ISN Informatics CommissionISN Informatics Commissionandand

NKF cyberNephrology:NKF cyberNephrology:The Next Phase and Beyond!The Next Phase and Beyond!

Kim Solez, M.D.Kim Solez, M.D.

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Key PointsKey Points

ISN Informatics Commission/NKF cyberNephrology ISN Informatics Commission/NKF cyberNephrology partnershippartnership

New Technologies Division of NKF - Gary GreenNew Technologies Division of NKF - Gary Green

History, Nephrology born of technology.History, Nephrology born of technology.

ISN Informatics/NKF cyberNephrology 1997-2000ISN Informatics/NKF cyberNephrology 1997-2000

ISN Informatics/NKF cyberNephrology beyond 2000ISN Informatics/NKF cyberNephrology beyond 2000

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Ray KurzweilRay Kurzweil

"Technology is the continuation of evolution by other "Technology is the continuation of evolution by other means....means....

It is in the nature of exponential growth that events It is in the nature of exponential growth that events develop extremely slowly for extremely long periods develop extremely slowly for extremely long periods of time, but as one glides through the knee of the of time, but as one glides through the knee of the curve, events erupt at an increasingly furious pace. curve, events erupt at an increasingly furious pace. And that is what we will experience as we enter the And that is what we will experience as we enter the twenty-first century." twenty-first century."

---- Ray Kurzweil - Ray Kurzweil - The Age of Spiritual Machines, When The Age of Spiritual Machines, When Computers Exceed Human IntelligenceComputers Exceed Human Intelligence

(a)(a) When computers exceed human intelligence - 2020When computers exceed human intelligence - 2020(b)(b) When computers and humans become indistinguishable from each - 2099When computers and humans become indistinguishable from each - 2099

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Arthur C. ClarkeArthur C. Clarke

"When a scientist states that something is possible, he "When a scientist states that something is possible, he is almost certainly right.is almost certainly right.

When he states that something is impossible, he is When he states that something is impossible, he is very probably wrong.very probably wrong.

The only way of discovering The only way of discovering thethe limits of the possible limits of the possible is to venture a little way past them into the impossible.is to venture a little way past them into the impossible.

Any sufficiently advanced technology is Any sufficiently advanced technology is indistinguishable from magic."indistinguishable from magic."

-- Arthur C. Clarke's three laws of technology-- Arthur C. Clarke's three laws of technology

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First Phase of ISN Informatics/NKF First Phase of ISN Informatics/NKF cyberNephrology 1997-2000cyberNephrology 1997-2000

Many accomplishmentsMany accomplishments

Email discussion groups - NEPHROL, Email discussion groups - NEPHROL, NEPHDEVEL, NEPHKIDS and progenyNEPHDEVEL, NEPHKIDS and progeny

WWW sites - virtual attendance at meetingsWWW sites - virtual attendance at meetings

AJKD Forum http://www.ajkd.orgAJKD Forum http://www.ajkd.org

Schrier Atlas http://www.kidneyatlas.orgSchrier Atlas http://www.kidneyatlas.org

Renal-Tech computer donation projectRenal-Tech computer donation project

Internet videoconferencing, wireless connectivity, Internet videoconferencing, wireless connectivity, panoramas. panoramas.

WWW site http://www.cybernephrology.orgWWW site http://www.cybernephrology.org

Support of NKF and ISN Support of NKF and ISN Programs. Furthering of new Programs. Furthering of new

technologies.technologies.WWW sites: WWW sites:

http://www.cybernephrology.org http://www.cybernephrology.org http://www.isn-online.orghttp://www.isn-online.org

http://www.kidney.orghttp://www.kidney.org

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Support of ISN ProgramsSupport of ISN Programs

COMGANCOMGAN

RENAL-TECH Computer Donation ProjectRENAL-TECH Computer Donation Project

Video Legacy ProjectVideo Legacy Project

ISN ArchiveISN Archive

Sister Centers Program Sister Centers Program

Teaching Resources Teaching Resources

Discussion Groups Discussion Groups

Assistance to National SocietiesAssistance to National Societies

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Support of NKF ProgramsSupport of NKF Programs

KEEP, RISEKEEP, RISE

K/DOQIK/DOQI

PARADEPARADE

People like UsPeople like Us

Spring Clinical Meeting , ASNSpring Clinical Meeting , ASN

Publications Publications

Donor Families, Donor Quilt Donor Families, Donor Quilt

Transplant GamesTransplant Games

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Making Full Use of the Favorable Making Full Use of the Favorable Local Environment in CanadaLocal Environment in Canada

Canada is way ahead of the U.S. in the Canada is way ahead of the U.S. in the deployment and adoption of next-generation deployment and adoption of next-generation broadband services: The cross-Canada high-broadband services: The cross-Canada high-speed network backbone, CA*net3, is the speed network backbone, CA*net3, is the world's first national optical research network.world's first national optical research network.

