1. ISN Informatics Commission and NKF cyberNephrology: The Next Phase and Beyond! Kim Solez, M.D.

2. Slide 2 Key Points ISN Informatics Commission/NKF cyberNephrology partnership ISN Informatics Commission/NKF cyberNephrology partnership New Technologies Division of NKF - Gary Green New Technologies Division of NKF - Gary Green History, Nephrology born of technology. History, Nephrology born of technology. ISN Informatics/NKF cyberNephrology 1997-2000 ISN Informatics/NKF cyberNephrology 1997-2000 ISN Informatics/NKF cyberNephrology beyond 2000 ISN Informatics/NKF cyberNephrology beyond 2000

3. Slide 3 Ray Kurzweil "Technology is the continuation of evolution by other means.... "Technology is the continuation of evolution by other means.... It is in the nature of exponential growth that events develop extremely slowly for extremely long periods of time, but as one glides through the knee of the curve, events erupt at an increasingly furious pace. And that is what we will experience as we enter the twenty-first century." It is in the nature of exponential growth that events develop extremely slowly for extremely long periods of time, but as one glides through the knee of the curve, events erupt at an increasingly furious pace. And that is what we will experience as we enter the twenty-first century." --Ray Kurzweil - The Age of Spiritual Machines, When Computers Exceed Human Intelligence (a)When computers exceed human intelligence - 2020 (b)When computers and humans become indistinguishable from each - 2099

4. Slide 4 Arthur C. Clarke "When a scientist states that something is possible, he is almost certainly right. "When a scientist states that something is possible, he is almost certainly right. When he states that something is impossible, he is very probably wrong. When he states that something is impossible, he is very probably wrong. The only way of discovering the limits of the possible is to venture a little way past them into the impossible. The only way of discovering the limits of the possible is to venture a little way past them into the impossible. Any sufficiently advanced technology is indistinguishable from magic." Any sufficiently advanced technology is indistinguishable from magic." -- Arthur C. Clarke's three laws of technology

5. Slide 5 First Phase of ISN Informatics/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

6. Support of NKF and ISN Programs. Furthering of new technologies. WWW sites: http://www.cybernephrology.org http://www.isn-online.org http://www.kidney.org

7. Slide 7 Support of ISN Programs COMGAN COMGAN RENAL-TECH Computer Donation Project RENAL-TECH Computer Donation Project Video Legacy Project Video Legacy Project ISN Archive ISN Archive Sister Centers Program Sister Centers Program Teaching Resources Teaching Resources Discussion Groups Discussion Groups Assistance to National Societies Assistance to National Societies

8. Slide 8 Support of NKF Programs KEEP, RISE KEEP, RISE K/DOQI K/DOQI PARADE PARADE People like Us People like Us Spring Clinical Meeting, ASN Spring Clinical Meeting, ASN Publications Publications Donor Families, Donor Quilt Donor Families, Donor Quilt Transplant Games Transplant Games

9. Slide 9 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, CA*net3, is the world's first national optical research network. 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, 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. 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. Living example of the success of wireless connectivity! From University of Alberta to College Plaza cyberNephrology complex.

10. Slide 10 New Operating Systems and Electronic Publishing Formats Palm computing platform Palm computing platform Macintosh OS 10 Macintosh OS 10 Linux Linux XML document presentation XML document presentation

11. Slide 11 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! 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!

12. Slide 12 Internet Users Worldwide June 1999 - Nua Internet Surveys World Total 179.00 million World Total 179.00 million Africa 1.14 million Africa 1.14 million Asia/Pacific 26.97 million Asia/Pacific 26.97 million Europe 42.69 million Europe 42.69 million Middle East 0.88 million Middle East 0.88 million Canada and USA 102.03 million Canada and USA 102.03 million Latin America 5.29 million Latin America 5.29 million

13. Slide 13 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. 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.

14. Slide 14 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. November 21, 1999 Clinton Calls for Widespread Internet Access - The New York Times FLORENCE, Italy -- President Clinton 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 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.

15. Slide 15 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. 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. 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.

16. Slide 16 The Internet in Europe, Asia, and Africa - including Kenya 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. 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)

17. Slide 17 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. 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. 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.

18. Slide 18 Bandwidth considerations 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. 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. 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.

19. Slide 19 Bandwidth considerations 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. 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. 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.

20. Slide 20 Few Countries Out of Reach! 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. 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. 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.

21. Slide 21 "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 "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

22. Slide 22 Factors Influencing Second Phase of NKF cyberNephrology 2000 - onward Digital photography now inexpensive and superior/equal to film photography. Video panoramas, 3D panoramas Video panoramas, 3D panoramas “Virtual microscope” panoramas “Virtual microscope” panoramas Books with “digital paper” pages Books with “digital paper” pages Circuits that combine digital and analog signaling just as the human brain does Circuits that combine digital and analog signaling just as the human brain does Human-centered rather than machine- centered computing, near perfect voice recognition Human-centered rather than machine- centered computing, near perfect voice recognition

23. Slide 23 Factors Influencing Second Phase of NKF cyberNephrology - Continued Gene chip DNA Microarrays for instant genetic diagnosis Gene chip DNA Microarrays for instant genetic diagnosis The wearable computer, digital clothing The wearable computer, digital clothing The bioartificial kidney The bioartificial kidney Evolution of new ethical standards for e- health Evolution 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 in disease Nanomachines/near molecular level organ repair in disease

24. Slide 24 Why not talk about distant future of technology/cyberNephrology? Because if Ray Kurzweil is right and people and machines will be indistinguishable from each other in 2099, what will be the relevance of nephrology then? Because if Ray Kurzweil is right and people and machines will be indistinguishable from each other in 2099, what will be the relevance of nephrology then? Machines/computers don’t have kidneys ! Machines/computers don’t have kidneys !

25. So follow our progress and remember: “Any sufficiently advanced technology is indistinguishable from magic.”

26. Contact Kim.Solez@UAlberta.CA To subscribe to NEPHROL send Email to majordomo@Ualberta.CA with the message subscribe nephrol