An app-ortunity

Quite reasonably I have been asked how an NHS ePortfolio app would benefit doctors, and what it would have to do to be worth any investment. In my opinion the need for an app is driven by the need to make WPBAs more relevant. An app would put control back in the hands of trainees, and make life significantly easier for trainers/assessors. This would reduce resentment towards WBPAs and would save an unimaginably huge amount of time for a stressed, squeezed, overworked profession.

The current situation:

I am doctor in training (this covers everyone who is not yet a Consultant/GP partner). I am required to complete a certain number of WPBAs to progress. One day I am at work and am on call admitting new patients to hospital. I think I’ve made a pretty thorough assessment of a patient with a condition I’ve not encountered before and ask my Consultant if, after presentation of the case on the post-take ward round they can fill in a mini-CEX. They say yes.

I present my case during the round and the Consultant provides some useful immediate feedback on my assessment, including a recommendation to read a recent review on the subject in an academic medical journal. However, the Consultant has another 7 patients to review after this and can’t stop to find a computer, login, wait for it to load up, access the NHS ePortfolio website, login and complete the assessment. “Send me a ticket” they say, with a genuine intent to complete is as soon as possible. My shift gets busier and after 13hours at work I go straight to bed when I get home. The next day i am very busy and forget to send the ticket via email. I remember when I get home but realise I don’t know the Consultant’s email address. It’s a weekend so I’m not in for another 2 days. I set a reminder with an alarm on my phone and on Monday the alarm prompts me to retrieve the email  from the hospital system and I send the ticket from the NHS ePortfolio site.

A week later the assessment has not been completed and I send a reminder. Three days after this I bump into the Consultant in the lunch queue and gently remind them about the mini-CEX. They make excuses, feel bad, and promise to do it ASAP.

A week after this the Consultant finally has some time for admin and discovers my reminder email in their inbox. They login and struggle to remember anything about the patient or the feedback they gave me. They have an overall impression of whether I’m any good or not and complete the assessment mainly based on this overall view, rather than the specifics of the case we discussed. I get an email to say that the assessment has been completed. At a later date I login and read the comments, which are brief, and get no educational benefit from the recording of the episode. I do however feel less stressed as that’s one less assessment to get ticked off. I can’t remember the author of the review recommended by the Consultant and never quite get round to searching for it.

A possible future situation:

One day I am at work and am on call admitting new patients to hospital. I think I’ve made a pretty thorough assessment of a patient with a condition I’ve not encountered before and ask my Consultant if, after presentation of the case on the post-take ward round they can fill in a mini-CEX. They say yes.

I present my case during the round and the Consultant provides some useful immediate feedback on my assessment. I get out my smartphone and login to the NHS ePortfolio app. I bring up the mini-CEX form and we complete it together adding comments based on the feedback the Consultant has just given, including the recommendation to read a recent review by author X in journal Y. There is a prompt to enter the Consultant’s email address so that they can validate the mini-CEX as an accurate representation of the assessment, and I input this as the Consultant dictates it. I save the form. The Consultant continues with the post-take ward round. I continue to admit new patients.

When I get home my phone picks up my wifi signal, and the ePortfolio app automatically synchs with my account so that the mini-CEX is uploaded. An email is sent to my Consultant and me to inform us of this new entry on my ePortfolio. I don’t have to waste time chasing up multiple assessments like this, so actually get round to looking up the review recommended by the Consultant, and learn something that will benefit my future patients.

It is essential that an NHS ePortfolio app:

  • is cross platform (iPhone, android etc)
  • can perform most functions offline with synching later with the main site. Most NHS hospitals have no wifi and poor phone sinal coverage. If an app required wifi it would be of no use to many, many, users

Another possible function would be to record reflection-in-action – essentially quick notes about things that happen that are particularly challenging, satisfying etc. There would then be scope to comment on this in the portfolio later (reflection-on-action).  Professionals must be reflective to learn and develop, but there is debate around the value of writing down these reflections. An app would at least make the process easier for those that wished to do this.

Oh, and of course ideally it would be free. But I’d pay £0.69 to make my life easier, wouldn’t you?


20 responses to “An app-ortunity

  1. Wai Keong Wong

    I’ll happily pay more!

