I know you have adopted the Internet early on as a technology, can you tell me what got you started?

The origin of my interest in the Internet was two-fold , something general and something specific. First, the general stimulus:

In the fall of 1994, when the growth of the web was starting in log phase, I recognized that no substantial nephrology resources were being created there and so I sensed a significant opportunity. My interest in communications goes back to my activities with the International Society of Nephrology http://www.isn-online.org, http://www.renal-tech.org and the various consensus-generating activities. For instance, the Banff Conferences on Allograft Pathology, which Dr. Lorraine Racusen and I have conducted over the past ten years http://cnserver0.nkf.med.ualberta.ca/Banff/ and the Future of Pathology and Laboratory Medicine in Canada Consortium http://www.med.ualberta.ca/lmp/000p0000.htm. In all of these efforts, effective communications were a key element. So creating resources on the Internet in 1994 seemed a natural extension of those other activities.

Second, the specific stimulus is mildly amusing:

When I finished the two year Future of Pathology and Laboratory Medicine in Canada Consortium project in 1994, I received a great deal of praise for the report we generated. However, no one in a position of authority seemed to actually want to receive the report (perhaps because then they would be expected to act on it!). The responses were quite comical: "Please don't send it by courier." "Yes, I think I saw something from you on my desk but I haven't opened it yet." "Perhaps we should vote on whether we wish to actually receive the report." I recognized that the Internet represented the ideal countermeasure to this attitude and so the site for the report http://www.med.ualberta.ca/lmp/000p0000.htm was the first WWW site we created.

I know you have done a lot of interesting things with the Internet. Tell me about some of the things you have done?

There are many things we could talk about here. Many are firsts in renal medicine but not firsts when one considers all medical specialties. We transmitted the first renal biopsy images over the Internet and we did the first Internet based videoconference (Edmonton-Milan) in renal medicine. In 1995, the Third Banff Conference on Allograft Pathology we held was the first International Medical Meeting that could be virtually attended via the WWW and CD-ROM. Our Email discussion groups have been very successful, especially NEPHROL and NEPHKIDS. You can find many of our more recent accomplishments under the "What's New" button at the upper left of the http://www.cybernephrology.org page. Also, I would like to bring your attention to the Renal-Tech project http://www.renal-tech.org and our recent "wiring" of Kosovo, Cuba, and Nepal. I feel it is important to mention that while our visits to these countries are necessary and valuable, they are just a preliminary part of the work we do. We seek to develop sustainable relationships with our colleagues in other countries and to use e-mail and the Internet to foster continued communication.

Our greatest academic accomplishment thus far has been the on-line presentation of the Schrier Atlas of Diseases of the Kidney. When Dr. Robert Schrier approached me to take on the cyberNephrology initiative for the National Kidney Foundation in early 1997, he mentioned in that conversation that he was creating a five-volume textbook with 2,500 images covering all areas of renal medicine, which he had specifically designed with the idea of having this appear on the web. This 66-chapter resource had been designed to be image intensive and most of the text is in figure legends rather than traditional text. This made it visually extremely interesting to look at on a computer screen. I knew that Dr. Schrier himself did not use computers (remember that there was a time when young people with promise did not learn to type!) and so that the fact that he had had the insight to create such a wonderful web-adapted resource really impressed me. The activity it has generated since we created the site for it http://cnserver0.nkf.med.ualberta.ca/cn/Schrier/Default9.htm in early 2000 has been nothing short of amazing! The site has generated up to 120,000 hits on-line a month and up to 5,600 unique visitors a month. Former Churchill Livingstone CEO Bill Marovitz and I spent Christmas and New Years preparing the Schrier Atlas site but it was well worth it! There are many firsts represented by the site including a really excellent search engine and the addition of PowerPoint files that allow the reader to create their own slide set for tailor-made presentations on any area of renal medicine in whatever language they wish at whatever level of complexity.

How did http://www.cyber-medicine.org/ come about?

I suppose I have had the idea for something like http://www.cyber-medicine.org for quite a long time. When the NKF cyberNephrology initiative began in 1997, I was approached by publishers about the possibility of providing to other medical specialties, for a fee. The experience we had gained creating Internet resources in renal medicine allowed us to use our constructs we had employed in other medical disciplines. This idea of providing consultant expertise to other medical disciplines was discussed at the cyberNephrology board meeting in the spring of 1998, but at the time it seemed like an unwelcome diversion from our ongoing programs in nephrology. The idea resurfaced when our new Chairman of Laboratory Medicine and Pathology, Dr. Victor Tron came to Edmonton in mid 1999. He suggested to me that we consider creating a cyberMedicine entity locally at the University of Alberta hospitals. We began doing some preliminary planning for that but it was still a pretty undifferentiated idea.