By the end of this year nearly 17% of Canadian By the end of this year nearly 17% of Canadian on-line homes will have a broadband on-line homes will have a broadband connection compared to 8.6% in the U.S.connection compared to 8.6% in the U.S.

Living example of the success of wireless Living example of the success of wireless connectivity! From University of Alberta to connectivity! From University of Alberta to College Plaza cyberNephrology complex.College Plaza cyberNephrology complex.

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New Operating Systems and New Operating Systems and Electronic Publishing FormatsElectronic Publishing Formats

Palm computing platformPalm computing platform

Macintosh OS 10Macintosh OS 10

LinuxLinux

XML document presentationXML document presentation

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

1.1. Most health care workers using the Internet.Most health care workers using the Internet.

2.2. Access becoming faster, cheaper.Access becoming faster, cheaper.

3.3. Computers themselves inexpensive.Computers themselves inexpensive.

4.4. No longer necessary to type. Voice No longer necessary to type. Voice recognition reaches 98% accuracy and still recognition reaches 98% accuracy and still improving!improving!

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

1.1. Most health care workers using the Internet.Most health care workers using the Internet.

2.2. Access becoming faster, cheaper.Access becoming faster, cheaper.

3.3. Computers themselves inexpensive.Computers themselves inexpensive.

4.4. No longer necessary to type. Voice No longer necessary to type. Voice recognition reaches 98% accuracy and still recognition reaches 98% accuracy and still improving!improving!

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Internet Users Worldwide Internet Users Worldwide June 1999 - Nua Internet SurveysJune 1999 - Nua Internet Surveys

World Total 179.00 millionWorld Total 179.00 million

Africa 1.14 millionAfrica 1.14 million

Asia/Pacific 26.97 millionAsia/Pacific 26.97 million

Europe 42.69 millionEurope 42.69 million

Middle East 0.88 millionMiddle East 0.88 million

Canada and USA 102.03 millionCanada and USA 102.03 million

Latin America 5.29 millionLatin America 5.29 million

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The World is Changing - Now! The World is Changing - Now!

September 26, 2001 New Hewlett Packard CEO September 26, 2001 New Hewlett Packard CEO Carly Fiorina said Tuesday that the world is Carly Fiorina said Tuesday that the world is now entering the "renaissance of thenow entering the "renaissance of theinformation age" -- a time when emerging information age" -- a time when emerging technologies and an "always-on Internet" technologies and an "always-on Internet" could transform human experience and could transform human experience and entire industries. "This world is clearly entire industries. "This world is clearly emerging before our eyes," "The shifts ahead, emerging before our eyes," "The shifts ahead, the opportunities ahead are massive." the opportunities ahead are massive."

September 28, 2001 Major advance in September 28, 2001 Major advance in quantum computing announced.quantum computing announced.

September 26, 2001 New Hewlett Packard CEO September 26, 2001 New Hewlett Packard CEO Carly Fiorina said Tuesday that the world is Carly Fiorina said Tuesday that the world is now entering the "renaissance of thenow entering the "renaissance of theinformation age" -- a time when emerging information age" -- a time when emerging technologies and an "always-on Internet" technologies and an "always-on Internet" could transform human experience and could transform human experience and entire industries. "This world is clearly entire industries. "This world is clearly emerging before our eyes," "The shifts ahead, emerging before our eyes," "The shifts ahead, the opportunities ahead are massive." the opportunities ahead are massive."

September 28, 2001 Major advance in September 28, 2001 Major advance in quantum computing announced.quantum computing announced.

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The World is Changing - Now! ... The World is Changing - Now! ... continuedcontinued

November 21, 1999November 21, 1999Clinton Calls for Widespread Clinton Calls for Widespread Internet Access - The New York TimesInternet Access - The New York Times FLORENCE, Italy -- President Clinton FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their called Sunday for developed nations to ensure their citizens have access to the Internet citizens have access to the Internet "as complete as telephone access," saying "as complete as telephone access," saying that would dramatically reduce the income gap that would dramatically reduce the income gap between rich and poor.between rich and poor.

