This presentation provides an overview of communities of practices in healthcare and opportunities to apply them globally using emerging technologies. A community of practice (CoP) is a group of people from a common profession that share knowledge and experiences with each other so that they can grow personally and professionally.   CoP often share with each other educational materials and best practices, meet online with peers to discuss the implementation of best practices, and meet regularly with colleagues for consultation and mentoring, and support. Communities of practices can become one of the most important sources of support for professionals and current knowledge. Communities of practice can also help to advance the profession by refining the implementation of best practices to new situations and environments. Communities of practice have expanded significantly in the last decade using online technologies that allow groups to communicate worldwide. This presentation will provide examples of implemented communities of practices, the barriers and facilitators, and opportunities for application using online and mobile technologies. 

1. DEVELOPING PROFESSIONAL
COMMUNITIES OF PRACTICE
Yuri
Quintana,
Ph.D.
Director,
Global
Health
Informa9cs
November
2014
An Academic Division of the Dept of Medicine
at Harvard Medical Faculty Physicians at BIDMC, Inc.
TM
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.

2. AGENDA
11/23/14 Developing Professional Communities of Practice – Yuri Quintana, Ph.D.
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! Global Health Challenges
! Defining Communities of Practice
! Developing Professional Communities
! Case Study
! Road Ahead

3. Global Health Challenges
• Rising
chronic
diseases
• Aging
popula9on
• Late
or
no
diagnosis
• Lack
of
trained
healthcare
workers
• Lack
of
essen9al
medicines
• Lack
of
appropriate
equipment
• Poor
or
no
integra9on
of
health
IT
systems
• Lack
of
reliable
data
at
local,
regional
&
na9onal
level
• Poor
coordina9on
of
healthcare
delivery
• Rising
costs
of
healthcare
• Adap9ng
healthcare
delivery
to
regional
needs
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4. Chronic Diseases Epidemic
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Source: SCIENCE VOL 333 29 JULY 2011 www.sciencemag.org

5. Diabetes Epidemic
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Source: IDF 2013 World Atlas http://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf

6. Global Shortage of Healthcare Workforce
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• There
will
be
a
shortage
of
230,000
physicians
across
Europe
in
the
near
future.
• The
number
of
caregivers
in
36
countries
in
Africa
is
inadequate
to
deliver
even
the
most
basic
immuniza9on
and
maternal
health
services.
Source: Deloitte 2014 Global health care outlook
https://www2.deloitte.com/content/dam/Deloitte/global/Documents/Life-Sciences-Health-Care/dttl-lshc-2014-global-health-care-sector-report.pdf

7. Global Shortage of Healthcare Workforce
• WHO 2014 Report - 57 countries identified in 2006 with low human resources
• 17 countries have no data point in the past five years.
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Source: WHO Report - A UNIVERSAL TRUTH: NO HEALTH WITHOUT A WORKFORCE
http://www.who.int/workforcealliance/knowledge/resources/hrhreport2013/en/

8. Definition
• A
community
of
prac.ce
(CoP)
is
a
group
of
people
from
a
common
profession
or
interest
area
that
share
knowledge
and
experiences
with
each
other
so
that
they
can
grow
personally
and
professionally.
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9. Types of Communities
• Local
Group
• Regional
Socie9es
• Na9onal
Professional
Socie9es
• Interna9onal
Professional
Socie9es
• Limited
Frequency
of
mee9ngs,
limited
depth
of
collabora9ons
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10. Evolution of Community of Practice
Collec9ve
Intelligence
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People
with
Common
Needs
Join
a
List
Create
a
Discussion
Forum
Share
Best
Prac9ces
Create
New
Knowledge

11. Evolution of Communities
Connect
People
Connec9ng
with
Common
Needs
Access
to
Con9nuing
Educa9on
Access
Best
Prac9ce
Guidelines
Collaborate
Peer
to
Peer
Support
Develop
New
Best
Prac9ces
and
Guidelines
Disseminate
new
knowledge
Trust
Mentoring
Networks
(Senior
–
Junior
member)
2nd
Opinion
Networks
(advice
giving
in
real
9me)
Data
Sharing
for
Quality
Improvement
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Professional Societies
Special Interest Groups
Communities of Practice

12. Facilitators
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Cri9cal
Mass
of
People
Common
Needs
Clear
Goals
Transparent
and
Inclusive
Leadership
Focus
on
Sharing
not
Credit
Suppor9ve
Community
Open
to
Innova9on
Common
Tools
and
Language
Suppor9ve
and
Responsive
Community
Renewal
of
Leadership
Evolving
and
Relevant
Goals
Crea9on
of
New
Communi9es

