The Computerworld Honors Program
Honoring those who use Information Technology to benefit society
LOCATION:
Baltimore, MD, US

YEAR:
2007

STATUS:
Laureate

CATEGORY:
Healthcare

NOMINATING COMPANY:
Polycom

ORGANIZATION:
Johns Hopkins

PROJECT NAME:
Center for Clinical Global Health Education

Short Summary
Integration of videoconferencing technology, multimedia webcasting, and recording provide a cost-effective infrastructure for e-learning, clinical training, and research collaboration between Johns Hopkins faculty and health providers in resource-limited regions of the world, facilitating improved clinical care, increased capacity, and delivery of rapidly changing infectious disease diagnostics and treatment guidelines.

Introductory Overview
Based on the 2006 World Health Report, the United States has 38 percent of the global healthcare workforce taking care of approximately 10 percent of the global burden of diseases compared with Africa that has only three percent of the global healthcare workforce taking care of 25 percent of the global burden of disease. Studies show that survival rates for diseases like HIV, TB and malaria have a direct tie to the learning and experience of those giving medical care. Training doctors, nurses and paramedical workers as well as medical and nursing students will improve the health of the people they serve. Recently, access to life-saving medications has given hope to communities and nations that toil under the burden of HIV/AIDS, but these lifesaving medications require a specialized knowledge base in order to be used effectively and safely.

Global infectious disease epidemics in many regions of the world are overwhelming the capacity of clinics and hospitals to take care of the high number of patients. Increasing the local capacity to care for more patients requires attracting and training more health care providers, and increasing the core expertise of existing physicians and nurses. The Johns Hopkins Center for Clinical Global Health Education (CCGHE) enjoys a broad network of partnerships with other Johns Hopkins Centers and Institutes with specific expertise and international relationships in more than 70 countries around the world. With this in mind, the CCGHE set out to bring the expertise, collaboration, and training of world-renowned Johns Hopkins clinical faculty directly to those with the greatest need through the use of modern technology like telemedicine and distance learning.

The mission of the telemedicine program within the CCGHE is 1) to provide clinical care training of health care providers in resource-limited settings, 2) to provide research training for clinicians in resource-limited settings, and 3) to demonstrate improved health outcomes among patients of trained health care providers. With this mission in mind, specific goals were established: Development of in-country expertise in clinical care, clinical training, and evaluation of local clinical outcomes without removing the provider from their daily practice environment and patient-care demands; participation of in-country experts; impact multiple levels of healthcare delivery to physician specialists/consultants, primary care physicians, nurses, paramedical workers, pharmacists, and others; locally appropriate, but high, standards for “certification” of clinical expertise; sustainability and long-term continuing distance education programs.

Existing technology and connectivity within developing countries was a key consideration in the deployment of any technology. To achieve these goals, the CCGHE sought the use of three major technology providers, Polycom, Sonic Foundry’s Mediasite, and Moodle in conjunction with Articulate Instructional Design Software. Polycom’s interactive video collaboration solutions allow for real-time media and multipoint conferencing with our global audience - groups include Ethiopia and India, currently. Mediasite technology synchronizes what is said with any visual aids, and instantly streams both over the Internet and offers storage for on-demand viewing through any web browser. Mediasite technology allows for modification to recorded files to accommodate an audience with low-bandwidth connectivity.

Moodle is a free Open Source course management system that allows the CCGHE to create distance education courses integrating Mediasite content and Articluate Quizmaker’s SCORM-compliant online testing. When possible, online learning modules are punctuated with live Q&A sessions through Polycom videoconferencing where course participants may present cases and seek advice related to the care of patients in their practice setting. The use of this technology by our global partners requires no program downloads on their part, because downloads are not always available to users who access our programs on public computers in hospitals and Internet cafe’s.

Benefits
Has your project helped those it was designed to help?   Yes

What new advantage or opportunity does your project provide to people?
The technology employed by the CCGHE provides multiple advantages to the global communities and providers served, including: customized, on-demand e-learning content punctuated with live question and answer sessions; collaborative meetings with data sharing; access to world-renowned faculty in infectious disease, such as Drs. John Bartlett, Joel Gallant, and Jean Andersen, leading authorities in HIV/AIDS. (see appendix 1)

Before the development of any distance educational content, the CCGHE partners with an in-country regional center. Collaboration though videoconferencing with these local partners produces a needs assessment which allows timely distance educational content to be tailored to the providers’ specific local health priorities, connectivity, medications and diagnostic tools available to that community. Johns Hopkins faculty experts are then assembled to create a customized curriculum and live Q&A sessions that meet these needs and provide locally relevant training using cost-effective e-learning technology.