November 21, 1999November 21, 1999Clinton Calls for Widespread Clinton Calls for Widespread Internet Access - The New York TimesInternet Access - The New York Times FLORENCE, Italy -- President Clinton FLORENCE, Italy -- President Clinton called Sunday for developed nations to ensure their called Sunday for developed nations to ensure their citizens have access to the Internet citizens have access to the Internet "as complete as telephone access," saying "as complete as telephone access," saying that would dramatically reduce the income gap that would dramatically reduce the income gap between rich and poor.between rich and poor.

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

At a gathering of world leaders who adhere At a gathering of world leaders who adhere to "third way" politics, Clinton said one of to "third way" politics, Clinton said one of the greatest domestic problems facing the greatest domestic problems facing developed countries is the "digital divide" developed countries is the "digital divide" that gives those who have computers an that gives those who have computers an enormous advantage over those who do not.enormous advantage over those who do not.

At a gathering of world leaders who adhere At a gathering of world leaders who adhere to "third way" politics, Clinton said one of to "third way" politics, Clinton said one of the greatest domestic problems facing the greatest domestic problems facing developed countries is the "digital divide" developed countries is the "digital divide" that gives those who have computers an that gives those who have computers an enormous advantage over those who do not.enormous advantage over those who do not.

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The Internet in Europe, Asia, and The Internet in Europe, Asia, and Africa - including KenyaAfrica - 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)

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)

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

1. Cost - 1. Cost - Communications reform. Flat rate.Communications reform. Flat rate.

2. High speed Internet access DSL 2. High speed Internet access DSL and cable modem coming, faster and cable modem coming, faster than ISDN and cheaper!than ISDN and cheaper!

3. Language - Increasing success 3. Language - Increasing success with non-English resources on the Internet.with non-English resources on the Internet.

1. Cost - 1. Cost - Communications reform. Flat rate.Communications reform. Flat rate.

2. High speed Internet access DSL 2. High speed Internet access DSL and cable modem coming, faster and cable modem coming, faster than ISDN and cheaper!than ISDN and cheaper!

3. Language - Increasing success 3. Language - Increasing success with non-English resources on the Internet.with non-English resources on the Internet.

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Bandwidth considerationsBandwidth considerations

The Internet in high bandwidth environments:The Internet in high bandwidth environments:

Only 35% of human communication is words. Only 35% of human communication is words. With Internet video conferencing can capture With Internet video conferencing can capture gestures, body language, inflections of the gestures, body language, inflections of the voice, facial expression etc. plus share voice, facial expression etc. plus share images, documents, software applications images, documents, software applications with "shared white board" or complete with "shared white board" or complete remote control of other computer! remote control of other computer! Requres 56 K modem or faster connection. Requres 56 K modem or faster connection. Allows telemedicine/telepathology.Allows telemedicine/telepathology.

The Internet in high bandwidth environments:The Internet in high bandwidth environments:

Only 35% of human communication is words. Only 35% of human communication is words. With Internet video conferencing can capture With Internet video conferencing can capture gestures, body language, inflections of the gestures, body language, inflections of the voice, facial expression etc. plus share voice, facial expression etc. plus share images, documents, software applications images, documents, software applications with "shared white board" or complete with "shared white board" or complete remote control of other computer! remote control of other computer! Requres 56 K modem or faster connection. Requres 56 K modem or faster connection. Allows telemedicine/telepathology.Allows telemedicine/telepathology.

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Bandwidth considerationsBandwidth considerations

The Internet in low bandwidth situations:The Internet in low bandwidth situations:

Web site educational content can be placed Web site educational content can be placed on CD-ROMs cheaply and easily so sites on CD-ROMs cheaply and easily so sites can be accessed without going to the can be accessed without going to the World Wide Web. Email-based low World Wide Web. Email-based low bandwidth discussion has been bandwidth discussion has been enormously successful in nephrology and enormously successful in nephrology and transplantation while WWW-based transplantation while WWW-based discussion has not. So potentially discussion has not. So potentially everyone has access to the Internet everyone has access to the Internet resources that have proven most valuable.resources that have proven most valuable.

The Internet in low bandwidth situations:The Internet in low bandwidth situations:

Web site educational content can be placed Web site educational content can be placed on CD-ROMs cheaply and easily so sites on CD-ROMs cheaply and easily so sites can be accessed without going to the can be accessed without going to the World Wide Web. Email-based low World Wide Web. Email-based low bandwidth discussion has been bandwidth discussion has been enormously successful in nephrology and enormously successful in nephrology and transplantation while WWW-based transplantation while WWW-based discussion has not. So potentially discussion has not. So potentially everyone has access to the Internet everyone has access to the Internet resources that have proven most valuable.resources that have proven most valuable.

