GHDonline.org: Year in Review

GHDonline.org is a collaborative, virtual forum for professional exchange developed by the Global Health Delivery (GHD) Project at Harvard University. The GHD Project creates public goods and professional networks in global health to systemize health care delivery.

GHDonline.org members – clinicians, administrators, architects, engineers, students, health care volunteers, policymakers, academics, and others – engage in discussions and share resources about specific health delivery challenges. Membership is free, and the site is lightweight, intuitive, and translatable.

As of January 1, 2012, GHDonline.org’s nine public and 51 private communities included nearly 6,000 members representing 1,900 organizations across 148 countries. Communities are moderated by experts who facilitate discussions, encourage participation, answer urgent questions, and discern which information is relevant and applicable. By capturing real-time experiences from the field, whether the proper ventilation of laboratory space and use of respirators or a call for help, GHDonline.org ensures that the lessons from our daily work are not lost in the tyranny of the urgent. Rather, they become adaptable learning tools to solve delivery challenges in multiple contexts.

"This is a good opportunity for an organization like mine working in the rural communities to share in their experience."(From the GHDonline.org Expert Panel, ‘Strengthening Health Systems: The Role of NGOs’)

Eucharia Samuel, Community Health Worker, AMPATH, Nigeria

Building and Connecting Communities in Health Delivery

For the past three years we have learned how to build, manage, and integrate professional virtual communities. GHDonline.org’s public communities are launched after a stakeholder analysis of current resources for professionals and health delivery. The public communities are not necessarily meant to be stand-alone channels of communication; GHDonline.org fosters connection and bridges conversation across communities:

Leveraging Expertise

The talent, expertise, and curiosity of our members and moderators continue to be key to GHDonline.org’s success. Between December 31, 2010 and December 31, 2011, the GHDonline.org membership base increased by 59%, from 3,700 to 5,900 members. Our new members include engineers, researchers, architects, policymakers, advocates, pharmacists, community health workers, physicians, managers, midwives, program officers, nurses, and social workers. GHDonline.org users speak 117 languages and work in all time zones. In 2011, the site was viewed more than 400,000 times, members shared 1,103 new resources and engaged in 1,556 new conversations.

Expert Moderators

This past year, GHDonline.org recruited 8 new expert moderators. They joined a dedicated team of over 20 GHDonline.org moderators who are clinicians, researchers, professors, and leaders in their fields. They live in 11 countries and infuse the discussions with unique insights, enthusiasm, and creativity. In 2011, our moderators provided advice on a range of issues, from unique identifiers for medical records to protocols on outdoor sputum collection for tuberculosis infection control.

Meet our moderators

Joaquin Blaya, PhD: Connector, Innovator, Health IT Expert

Joaquin Blaya, PhD, is the co-founder and CIO of eHealth Systems, a Chilean company that offers eHealth strategies and open source solutions to companies. Joaquin is a member of the Bellagio eHealth Evaluation Group and was named one of the Leading Mobile Health Innovators of the Year in 2011 by the mHealth Alliance and the Rockefeller Foundation for his work on MiDoctor, a system that uses phone calls, SMS and electronic medical records to support patients with diabetes and other chronic diseases. joaquin has been a moderator of the health it community with ghdonline.org since 2009.

Edward Nardell, MD: Expert in TB Infection Control

In 2007, we recruited Dr. Edward (Ed) Nardell to join us as the first GHDonline.org moderator. Paul Jensen from the Centers for Disease Control and Prevention and Dr. Grigory Volchenkov from the Vladimir Oblast Tuberculosis Dispensary in Russia soon joined Ed to form the first cohort of moderators supporting the TB Infection Control community on GHDonline.org.

With decades of experience, Ed was searching for a public space to create an interactive archive of TB infection control knowledge that others could search and build upon. From the early 1980s, when he worked on TB control for the Massachusetts Department of Public Health, to 2005 when he joined the Brigham and Women’s Hospital, Ed’s work focused on controlling the transmission of TB and multidrug resistant tuberculosis (MDR-TB) in high-burden countries. By moderating GHDonline.org, Ed can now discuss the most pressing and perplexing issues in TB with global colleagues, and offer his honed expertise. Over four years later, Ed, Paul, and Grigory have advised and connected more than 2,100 professionals working on TB infection control, from architects to national TB program managers.

The community has become an intrinsic part of Ed’s work. He introduces GHDonline.org at conferences and keeps in touch with participants and faculty of training programs. Alumni of his summer course at the Harvard School of Public Health, "Engineering Methods to Control Airborne Infections – An International Perspective," stay connected via the GHDonline.org TB IC community, where content from the course is available to all at no cost.

Expert Panels

In 2011, GHDonline.org hosted 12 Expert Panels, virtual asynchronous conferences where community experts address a specific topic. Unlike traditional conferences, there are no fees and no travel expenses. Members with only intermittent internet access can opt to receive email digests of the discussion, and respond back via email. The panel’s key insights are compiled into a two-page Discussion Brief and published on GHDonline.org. Discussion Briefs are summaries of the most vibrant and timely discussions. In 2011, we added 19 new Discussion Briefs to the series.