13. Barriers
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Misaligned
Goals
and
Needs
Inflexible
and
Non-­‐Transparent
Leadership
Domina9ng
Personali9es
Focused
on
Credit
Hidden
Agendas
Lack
of
Access
to
Knowledge
Ins9tu9onal
Rigidity
Infrequent
Mee9ngs
Non-­‐Responsive
Community
Non-­‐Returning
Membership
Non-­‐Renewing
Leadership
Irrelevant
Mission
and
Goals

14. Components of an Online Community of Practice
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Online
Learning
Pla7orm
- Online
Seminars
- Self-­‐Paced
Courses
- Instructor
Led-­‐Courses
- Care
Guidelines
- Competency-­‐based
curriculums
linked
to
online
educa9onal
resources
- Clinical
Case
Library
Online
Collabora.on
Pla7orm
- Online
web
mee9ng
services
- Group
shared
documents
- Online
teaching
classes
- Online
clinical
case
discussions
for
second
opinion
on
care
treatments
- Online
mee9ng
minutes
notes
- Recorded
mee9ngs
archive
- Shared
collabora9ve
projects
tools

15. Case Study: Central America Pediatric Oncology
• 1980s:
Few
pediatric
oncologists,
-­‐
civil
wars,
earthquakes,
floods
and
hurricanes
-­‐
childhood
cancer
survival
rates
below
20%
[1]
• 1990s:
Specialized
centers
form
-­‐
training
via
site
visits
and
annual
regional
mee9ng
-­‐
survival
rates
climb
slowly
to
over
20%
[2]
• 2002-­‐2014:
Cure4Kids.org
launched
to
provide
online
educa9on
and
collabora9on
tools
-­‐
weekly
online
mee9ngs
to
discuss
best
prac9ces
-­‐
survival
rates
climb
to
48%
[3]
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Sources: [1] Ann Oncol. 1993 Jan;4(1):37-40; [2] Lancet. 1998 Dec 12;352(9144):1923-6; [3] Pediatr Blood Cancer. 2014 May;61(5):827-32.

16. Case Study: Central America Pediatric Oncology
Connect
AHOPCA
pediatric
oncology
society
annual
mee9ng
Access
to
con9nuing
Educa9on
on
Cure4Kids.org
Access
experts
via
Web
mee9ngs
on
Cure4Kids.org
Collaborate
Develop
common
protocols
on
Cure4Kids.org
Disseminate
new
knowledge
via
weekly
mee9ngs
on
Cure4Kids
Trust
Data
sharing
for
quality
improvement
on
POND4Kids.org
Second
opinion
consulta9on
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Knowledge Synthesis
Continuous Quality Improvement
Education and
Knowledge Sharing
Sources: Quintana Y, O’Brien R, Patel A, Becksfort J, Shuler A, Nambayan A, Ogdon D, Chantada G, Howard SC, Ribeiro RC. Cure4Kids: Research challenges
in the design of a website for global education and collaboration. Information Design Journal 2008; 16:3, 243-249.
May D, Quintana Y, Chantada G, Ribeiro R. Developing Oncopedia: Creating and Editing an Online Collaborative Educational Resource for a Global Audience,
Science Editor, Council of Science Editor, May – June 2009, Vol 32, No 3, pp. 75-77.
Quintana Y, Patel AN, Naidu PE, Howard SC, Antillon FA, Ribeiro RC. POND4Kids: a web-based pediatric cancer database for hospital-based cancer
registration and clinical collaboration. Stud Health Technol Inform. 2011;164:227-31. PubMed PMID: 21335715

17. Case Study: Central America Pediatric Oncology
• Online
mee9ngs
for
– Con9nuing
educa9on
– Second
opinion
on
case
management
– Program
administra9on
development
• Key
Success
Factors
– Regular
mee9ng
9me
– Mul9-­‐disciplinary
team
par9cipa9on
– Involvement
and
mentoring
of
new
staff
Sources: Guimera D, Hernandez H, Huertas M, De Colsa A, Robles VP, Johnson K, Quintana Y, Caniza MA. Combined web-based distance learning followed
by brief on-site practice: a cost-effective way of training infection preventionists in countries with limited resources. Am J Infect Control 39:E152-E153, 2011.
Santiago TC, Jenkins JJ, Pedrosa F, Billups C, Quintana Y, Ribeiro RC, Qaddoumi I. Improving the histopathologic diagnosis of pediatric malignancies in a low-resource
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setting by combining focused training and telepathology strategies. Pediatric Blood Cancer. 2012 Feb 7.
AlFaar A, Kamal S, Abouelnaga S, Greene W, Quintana Y, Ribeiro R, Qaddoumi I. International Telepharmacy Education: Another Venue to Improve Cancer
Care in the Developing World. Telemedicine and e-Health. 2012 Jul-Aug;18(6):470-4.