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Few Countries Out of Reach!Few Countries Out of Reach!

Almost all countries can benefit from Almost all countries can benefit from Internet-based discussion. Internet-based discussion. Email connectivity has reached almost Email connectivity has reached almost everywhere. Very few exceptions: everywhere. Very few exceptions: Countries lacking Internet access include Countries lacking Internet access include only Afghanistan , Angola, Cape Verde, only Afghanistan , Angola, Cape Verde, the Comoros Islands, Equatorial Guinea, the Comoros Islands, Equatorial Guinea, Libya, Mauritania, São Tome and Principe, Libya, Mauritania, São Tome and Principe, Somalia and Western Sahara.Somalia and Western Sahara.

Almost all countries can benefit from Almost all countries can benefit from Internet-based discussion. Internet-based discussion. Email connectivity has reached almost Email connectivity has reached almost everywhere. Very few exceptions: everywhere. Very few exceptions: Countries lacking Internet access include Countries lacking Internet access include only Afghanistan , Angola, Cape Verde, only Afghanistan , Angola, Cape Verde, the Comoros Islands, Equatorial Guinea, the Comoros Islands, Equatorial Guinea, Libya, Mauritania, São Tome and Principe, Libya, Mauritania, São Tome and Principe, Somalia and Western Sahara.Somalia and Western Sahara.

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"We strongly believe that better telecommunications "We strongly believe that better telecommunications will enhance our ability to deliver improved will enhance our ability to deliver improved quality of life, electronic health and quality of life, electronic health and learning services to previously disadvantaged learning services to previously disadvantaged areas in the continent".areas in the continent".

President Nelson Mandela in an address to the President Nelson Mandela in an address to the Africa TELECOM 98 Exhibition and Africa TELECOM 98 Exhibition and Forum Johannesburg 4-9 May 1998Forum Johannesburg 4-9 May 1998

"We strongly believe that better telecommunications "We strongly believe that better telecommunications will enhance our ability to deliver improved will enhance our ability to deliver improved quality of life, electronic health and quality of life, electronic health and learning services to previously disadvantaged learning services to previously disadvantaged areas in the continent".areas in the continent".

President Nelson Mandela in an address to the President Nelson Mandela in an address to the Africa TELECOM 98 Exhibition and Africa TELECOM 98 Exhibition and Forum Johannesburg 4-9 May 1998Forum Johannesburg 4-9 May 1998

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Factors Influencing Second Phase of Factors Influencing Second Phase of NKF cyberNephrology 2000 - onwardNKF cyberNephrology 2000 - onward

Digital photography now inexpensive and Digital photography now inexpensive and superior/equal to film photography.superior/equal to film photography.

Video panoramas, 3D panoramasVideo panoramas, 3D panoramas

““Virtual microscope” panoramasVirtual microscope” panoramas

Books with “digital paper” pagesBooks with “digital paper” pages

Circuits that combine digital and analog Circuits that combine digital and analog signaling just as the human brain does signaling just as the human brain does

Human-centered rather than machine-centered Human-centered rather than machine-centered computing, near perfect voice recognitioncomputing, near perfect voice recognition

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Factors Influencing Second Phase of Factors Influencing Second Phase of NKF cyberNephrology - ContinuedNKF cyberNephrology - Continued

Gene chip DNA Microarrays for instant genetic Gene chip DNA Microarrays for instant genetic diagnosisdiagnosis

The wearable computer, digital clothingThe wearable computer, digital clothing

The bioartificial kidneyThe bioartificial kidney

Evolution of new ethical standards for e-healthEvolution of new ethical standards for e-health

Quantum computing Quantum computing

Optical switching/Optical Internet Optical switching/Optical Internet

Nanomachines/near molecular level organ repair Nanomachines/near molecular level organ repair in diseasein disease

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Why not talk about distant future of Why not talk about distant future of technology/cyberNephrology?technology/cyberNephrology?

Because if Ray Kurzweil is right and people Because if Ray Kurzweil is right and people and machines will be indistinguishable from and machines will be indistinguishable from each other in 2099, what will be the relevance each other in 2099, what will be the relevance of nephrology then?of nephrology then?

Machines/computers don’t have kidneys !Machines/computers don’t have kidneys !

So follow our progress and So follow our progress and remember: “remember: “Any sufficiently Any sufficiently

advanced technology is advanced technology is indistinguishable from indistinguishable from

magicmagic..””

Contact Contact Kim.Solez@UAlberta.CAKim.Solez@UAlberta.CA

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