Published on February 15, 2014
Slide 1 ISN COMGAN Bellagio Conference Electronic Strategies for Information and Research Kim Solez, M.D. around the World Improving Nephrology
Electronic Strategies for Information and Research: cyberNephrology in the Emerging World Kim Solez, M.D.
Slide 3 Technology and sustained relationships. Meeting with Ivor Katz, Sept. 18, 1997
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.
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.
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
Technology Evolution Need Not be Complex! Machines should serve human beings, making our lives easier. The latest technology in cell phones, the windup charger.
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:
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
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
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.
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.
Email Discussion Groups Slide 13
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."
Internet Now Mainstream Searching - A Wonderful World Out There!
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
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.
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
Slide 25 Renal-Tech Visits Led to ISN Sister Center Relationship Administrator Ram Dulal now obtaining Ph.D. in Germany.
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/
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
Methods: Supercourse model Teacher in Alexandria Teacher in Tanzania Teacher in Paris Slide 28 Teacher in Cairo Teacher in Pittsburgh Teacher in Moscow
Metodi: il modello Supercourse Docente a Alessandria Docente in Tanzania Docente a Parigi Slide 29 Docente al Cairo Docente a Pittsburgh Docente a Mosca
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.
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
Slide 32 Regional Centers: Using Internet videoconferencing, other informatics tools to enhance communications.
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
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
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.
Internet Video Conferencing Remote Collaboration/ Education/Telemedicine
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.
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)
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.
Dedicated Internet VideoConferencing Equipment Practical Now in Many Regions.
In 2003-2004 iSight and iChatAV on Mac G4/G5 computers practical in most areas of world.
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.
Can send images in iChatAV by just dragging image icon to chat window.
Telepathology as a Subset of Telemedicine
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.
Slide 46 The Camera to Buy Changes Daily! Becoming cheaper, better. The Nikon Coolpix 990 with MXB29005 adaptor
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!
Slide 48 Convergence - Not just devices.
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.
The link between advertising and educational psychology. Slide 50
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.
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.
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.
Slide 54 Becoming the model - Expanding to other related areas of medicine: diabetes, hypertension, cardiovascular, crit.care.
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.
Be the catalyst in a coalition! Slide 56
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