18. Case Study: Central America Pediatric Oncology
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Common
needs
Clear
goals
Focus
on
sharing
not
Credit
Weekly
mee.ngs
to
discuss
clinical
cases
Suppor9ve
community
–
Developed
common
protocols
adapted
to
local
resources
Access
to
con.nuing
educa.on
on
Cure4kids.org
Shared
data
and
outcomes
on
POND4Kids.org
Peer-­‐to-­‐Peer
Collabora9ons
Expanded
from
1
to
over
30
communi9es
in
en.re
region
-­‐
Clinical
Protocols
-­‐
Nursing
-­‐
Pallia9ve
Care
-­‐
Laboratory
Medicine
-­‐
Pathology
-­‐
Data
Management
-­‐
Clinical
Improvement
Source: Richardson, S., Banks, M.S., Kettinger, W., and Quintana, Y. (In Press) IT and Agility in the Social Enterprise: A Case Study of St. Jude
Children’s Research Hospital’s ‘Cure4Kids’ IT-Platform for International Outreach. Journal of the Association of Information Systems. 2014: 15(1).

19. Case Study: Central America Pediatric Oncology
• Increased
survival
rates
from
20%
to
over
50%
for
common
types
of
cancer
in
some
low
income
clinics
• Expanded
Communi9es
of
Prac9ce
to
all
disciplines
• Expanded
Mul9-­‐Disciplinary
Teamwork
• Mul9plier
effect
–
impact
beyond
ped-­‐onc
clinic
• Quality
Improvement
Ini9a9ves
-­‐
Late
Referrals
(community
outreach)
-­‐ Toxic
deaths
(adap9ng
protocols)
• Crea9on
of
new
communi9es
of
prac9ces
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Sources: Quintana Y, Patel AN, Arreola M, Antillon FG, Ribeiro RC, Howard SC. POND4Kids: A Global Web-based Database for Pediatric Hematology and
Oncology Outcome Evaluation and Collaboration. Stud Health Technol Inform. 2013;183:251-6.
Ayoub L, Fu L, Pena A, Sierra JM, Dominguez PC, Pui CH, Quintana Y, Rodriguez A, Barr RD, Ribeiro RC, Metzger ML, Wilimas JA, Howard SC.
Implementation of a data management program in a pediatric cancer unit in a low income country. Pediatric Blood Cancer. 2006 Jul 21.
Barr RD etl al. Asociación de Hemato-Oncología Pediátrica de Centro América (AHOPCA): a model for sustainable development in pediatric oncology.
Pediatr Blood Cancer. 2014 Feb;61(2):345-54.

20. Expanded Architecture of CoP Platforms
Creating communities along the continuum of healthcare
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• Early
Diagnosis
• Pa9ent
Referrals
• Community
Health
Indicators
Community
Outreach
•
Op9mizing
Clinical
Care
• Crea9ng
Peer
Networks
Clinical
Care
• Pa9ent
Reported
Data
• Family
Care
Networks
Pa9ents
and
Families

21. Systematic Approach
• Need
reliable
data
to
analyze
and
plan
• Plan
has
to
have
objec9ves,
target
outcomes,
9melines
• Design
solu9on
to
regional
needs
• Long
term
commitment
• Training
is
key
• Culture
change
approach
• Incen9ves
and
rewards
• Pilot
programs
with
plans
to
scale
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22. Road Ahead
• Select
area
to
focus
• Iden9fy
people
with
keen
interest
in
CoPs
• Engage
with
community
to
define
needs
• Establish
communica9on
plakorm
• Pilot
a
clinical
community
of
prac9ce
• Extend
to
other
disciplines
• Create
regional
networks
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23. Thank you!
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Yuri Quintana, PhD
Director, Global Health Informatics
yquintan@bidmc.harvard.edu
An Academic Division of the Dept of Medicine
at Harvard Medical Faculty Physicians at BIDMC, Inc.
TM