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Telemedicine, Nephrology,
and Renal Pathology
Kim Solez, M.D.
[email protected]
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
in e-health. Providers no longer
dictate but become partners with
patient or parent.
Slide 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
ClassPoint, practical for developing
countries.
Slide 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.
Slide 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
Slide 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.
Slide 8
Banff Classification
Inflammation does not equal rejection.
Tubulitis suggests rejection,
intimal arteritis diagnostic of rejection.
Three histologic forms, tubulointerstitial,
vascular, and transmural.
Slide 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 C4D findings specific for
chronic rejectiion, antibody mediated
rejection. Donor biopsy classification.
Slide 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.
Slide 11
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)
Slide 12
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
Support of ISN and NKF
Programs. Furthering of new
technologies.
WWW sites:
http://www.cybernephrology.org
http://www.isn-online.org
Slide 14
Support of NKF Programs
 KEEP, RISE
 K/DOQI
 PARADE
 People like Us
 Spring Clinical Meeting , ASN
 Publications
 Donor Families, Donor Quilt
 Transplant Games
Slide 15
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
Slide 16
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 highspeed network backbone, CA*net3, 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.
Slide 17
New Operating Systems and
Electronic Publishing Formats
 Palm computing platform
 Macintosh OS 10
 Linux
 XML document presentation
Slide 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!
Slide 19
Internet Users Worldwide
June 1999 - Nua Internet Surveys
World Total
Africa
Asia/Pacific
Europe
Middle East
Canada and USA
Latin America
179.00 million
1.14 million
26.97 million
42.69 million
0.88 million
102.03 million
5.29 million
Slide 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.
Slide 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.
Slide 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.
Slide 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)
Slide 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.
Slide 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.
Slide 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.
Slide 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.
Slide 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
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