Discussion of patient cases has been shown to be the most effective way to learn as a health care provider. Within the Infectious Disease Division of Johns Hopkins Medicine, weekly case discussions (Grand Rounds) take place which provide interactive clinician training on an in-depth range of infectious diseases for students and trainees. Through the CCGHE programs, access to this advanced training is now available to anyone with an Internet connection. Weekly Infectious Disease Grand Rounds are streamed live and captured for on-demand available via the Internet (see appendix 2). With the use of Mediasite technology, live viewers globally can use the “Ask” and “Polls” feature to interact with the presenters by asking questions and voting on a differential diagnosis for the case presented. Since June 2005, 102 adult and 62 pediatric case presentations and interactive discussions have been freely available worldwide for on-demand viewing. Our data indicate that our archives are accessed by over 100 countries and average 1000 views per month.

Has your project fundamentally changed how tasks are performed?   Yes

How do you see your project's innovation benefiting other applications, organizations, or global communities?
Global infectious disease epidemics in many regions of the world are overwhelming the capacity of clinics and hospitals to take care of the high number of patients. The advantages of this customized telemedicine program create several opportunities for our global partners and communities. The CCGHE helps limit “Brain Drain”. A brain drain or human capital flight is an emigration of trained and talented individuals to other nations or jurisdictions, due to conflicts, lack of opportunity or health hazards where they are living. Brain drain can also occur when individuals who study abroad and complete their education do not return to their home countries. The telemedicine and e-learning programs offered by the CCGHE use proven learning methodologies which empower persons with knowledge and most importantly, provide and promote in-country training through remote access to experts in content areas most relevant to their patient care needs.

The Importance of Technology
How did the technology you used contribute to this project and why was it important?
Timely, up-to-date clinical training for health providers is critical for effective patient care. This is especially true in the rapidly changing world of infectious diseases. “The need is real,” Dr. John Bartlett says, a world renowned HIV and infection specialist. “Our efforts to deal with AIDS on a global level have just begun. But if we’re persistent, these advances will benefit everyone, not just the lucky ones.” Delivering the necessary clinical training to countries that can ill afford to lose health providers to travel requires a complementary system of technology able to be integrated with global communities with varied connectivity. With such technology, poorly funded groups in many global communities can have the opportunity to be educated in new discoveries and advances in infectious diseases.

India has the largest buden of HIV-infected patients in the world (>6 million). Through the CCGHE programs, a series of cost-effective telemedicine/e-learning courses for providers has been initiated. To date, more than 300 health care providers in Pune, India have participated in one of these CCGHE HIV care training courses. Without this program, access to this training would not have been possible for these physicians.

Originality
What are the exceptional aspects of your project?
The use of videoconferencing and e-learning is not new technology. However, the deployment of this technology to create customized clinical care and research training specifically focused on resource-poor regions of the world is novel.

How is it original?
Internet usage is growing rapidly. According to Internet World Stats (www.internetworldstats.com), Africa has seen a 600-percent growth in usage over the last six years. Taking advantage of the Internet to connect renowned expertise with globally remote learners in the poorest of communities is a necessary step.

Hopkins was approached by Internet2 and the World Bank Group to develop an interactive, online clinic for use with India. Using the Polycom technology and the high broadband connectivity of Internet2, the CCGHE telemedicine program developed the first Indo-US Internet2 program. In October 2006, Hopkins doctors engaged in an interactive HIV/AIDS clinic with doctors in three different Indian facilities. All told, the program connected eight U.S. institutions with three in India.

Besides lively medical debate through DVD-quality video conferencing, the clinic included high-resolution digital microscopy, three-dimensional MRIs and an interactive representation of HIV drug resistance. (see appendix 3)

Is it the first, the only, the best or the most effective application of its kind?   First

Success
Has your project achieved or exceeded its goals?   Achieved

Is it fully operational?   Yes

How many people benefit from it?   10,000

If possible, include an example of how the project has benefited a specific individual, enterprise or organization. Please include personal quotes from individuals who have directly benefited from your work.
Ethiopia has an estimated 1.7 million people that are HIV-infected, and 96,000 are children under the age of 15. In 2003, using videoconferencing technology, working with the Ethiopian North American Health Division of Infectious Diseases, the CCGHE provided three training modules in HIV/AIDS to a group of 66 providers. The telemedicine program then developed into a bi-monthly HIV/AIDS Case Conference Program.