Expert Panel Spotlight

In November 2011, we hosted "Strengthening Health Systems: The Role of NGOs," an Expert Panel moderated by Dr. Agnes Binagwaho, Minister of Health of Rwanda, and practitioners from The Access Project, Health Alliance International, Partners In Health, and Tiyatien Health.

Participants commented on partnerships between NGOs and Ministries of Health, including the challenges of administering joint programs, building human resource capacity, and managing infrastructure needs.

We promoted the panel through blog posts, social media (Twitter, Facebook and LinkedIn), and via emails to our members and professional networks. The panel generated over 120 contributions and more than 430 people from 64 countries followed the discussion.

In the first quarter of 2012, we will host panels on surgical training in resource-limited settings, telemedicine, insecticide efficacy and mosaic spraying against malaria, management of second line anti-TB drugs, and TB laboratory capacity. Future panels will include multimedia (e.g. video) when valuable, or panels in other languages such as French, Haitian-Creole, Spanish, Russian, or others.

Clinical Exchange

Over 250 physicians in Rwanda and Boston have cultivated a robust private community on GHDonline.org called Clinical Exchange. The Clinical Exchange community is home to a variety of de-identified medical cases and consults on diagnostic and therapeutic decisions.

In 2011, we introduced a standardized form to present cases, published a list of evidence-based clinical guidelines, recruited new specialists to join the community, and attracted new moderators.

From the Field: A Clinician’s perspective

In a recent essay in the Annals of Internal Medicine, Dr. Michael Postow reflects on diagnosing a rare HIV-related cancer in Rwanda. The patient had been lost to follow-up for two years and presented with an occluding mass. Postow and his Rwandan colleagues performed a biopsy and collaborated on GHDonline.org’s Clinical Exchange community to determine the diagnosis and treatment course.

Postow recounts the complexity of managing this patient, and "the Internet helped provide the solution." His essay addresses the challenge of providing curative versus palliative care in a country with limited resources.

A Patient’s perspective: 18-year-old Rwandan Cancer Survivor

In the Non-Communicable Diseases community, Claudine Humure, 18, shares her story as patient in Rwanda with a cancer diagnosis. She received treatment in Boston and hopes to advocate for expanding cancer care in resource-limited settings.

She shares a message of hope with patients:

Valuable Partnerships for Content

GHDonline.org partners with UpToDate, Inc®—an online, evidence-based, peer-reviewed clinical information resource for clinicians—to manage its International Grant Subscription Program. Qualifying organizations that provide medical care or related services, including medical education, in resource-limited settings apply through GHDonline to receive one-year, complimentary UpToDate® subscriptions.

The GHDonline—UpToDate® partnership has produced 122 grantees. In 2011 alone, organizations that were granted a subscription through GHDonline reached 170,000 patients, worldwide, every month.

GHDonline.org provides important information on the conditions of the grant program and includes the entire application form for prospective applicants. Grantees have access to GHDonline’s nine public communities and a private GHDonline community where they can share feedback, access training and grant materials, and connect with other grantees. The GHDonline—UpToDate, Inc.® partnership improves access to clinical information for better health outcomes through online collaboration.

An Adaptable Platform

The GHDonline.org platform was developed entirely in-house using existing open source software, allowing us to tailor the platform as needed. By having direct control over the development and direction of the system, we can keep our focus on our primary customers: our members. There is no charge for our members to use the service and we engage with our members as we make improvements.

We regularly solicit member feedback in order to improve the software so it evolves alongside the needs of our communities. For example, in 2011, we upgraded our search engine to provide a better search experience for our members. We also upgraded our hosting infrastructure to improve the site performance in geographically-remote settings.

The most visible change for GHDonline.org members was based on collecting over a year of user feedback: we redesigned our interface and added new features. Select improvements include:

• Dashboard with tailored activity feeds that capture the most active conversations.

• Recommendation tool for members to promote the most useful discussions.

• Streamlined uploading of multiple resources to a discussion or reply.

• Enhanced speed and site performance.

Future Collaborators

Our goal in 2012 is to expand the global reach of GHDonline.org, and we need your help. Please consider the following ways to get involved.

1. Share this report and let others know what we’ve accomplished in 2011.

2. Invite your colleagues to join GHDonline.org. Send a short email about GHDonline.org to your fellow researchers, practitioners, students and others who are passionate about improving global health care delivery.

3. Ask a question. Start a new discussion in one of your communities by asking a question. Maybe it’s a question you have for others, or maybe it’s a question others often ask you – answer it once on GHDonline.org and share a link to the discussion when the topic comes up again.

4. Participate or organize an Expert Panel discussion. Is there a topic you’d like to discuss or see addressed by experts in your GHDonline.org community? Email us: your idea, and we’ll work with you to make it happen.

5. Volunteer as a Guest Moderator for your community. Want to lead discussions on your area of expertise, answer questions and help members make connections? Email us to volunteer for 3 to 6 months as a Guest Moderator in your community.

The Global Health Delivery Project prepared this year in review with support from the Abundance Foundation, The Pershing Square Foundation, the Leon Lowenstein Foundation, the Schooner Foundation, and the Bill and Melinda Gates Foundation.

Additional support provided by GHD’s institutional partners: Harvard Medical School, Brigham and Women’s Hospital, and the Harvard Business School’s Institute for Strategy and Competitiveness.