Telemedicine, Nephrology, and Renal Pathology

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Telemedicine, Nephrology, and Renal Pathology

• Kim Solez, M.D.
• Kim.Solez_at_UAlberta.CA

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A transition Telemedicine, telehealth, e-health

• The primary care physician of the future is the
  patient (or parent) !

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e-health Consumer-drivenTelemedicine 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.

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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 ClassPoint, practical for developing countries
.
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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.
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Internet technologies the ideal way to build
consensus
Three examples ISN Disaster Relief Task
Force ISN Consensus Conferences - COMGAN Banff
conferences on allograft pathology
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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.
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Banff Classification
Inflammation does not equal rejection. Tubulitis
suggests rejection, intimal arteritis diagnostic
of rejection. Three histologic forms,
tubulointerstitial, vascular, and transmural.
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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 C4D
findings specific for chronic rejectiion,
antibody mediated rejection. Donor biopsy
classification.
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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.
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Origins of cyberNephrology
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)
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First Phase of 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

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

• WWW sites
• http//www.cybernephrology.org http//www.isn-onli
  ne.org

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Support of NKF Programs

• KEEP, RISE
• K/DOQI
• PARADE
• People like Us
• Spring Clinical Meeting , ASN
• Publications
• Donor Families, Donor Quilt
• Transplant Games

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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

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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, CAnet3, 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.
• Living example of the success of wireless
  connectivity! From University of Alberta to
  College Plaza cyberNephrology complex.

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New Operating Systems and Electronic Publishing
Formats

• Palm computing platform
• Macintosh OS 10
• Linux
• XML document presentation

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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!
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Internet Users Worldwide June 1999 - Nua
Internet Surveys

• World Total 179.00 million
• Africa 1.14 million
• Asia/Pacific 26.97 million
• Europe 42.69 million
• Middle East 0.88 million
• Canada and USA 102.03 million
• Latin America 5.29 million

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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.
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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.
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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.
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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)
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.
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The Internet in Europe, Asia, and Africa -
including Kenya - 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.
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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.
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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.
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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.
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"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
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