Just recently, I discovered that Medical Matrix, which I had not looked at for three years, had given top five star billing to two of the Internet resources with which we were associated (the Schrier Atlas and the K/DOQI site of http://www.kidney.org). K/DOQI is the name for the comprehensive clinical practice guidelines the NKF has developed to improve the treatment of chronic kidney disease. This surprising discovery made me look at the Medical Matrix data more carefully. That then led to the analysis of Medical Matrix data and the search for Internet innovations amongst the various on-line offerings across all areas of medicine, which now appear on the cyber-Medicine.org web site.

Cyber-Medicine and cyberNephrology are formally quite separate, housed in different physical spaces within the local medical school complex. Of course, intellectually many of the ideas that went into cyber-Medicine came from our experience in cyberNephrology.

The basic idea behind the cyber-Medicine site is quite intriguing. To me, it is one of the most satisfying things in life to find the world obviously poised to do something that they do not know they are about to do! And that is the situation here. People are creating very high quality resources in individual medical disciplines with very little incentive to see what others are doing outside. All I have done is stimulate people to move in the very obvious direction of sharing innovations between medical disciplines. Some people have used the analogy of "communal intelligence" as Lewis Thomas has described in some of his writings. But I am not sure that the analogy between what we are up to here and the anthill for instance is very appropriate. In the case of the anthill, each individual ant is not very smart or innovative. It is only the aggregate activity of the whole anthill that represents an intelligence to be reckoned with. Our situation is quite different. The individuals creating resources within the individual medical specialties are high skilled and innovative. Therefore, think of how much more we can create when we start sharing the information about innovations between medical disciplines!

Cyber-Medicine's goals are essentially two-fold. First, to evaluate medical resources currently available, presenting them in a manner that will encourage cross-fertilization among medical specialties. Second, to assist the medical community to keep pace with the new technological tools developing at unprecedented rates. Both of these goals rely on consensus, cooperation, and contribution from the medical community.

What audience are you reaching?

I guess there are three aspects of this: numbers, breadth, and "stickiness". The stickiness of the cyber-Medicine site does not yet equal that for the Schrier site, but we are getting there! Current average visit length is about 2 minutes compared with 6 minutes for the Schrier site. Of course cyber-Medicine.org has been up less than a week while the Schrier site has been up since the beginning of 2000 and has developed a large committed audience. Of course, Schrier is a textbook to be studied; a different purpose from cyber-Medicine's at the moment. We hope that since the interest spanned by cyber-Medicine is so much larger, our ultimate audience should be much larger. Right now we are drawing up to 300 new visitors a day. The top twenty countries reached thus far are:

We urge everyone who reads this interview to become a part of our audience and participate!

What has the reaction been to cyber-medicine.org, so far?

I would say that few things I have ever done have elicited such a positive response so quickly! It really has been very gratifying. Many of the responses suggest a light bulb going on as people realize that this is a really good idea!

How do you see cyber-medicine.org developing and what do you want to accomplish in the future?

The ultimate plan is that the cyber-Medicine site will have many other excellent educational products linked to it from all areas of medicine and the cyberNephrology site will have similar renal products beyond Schrier linked to it. Of course, with the emphasis on quality and innovation on the cyberMedicine site, we have set the bar very high. So, the resources we put on that site will have to meet a very high standard indeed!

I know your work and I realize what you do is a labor of love. Are you getting funding or outside assistance to support cyber-medicine?

We are actively searching for funding and are encouraged by the current dialogues we are engaged in.

What role do you see Telehealth playing in this?

I look upon the telehealth community, and this resource in particular, as a possible avenue to dimensions of added value: funding opportunities and Internet-based health innovations.

I know you are somewhat involved in international efforts. Can you tell me about these?