    I’ve copied my suggestion from a previous post that is probably more appropriate here:

    As you said, the key is about making it easier, reducing duplication and encouraging timely entry of data. If we can use voice dictation available on the latest smartphones all the better 😉

    – Has as inbox that allowed me to email it to create reminders assessment. For example:- I’ve just done a Lumbar Puncture and want a Direct Observed Procedure assessment (DOPS) done. The current process requires me to find a computer, login, click 3 buttons or so. If I don’t do this immediately I would forget. Instead, imagine an ability to just email a pre-defined email address like with the Subject: ‘Lumbar Puncture.’ This would create a placeholder DOPS for you to return to it later when you have the time.

    – Send me and my supervisors reminders if I’m clearly not performing enough work-based assessments.

    – Ability to email attachments that will automatically form part of my document and evidence library. Example use case: Thank you letter from patient. Photograph with smartphone -> Email to with appropriate subject title. Done !

    – Ability to save the state of an assessment so that each one does not have to be completed in one sitting.

    – ‘Clever’ pdf forms that allow offline inputting of information that be uploaded to the NHS eportfolio when convenient. This is how ‘companies house’ does its annual submissions.

  2. Thanks for the suggestions – will take these back to the technical team!

  3. There are definitely a few issues with smartphone use in the wards though, and plenty of consultants who will not stop a ward round in the middle to do an assessment. Surgeons in particular mostly would not tolerate this, don’t you think? So if you say “oh, can we fill it in now on my iPhone” I can imagine a lot of them saying “No, we’re in the middle of a ward round, send me a ticket” just the same.

  4. Of course a single solution is not going to work for every situation or individual. But an app would make life significantly easier for a vast majority of trainees, and with a bit of encouragement I’m sure there are many Consultants who would see the advantages for them too. I’m not advocating asking ward rounds to stop mid-flow, but an app could reduce the disconnect between time of assessment and time of documentation.

  5. Is there an ePortfolio API available, it’d be an interesting exercise to see what the community could come up with as a solution to this if such a thing was available.
    Certainly the RCoA e-portfolio is in definite need of a mobile solution due to limited amount of computers available in theatre

    • I don’t think there is an NHS ePortfolio API. Would this provide a middle-ground for the OSS evangelists and sceptics, at least short term? What would allow the community to do, and what would the limitations be?

  6. I’ve just paid £330 to the JRCPTB for an eportfolio for the next 2 years – I’d happily pay more than £0.69 for something that would make it more user-friendly!

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  8. I actually started developing this app last year – initially in discussion with Colin Lumsden for the RCPCH and then for a project for the RACP (Australian College). Unfortunately the Australian College weren’t able to support it. But I think it would be of great benefit. It’s a pretty straightforward app and would make everyone’s lives much easier. (P.S. I’m a paeds trainee with an IT interest and have developed a few iphone/android apps).

    • Can you give an more details? Was it HTML5? Why didn’t the project result in a product. I keep hearing that this is a simple app – if so why doesn’t it exist already?

      • What’s not simple is that it needs to integrate into the College system. In your example above you are e-mailing you info to eportfolio so it will keep a note. It would then need to be agreed by the College. Otherwise all you have is a memo system, and you can set reminders on your iPhone without this app. So an app would need to offer something better that you can actually post a reflection/thank you letter to your eporfolio directly or submit your DOPS assessments online. That would be extremely useful indeed. The reason we haven’t completed it is because we didn’t get the chance to speak to the College and got busy on other projects.

  9. I have been pointed in the direction of HORUS, the ePortfolio used by the NW Deanery (the only one not to use the NES ePortfolio). They have recently developed a mobile platform for WPBAs that you can see demonstrated on their site: . I like their thinking but it’s not offline so wouldn’t solve our problems I’m afraid. The NES ePortfolio has a mobile optimised site (although parts of it are not that well optimised on my iPhone), but wifi and 3G are too unreliable in hospitals to make this useful. Come on people, where are your APIs so we can build decent apps that integrate with your systems?

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  14. We now have a beta App available that is free, cross platform, and works offline. I am still working on it and it has a few bugs but get in touch if you want to try it out with your trainee account. At the moment it only works with tickets but in the future it will support reflection logs and later, assessments.

  15. The new version of the app now supports reflection forms, and will soon support assessments and SLEs.

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