Since March 2005, bimonthly interactive patient case discussions have been broadcast live using Polycom video conferencing technology to Ethiopian health workers from the Ethiopian Civic Service College, Addis Ababa University, Addis Ababa Federal Hospital, and other private hospitals and clinics. These discussions are transmitted via the World Bank Videoconferencing Facility in the capital city of Ethiopia, Addis Ababa. The discussions and learning points are simultaneously webcast so clinicians in rural and remote sites outside of Addis Ababa can participate. The program has expanded to include East Carolina University and Tanzania.

Each interactive videoconference session is also captured for on-demand viewing. Approximately 100 discussions are available and data indicate these archives are accessed an average of 100 per month. In a recent survey of 14 participating physicians at Addis Ababa, the following comments were made.

i.“I can learn in the process, participate in discussion (add input) share experience, upgrade clinical skills and update to new developments.”
ii.“I am lecturer of Pharmacology and a PhD student so I can transfer updated knowledge to my students and as well I apply the knowledge for the research that I am doing for my PhD”
iii.“I can update my skills and teach other doctors in my health center.”
iv.“I can discuss difficult cases with my colleagues and the program is helping me to get answers for some difficult cases in day-to-day clinical activities”
v.“It improves my skill.”

How quickly has your targeted audience of users embraced your innovation? Or, how rapidly do you predict they will?
Based on 2006 statistics, the CCGHE website (http://ccghe.jhmi.edu) providing the telemedicine programs had more than 100,000 visitors and close to 600,000 page views, approximately 50% of those views were directed to e-learning content including on-demand listings of Infectious Disease Grand Rounds, Ethiopian HIV/AIDS Videoconference Case Discussions, and focused clinical training curriculum. Of the over 100 countries accessing the CCGHE e-learning programs the most active of these countries include three nations where we have focused online educational efforts: Ethiopia, South Africa, and India.

There are a total of 451 on-demand lectures and case discussions available captured through the use of Polycom and Mediasite technology. Of the 28,000 views logged to these presentations, approximately 6000 were to clinical training curriculum, 2300 to Ethiopian Videoconference Case Discussions, and 20,000 ID Grand Rounds. Activity to our on-demand e-learning and telemedicine programs has grown exponential since our initial launch with extremely little funding directed towards marketing.

Our most recent telemedicine course has been an intensive 8-10 week long program for 40 physicians who care for more than 4000 HIV+ patients in Pune, India. At conclusion, 97 precent of the physicians who took all the knowledge assessments passed the course. Eighty-five percent of the respondents reported the course applicable to their practice setting and improving their ability to treat HIV patients. Ninety-percent would recommend the course to a colleague and 85 percent would take a similar course again.

These data indicate the CCGHE program’s novel use of technology in training a global audience of healthcare providers is indeed embraced by its target audience. However, these data also indicate a demand for global health education and we predict greater need and demand for the e-learning and distance education programs as the poorest of countries acquire global Internet connectivity even though a clean glass of water remains elusive.

Difficulty
What were the most important obstacles that had to be overcome in order for your work to be successful? Technical problems? Resources? Expertise? Organizational problems?
Many potential funding sources do not believe the Internet can be used effectively in resource challenged settings. However, often in places in the world where one can’t find clean drinking water; there are cell phones and Internet cafes. The important step is to gather information about local technologic capacity and limitations, and tailor a clinical training program accordingly. That applies to content as well. It will not do to design a training program that incorporates the diagnostic tests and medications that are available in Baltimore. The CCGHE partners with local care providers to design clinical training programs that are timely and relevant to the local setting.

Often the most innovative projects encounter the greatest resistance when they are originally proposed. If you had to fight for approval or funding, please provide a summary of the objections you faced and how you overcame them.
Finding funding for clinical training is difficult. There is a lot of money available for clinical research and for providing low-cost and highly effective new therapies to treat infectious diseases that disproportionately affect developing countries. Clinical research has identified areas of need for these treatments, but in many countries the medications pile up in overheating warehouses, because there is a lack of adequately trained health care providers to deliver these medications safely and effectively. A critical gap in delivering treatment to the people is clinical training. Yet there is a critical shortage of funds available for clinical training programs. We are still trying to overcome this hurdle by developing relationships with sources that are outside the usual scope of funding for medical and nursing education.
Digital/Visual Materials
The Program welcomes nominees to submit digital and visual images with their Case Study. We are currently only accepting .gif, .jpg and .xls files that are 1MB or smaller. The submission of these materials is not required; however, please note that a maximum of three files will be accepted per nominee. These files will be added to the end of your Case Study and will be labeled as "Appendix 1", "Appendix 2" or "Appendix 3." Finally, feel free to reference these images in the text of your Case Study by specifically referring to them as "Appendix 1", "Appendix 2" or "Appendix 3."

Currently Uploaded Appendices:
Appendix1.jpg
Appendix2.jpg
Appendix3.jpg