I have been involved in organizing international symposia on acute renal failure since 1982 when I was at Johns Hopkins Medical Institutions in Baltimore. These involved an extensive international communications network. When I moved to Edmonton, Canada in 1987 to accept the Chairmanship in Pathology at the University of Alberta, fax became the main medium of communications keeping this network going. The network expanded considerably in 1989 when I established the Acute Renal Failure Commission of the International Society of Nephrology and its Disaster Relief Task Force to provide dialysis aid to patients with crush injury induced acute renal failure following earthquakes. In 1994-95, fax gradually gave way to the Internet as the primary means of communication. Michele Hales played a key role in helping to establish our Internet presence and in organizing our international activities. In 1997, I stepped down from the leadership of the Acute Renal Failure Commission and formed the ISN Informatics Commission and NKF cyberNephrology. In 1998, the Renal-Tech project was initiated under the leadership of Zina Munoz. This project http://www.renal-tech.org involves computer donation and training assistance to developing countries. We recognized that in order to reach our colleagues in some of these countries, we needed to provide them with equipment and Internet connections. In doing so, we have provided the means for them to participate in the global medical community. I was part of a fact-finding mission to Kosovo in December 1999 and then the definitive trip there by Zina Munoz, Mark Adams, and Wendy Brown took place in June. The June trip was followed in July by a trip organized by the ISN Acute Renal Failure Commission now headed by Dr. Norbert Lameire. Our efforts in Kosovo are part of a much larger program of Internet assistance to the country, which is still very active, highlighted in a special CNN report http://www.cnn.com/SPECIALS/views/effect/2000/08/sher.kosovo.aug22/index.html. One additional international activity I would like to mention is The National Kidney Foundation, which has spearheaded the formation of the International Federation of Kidney Foundations. I have been involved in the communications side of that effort. The first major meeting of IFKF will occur in Capadoccia, Turkey this September.

I have heard a few people say that Canada is behind the US in cyber-medicine. What is your view of that statement?

As a U.S. citizen now living in Canada for 13 years, I guess I can see both sides of that question. Canada is a less aggressive, more polite and genteel country than the U.S. with a high standard of living and great tradition of compromise. The critical mass question is always there. Are there enough Canadians concentrated in one place or on one effort to really "do" something! Recent statistics show that Canada has some distinct advantage in Internet resources. Canada is way ahead of the U.S. in the deployment and adoption of next-generation broadband services http://www.ualberta.ca/CNS/PUBS/next-gen.html. 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. http://cyberatlas.internet.com/big_picture/geographics/article/0,,5911_434711,00.html. But it would take someone with a bit of uncompromising passion to stir up the country and maintain an edge over the US. I am trying to stir up some of that passion, but have succeeded only in engendering a kind of bemused suspicion and tolerance thus far!

How do see cyber-medicine.org one year from now and five years from now?

In a year from now I would hope to have at least four major educational resources linked to cyber-medicine.org in the same fashion that we now link the Schrier Atlas to cybernephrology.org. I would also expect it to become a major force promoting the development of high quality Internet resources across all areas of medicine. Five years from now I would hope that it has become a major portal for medicine on the Internet and was employing many of the technological innovations discussed in our recent ISN Newsletter piece, "Technology and the ISN: cyberNephrology and the Informatics Commission".

Obviously, our initial goal is to get the word out about cyber-medicine. The rate at which the Internet is growing makes this a continuing process. Eventually, we would like to see cyber-medicine as a clearinghouse for information on technological developments in medicine and present this information in a manner relevant across medical specialties.

I think it would be interesting to develop a special "Cyber-Med Successes" column where subscribers could describe their own successes achieved through the sharing of new technology, or through a combined-specialty approach to solving a problem. Similarly, the development of a "Cyber-Med Needs" column would allow subscribers to ask others if there is already a potential solution already in existence out there (a process, tool, material, etc.) that might help them solve a particular problem.

I think those ideas would help trigger a lot of imagination and promote Cyber-Med as a huge think tank. It could be a place that would be most appealing to people with ideas, including the researchers and the inventors. Also, we might consider the development of a Cyber-Med Email discussion group where people can exchange ideas and info on-line, differentiated in some way from existing groups.

What do you want to say to your peers out there and what advice would you give them?

Computers are your friends! Seriously.

Never be afraid to start something when you know that is of value and stick with it. Don't be afraid to take the long road and follow something through to success. The ISN Disaster Relief Task Force took 10 years to be fully successful and http://www.cyber-medicine.org/ is showing some signs of success after only one week but has a six-year background. Both were very worthwhile spending time on. Seek intrinsically rewarding work, work with obvious value where you can stay committed without praise or external reward, and where your family and friends can readily understand why you are doing what you are doing.

Dr. Kim Solez is Professor of Pathology at the University of Alberta in Edmonton, Alberta, Canada and Director of NKF cyberNephrology, a joint venture between the National Kidney Foundation, U.S. and the University of Alberta. He also is Chair of the Commission on Nephrology Informatics of the International Society of Nephrology. He was the Chair of the ISN Commission on Acute Renal Failure from 1989 to 1997 and started the ISN Disaster Relief Task Force. He is also one of the world's foremost renal pathologists. There is further background data at: http://www.kidney.org and http://www.isn-online.org and media coverage at: http://www.cybernephrology.org/education/eduPress.htm