMGAN/Bellagio/Pres/Solez/SolezB.wav

1. Slide 1
ISN COMGAN Bellagio Conference
Electronic Strategies for
Information and Research
Kim Solez,
M.D. around the World
Improving Nephrology

2. Electronic Strategies for
Information and Research:
cyberNephrology in the
Emerging World
Kim Solez, M.D.

3. Slide 3
Technology and sustained relationships.
Meeting with Ivor Katz, Sept. 18, 1997

4. African Renal Pathology Course 2000 Nairobi,
Kenya - Little Sustained Effect.
Slide 4
No sustained informatics
component Just a
momentary blip in
quality
of life locally,
despite
much preparation.

5. Slide 5
We need to take the long view.
Ensure follow-up strategy is
always in place after
events/educational visits using
Email, web, and
videoconferencing resources.

6. ISN Informatics Fostering
nephrology’s
Human Centered Computing
embrace of the
Internet and new
technology since
1994 with Email and
web resources. ISN
homepage, websites
which allow virtual
attendance at
meetings.
www.cybernephrology.or
g
www.cyber-medicine.org

7. Technology Evolution Need
Not be Complex!
Machines should serve human beings,
making our lives easier.
The latest technology in cell phones, the
windup charger.

8. ISN Informatics provides:
Slide 8
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.
ISN Informatics/cyberNephrology is the
embodiment of kidney medicine’s embrace of
technology.
A wealth of offerings for physicians, other
nephrology professionals, and patients and
families at:

9. ISN Informatics can assist with:
Slide 9
•
Creation of web, email, and chat resources (AIM
and MSN messenger like, or IRC). Online
research databases.
•
Recommending links for nephrology resources.
http://www.cybernephrology.org/education/eduPhysicians.htm
•
Recommending searching resources on your
site.
•
Promotion of the resources you create.
www.cybernephrology.org

10. But putting matters more
simply…
Slide 10
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
Michele Hales
Kim Solez, M.D.
jm5@ ualberta.ca
Michele.Hales@ UAlberta.CA
Kim.Solez@ UAlberta.CA
We can help you create Internet resources specific
to the local language and culture of your own

11. Slide 11
Out In Front! 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.

12. Slide 12
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!
18 Email discussion groups in all connecting more than 3000
health professionals and patients.

13. Email Discussion Groups
Slide 13

14. 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."

15. Internet Now Mainstream Searching - A Wonderful
World Out There!

16. General Search Tools
http://www.google.com/
Google - Searching 4,285,199,774 web pages
(increased by one billion Feb. 18, 2004)
http://www.alltheweb.com/
Currently searching 3,151,743,117 web pages

17. Slide 17

18. Slide 18

19. Slide 19

20. Slide 20

21. Extending Internet knowledge from
nephrology to medicine in general!
Slide 21
 cyberM edicine - New M edicine http://www.cybermedicine.org
 Discipline upgrade from other areas which can
learn from nephrology - Critical Care M edicine
 cyberMedicine as part of the technology future search strategies - efficient information retrieval,
future of technology and the human spirit.

22. Slide 22

23. Slide 23

24. Renal-Tech Program to become
WWRAP -World-Wide Renal
Assistance Project
Slide 24
Computer software and hardware
donation, informatics training, past
initiatives in Cuba, Kosovo, Nepal,
Nigeria. Needs to become formally a
part of ISN. Zina Munoz

25. Slide 25
Renal-Tech Visits Led to ISN Sister
Center Relationship
Administrator Ram Dulal now obtaining
Ph.D. in Germany.

26. Supercourse Needs Kidney
Supercourse, funded by the National
DiseaseMedicine, NIH, is an Internet
Content
Library of
based library of lectures on prevention
and public health, shared for free by
10,000 members from 151 countries in
the Global Health Network. Has
developed a Golden Lecture of
Prevention to illustrate and
commemorate the role of prevention in
continuing to make our planet healthier.
http://www.pitt.edu/~super1/

27. Slide 27
Number of Internet users (millions)
Prevention and Internet:
Internet “Epidemic”
800
700
600
552.5
451
400
160
200
201
101
26
37
1995
1996
0
1997
1998
Year
1999
2000
2001
2002

28. Methods: Supercourse model
Teacher in
Alexandria
Teacher in
Tanzania
Teacher in
Paris
Slide 28
Teacher in
Cairo
Teacher in
Pittsburgh
Teacher in
Moscow

29. Metodi: il modello Supercourse
Docente a
Alessandria
Docente in
Tanzania
Docente a
Parigi
Slide 29
Docente al
Cairo
Docente a
Pittsburgh
Docente a
Mosca

30. Slide 30
Inexpensive Low to High bandwidth
systems designed to reach large numbers
of healthy people to prevent disease.
Expensive High bandwidth systems
designed to reach small numbers of sick
people to cure disease.

