Monthly Archives: August 2012

Can we make ePortfolio open source? a guest post from Karen Beggs

My first question is WHY?

Here are the main issues I hear about:

  • A lot of trainees aren’t happy with workplace based assessments
  • Internet speed is an issue in some NHS locations
  • Some people don’t like using an ePortfolio
  • Some people want to have more input into ePortfolio design
  • Some trainees want their seniors to be more engaged with their learning
  • There is a common misunderstanding that College membership fees are used solely to pay for the ePortfolio

So what are we already doing about these issues?

  • We are eliciting feedback directly from the wider ‘user’ community through social media to find out what usability improvements we can make…and get them done.

We’ve started this already… following a conversation last month with a trainee who was frustrated by the curriculum linking process, our architect made a simple change that was deployed a few days later (see demo here), reducing the number of clicks needed to make multiple links. We have also introduced a twitter feed, visible on the www.nhseportfolios.org home page).

We are moving to a more elastic hosting environment so that as the system gets busier it can engage more resources to deal with the increased load. We aim to have this fully implemented by autumn 2012.

The NHS ePortfolio team do not make decisions about assessment processes, training requirements or the use of specific workplace based assessments. Expertise in these areas usually lies with the Colleges, Postgraduate Deans and the Academy of Medical Royal Colleges. However, we can:

  • Help connect trainees with ideas (or complaints) with the relevant people, whether College, user group, developers or others. In July 2012 I attended the AoMRC Trainee Doctors Committee, and as a result will recommend to the Chair of the specialty ePortfolio User Group that a representative from the committee sits on that group. Some trainees are not aware of their own College decision making processes, and we will pass on contact details as required.

Would open source address any of these issues?

As far as I can see, NO!

But why don’t we just hand over the code to the large community of willing, enthusiastic OSS developers?

  • It’s not as easy as just handing out ‘the code’. Open source software must comply with a number of criteria (see www.opensource.org), many of which would contradict the current NHS ePortfolio license terms.
  • Who would fund re-writing and re-negotiating software licenses for the existing 25 or so organisations using the NHS ePortfolio? What if one of these organisations objects? It’s an integrated application with many shared features, so to separate out one ‘Customer’ would require a large-scale re-write. That seems to defeat the purpose.
  • The ePortfolio is integrated with a number of external (usually College run) systems and moving to an OSS model would have implications for each of these systems. Would Colleges want to pay to conduct a thorough risk assessment before signing up? And would they then want to pay for any adjustments needed to maintain the integrity of their own systems?
  • There would still have to be stringent controls over the quality of the code submitted. This would require a quality control team – possibly a larger one than we have at the moment. Who would pay for this?

I’m not sure I quite follow the argument… get rid of our current team of developers (some of whom have been with us for over 4 years), keep fingers crossed that some OSS developers can meet our commitments, beef up our QA team so they can check the code of the unknown OSS developers…. Seems that we increase our risks (of not meeting SLAs), decrease predictability (how can we hold anyone to a delivery date if we don’t employ them?) and end up with a QA team but lose our development expertise (the current team wouldn’t hang around for long – why would they?). I can’t see a sustainable business model in here unless we were to maintain a large core team – and if we do that, where are the assumed cost savings of OSS?

I have heard arguments that OSS is cheaper overall, but I don’t really see that cost is the problem (see My first question is WHY? above). It seems to me that the per capita charges for the ePortfolio are pretty reasonable. There is currently no charge made for any supervisor (educational or clinical), programme director, administrator, ARCP panel member or assessor using the ePortfolio. Per capita charges are based only on trainees at present. Would OSS have any impact on this? I can’t see that it would.

Final thoughts

If we were starting from scratch we would look at OSS as one of the options. We would probably look at an off-the-shelf ePortfolio too. We would be foolish not to. But we are not starting from scratch. We have an established, bespoke ePortfolio that is used across the professions (we have versions for Dentists, Nurses & Midwives, Pharmacists, Doctors and Undergraduates), is integrated with a number of external systems and capturing over a million forms submitted by ‘assessors’ every year. Each version has a custom set of features, making it adaptable and cost effective (sharing an underlying code base and database).

Many of the problems we hear about relate to complaints about the educational processes, and changes are already underway to address these (eg move to Supervised Learning Events in Foundation from August 2012). We contribute to these discussions when appropriate.

We have developed good relationships with our broad range of Customers, and continue to work with them to improve our change control and development processes. We work within the constraints of the NHS, which impacts our management of finance, procurement, stakeholder management, technology and decision making, as well as our governance arrangements.

We have an established application and an experienced team, whose expertise and commitment cannot be underestimated. Our development costs are at the lower end of the market, and maintenance charges are extremely good value. We can bring in additional specific expertise as and when we need to.

I can’t help but think the suggestion to move NHS ePortfolio to OSS is a solution to the wrong problem.

To Open Source or not to Open Source

Recent discussions around possible solutions to the need for NHS ePortfolio development have led to the suggestion that harnessing Open Source Software (OSS) may be the answer.

So what is Open Source Software (OSS) I hear you cry?

Open Source is collaboratively developed, freely available software or application. You may now hear people using the term ‘Open Source’ across a wide variety of different sectors in order to describe a more open, networked and user generated way of developing ideas and projects. While the term applied originally only to the source code of software, it is now being applied to many other areas.

But it is not just for new projects. For established projects, the software or application itself does not have to be dismantled.  There can be huge benefits of opening up the code to outsiders who then use the software, fix bugs, submit patches, file  bug reports, and create new content. Often for free. In times of ever-contracting training budgets and with austerity in the national consciousness, free sounds very appealing.

NHS Hackday is the most relevant example of this concept, and does a good job of explaining why OSS fits with the concept of openness in healthcare and academia, and why it is financially beneficial.  Examples of projects so far include an app to aid safe handover (in line with recommendations from the acute care toolkit, and clinical governance principles), and OpenBNF (an open source app for access to the tax-funded British National Formulary of medications, currently only available at a cost of £30 via a private provider). I think the projected cost savings may be over-enthusiastic, but the model of using the knowledge of “coalface” clinicians, and harnessing technological expertise for the public good is clearly powerful. This same argument could be made for the NHS ePortfolio as in the short-term all time saved means more time for patient care or educationally valuable activities. And in the longterm a better ePortfolio could facilitate better education and training, ultimately producing better doctors.

There are Open Source evangelists:

Carl is an evangelist,  Ben Goldacre is an evangelist

And there are those with legitimate concerns about control, and whether Open Source would deliver what is needed. As Karen Beggs (ePortfolio project manager at NES) points out it is no panacea: we must look critically at our needs and apply the right solutions. Here are some responses to questions about security and maintaining control, and an insight into the potential hidden problems of not using OSS.

Encouragingly, OSS in healthcare is not new (examples), and OpenSource in ePortfolios is not new (see Mahara) so there is already work to build on.

A vision of collaboration, openness, and harnessing clinical knowledge to create rapid solutions to real-world problems, working from the ground up instead of the top down is incredibly powerful and one the NHS and education communities should celebrate.

Will OSS be the cure for the NHS ePortfolio’s chronic disease? If you’re a geek who loves the NHS maybe you can help us find out..