31. Slide 31
1400
1312
1200
1000
800
600
503
400
202
200
0
4
Sept-97
52
Sept-98
101
Sept-99
Sept-OO
Sep-02
May_03

32. Slide 32
Regional Centers: Using Internet
videoconferencing, other informatics
tools to enhance communications.

33. 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.
Slide 33

34. Slide 34
Evaluation! Possible to measure
success of both modalities. Integrated
approach.
By obtaining feedback on success of
visits and videoconferencing can
determine ideal formula for proper mix
of both.
Success of COMGAN in the future will
be much about finding proper mix of
face to face and virtual delivery
methods. Coordinating center can
handle both trip planning and

35. Slide 35
Formula for success can be literally a
formula with parameters determined by
feedback and modalities available.
Will not always require top down
direction, much can be accomplished
at grass roots, emergence, self
organizing level.

36. Internet Video Conferencing Remote Collaboration/
Education/Telemedicine

37. Video conferencing/
Telemedicine/Telepathology The
near future of medical
Internet video-conferencing affordable.
education and practice!
There are two practical ways to establish
this:
1. Dedicated videoconferencing equipment
from Sony or Polycom using
Internet2/Abilene “research” Internet with
guaranteed bandwidth.
2. Desktop videoconferencing using iSight
and iChatAV on Macintosh G4 or G5
computers.

38. Slide 38
Internet2 International Memorandum
of Understanding Partners
Europe-Middle East
ARNES (Slovenia)
BELNET (Belgium)
CARNET (Croatia)
CESnet (Czech Republic)
DANTE (Europe)
DFN-Verein (Germany)
GIP RENATER (France)
GRNET (Greece)
HEAnet (Ireland)
HUNGARNET (Hungary)
INFN-GARR (Italy)
Israel-IUCC (Israel)
NORDUnet (Nordic Countries)
POL-34 (Poland)
RCST (Portugal)
RedIRIS (Spain)
RESTENA (Luxembourg)
SANET (Slovakia)
Stichting SURF (Netherlands)
SWITCH (Switzerland)
TERENA (Europe)
JISC, UKERNA (United Kingdom)
Asia-Pacific
AAIREP (Australia)
APAN (Asia-Pacific)
APAN-KR (Korea)
APRU (Asia-Pacific)
CERNET, CSTNET, NSFCNET (China)
JAIRC (Japan)
JUCC (Hong Kong)
NECTEC / UNINET (Thailand)
SingAREN (Singapore)
TAnet2 (Taiwan)
Americas
CANARIE (Canada)
CEDIA (Ecuador)
CNTI (Venezuela)
CRNET (Costa Rica)
CUDI (Mexico)
REUNA (Chile)
RETINA (Argentina)
RNP2 (Brazil)
SENACYT (Panama)

39. In Jan. 20th, 2004 The Hindu
Plans for India’s Own 2.5GB/sec
1.Research Internet Announced
Will allow very high bandwidth
connections between educational
institutions in India and with other
institutions connected to
Internet2/Abilene around the world.
2. Starting with connection between all
Indian Institutes of Technology and Indian
Institutes of Management.
3. Will allow countrywide classrooms using
MHRDNet, routine videoconeferencing.

40. Dedicated Internet VideoConferencing Equipment
Practical Now in Many Regions.

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

42. iSight/IChatAV Internet Video
Conferencing Demo - Chennai
Medical 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.

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

44. Telepathology as a Subset of
Telemedicine

45. Slide 45
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.

46. Slide 46
The Camera to Buy Changes Daily!
Becoming cheaper, better.
The Nikon Coolpix 990
with MXB29005 adaptor

47. Slide 47
Details - The Nikon Coolpix 990
3.34 Megapixel Resolution
High-Speed USB Connection
Today less than $300 US.
Photographic results
indistinguishable from film!

48. Slide 48
Convergence - Not just devices.

49. Convergence of marketing,
advertisement, and entertainment
concepts and education.
Slide 49
Changing human behavior through
marketing, public relations to promote
health. Our corporate partners can be
of tremendous assistance in this.
Concepts of marketing maps, social
marketing.
Promote health
through
high impact education.

50. The link between advertising
and educational psychology.
Slide 50

51. Slide 51
Corporate gifts in kind and personnel
can be quite valuable
Microsoft School of the Future concept,
expanding into medicine, provides
Microsoft equipment, software, and
personnel for worthy educational
projects.

52. Slide 52
Epidemiology Center providing study
design help etc.
This would also be of great interest to
donors and corporate world could lend
expertise. Informatics is an important
part of this.

53. Slide 53
Build on existing programs of WHO,
other organizations.
HINARI initiative providing full text
access to key journals and books in
developing world. Lobbying to expand
to countries of intermediate status.

54. Slide 54
Becoming the model - Expanding to
other related areas of medicine:
diabetes, hypertension, cardiovascular,
crit.care.

55. Slide 55
Incorporate nurses into initiatives in
cooperation with nephrologist leaders.
Public health nurses crucial to many of
programs we are planning. World
Foundation for Renal Care.

56. Be the catalyst in a coalition!
Slide 56