Monthly Archives: January 2013

NHS Hackday and the

This weekend I was at NHS Hackday. Doctors, other healthcare workers, students, patients, organisations and software developers came together in their free time to make stuff that could make the NHS better.

Thanks to @londonlime

Thanks to @londonlime

I was astounded by the last Hackday. I didn’t think my expectations could be surpassed. They were.

The projects were diverse, aiming to solve everyday problems at all levels of the NHS. You can see the list on the Google doc and they’ll be on the wiki soon. The highly deserved winner was OpenHeart. The team used the amazing open source electronic health record at Moorfields Hospital, Open Eyes, and adapted it for use in Cardiology. The end result was stunning. It will save hours of doctors’ time, will create patient records that are much more understandable for patients themselves and for GPs, and will improve communication and therefore the quality of care.

Another favourite was Dementia scrapbook, an app to allow family and friends to contribute to a virtual scrapbook of memories and reminders. It has an easy to use touch interface that can be used by carers or people with dementia themselves. Dementia is common and this takes a very patient-centred approach to solving problems many of us may face in the future. I hope to see it available soon on the app store.

Cellcountr, initially hacked at the Liverpool hackday, was built on with additional features such as data visualisation and a customisable keyboard. It will be launched in the next month at a Pathology conference, and will then make a real difference to doctors, and their ability to accurately diagnosis patients with haematological conditions.

So what did we do? We created oPortfolio, an open API which allows trainee doctors to record learning events online, offline and on the go. It includes a webapp, a mobile-friendly site, an iPhone app, and an android app that all synch data. From nothing to all this in 36 hours! The team were incredible: full of talent, patience, and creativity.


What does it do?

It solves an immediate need to log learning events on the go (see examples below). It lays the foundation for a more complex system to log assessments and meetings. With (quite a bit) more work it could be a simple open portfolio that doctors who are not currently in a training programme (eg LATs, people doing fellow jobs in between F2 and speciality training) could use to track their professional development. The funding model would have to be clarified as development and hosting is not free! It could also be an arena to experiment with and showcase new ways of organising a professional portfolio that could usefully feed into the debate on what and who a portfolio is for. It could highlight how different systems talking to each other and 3rd party apps and plug-ins have the potential to improve a core product. Another fabulous creation was Quicklog, an app to log personal development in performing procedures on the go. They built in data visualisation to encourage reflection and chart progress. It would be fantastic if the data from Quicklog could be integrated into a portfolio system. Anyone who is interested (and understands it!)  should look at the code on github for oPortfolio and Quicklog!

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What does it not do?

It is not a replacement for the current ePortfolio system(s). The NES ePortfolio and others (eg surgical portfolio) are complex structures build up over years, with thousands and thousands of pounds of investment. Many have questioned whether they are value for money and I can’t answer that but good software does cost. Existing systems have  layers of access rights and methods of data extraction since these were priorities for the bodies who paid for them. They have cloud hosting and data security. People have spent years making them do what they do and it would be crazy to think they could be replicated in a weekend. They have their problems and must be improved but they are here to stay until a better alternative exists.

The focus of building a model Oportfolio was the user experience. If it was developed further it could fulfil a need for trainees who are not in a current training programme, who currently use various cobbled together documents on Evernote, phone notes apps, word documents and paper to record their learning and showcase their achievements when applying for jobs. With regular end-user input it could be beautiful, and a joy to use!

I am sure that our exploits this weekend will appear highly challenging and controversial to some. But I am not controversial. I have always highlighted the frustrations felt by trainees (which are well known) but advocated for engagement with all interested parties: individual trainees, trainers/educational supervisors, LETBs, Trusts, Royal Colleges, current ePortfolio provider NES, the GMC and HEE. We need to get our heads together and think about what the future of training will look like, what tools are needed to enhance learning, and how they will be funded.

The NHS can’t keep putting up with unintuitive, inflexible IT that doesn’t match the realities of practice. As demonstrated at NHS Hackday; intelligence, enthusiasm, creativity, a few humous sandwiches and some coffee can create magic. But that magic needs support and investment to make it sustainable. Muir Gray says change in the NHS will come from the bottom up. He is one of a few inspirational people at the top supporting projects in which frontline staff make a difference. We could do with a few more like him….


The perfect ePortfolio

Thanks to @londonlime

Thanks to @londonlime

This weekend I am at NHS Hackday in Oxford. I have written about hackdays before. I am a huge enthusiast. It is amazing to see doctors, other healthcare workers, patients, organisations and software developers coming together in their free time to make stuff that could make the NHS better. A hackday IS agile software development, speeded up, with people motivated not by profit but by intellectual curiosity and a desire to make the world a little bit better.

There are some amazing people coming to NHS Hackday Oxford. Some of them are interested in rethinking a professional ePortfolio. The one we have currently is competent. It does a job. The creators at NES are great, but they are constrained by their history and location. In my opinion an IT project that supports thousands of healthcare professionals’ development should not be run by project managers in a Scottish NHS health board. Their customers are Royal Colleges, not ePortfolio users. However great NES are at their job are they really the best people to make the perfect ePortfolio?

As trainees we want more. In relation to the software we want seamless functionality, we want flexibility, we want personalisation, we want visualisation of data, we want speed, we want interoperability, we want openness and APIs, we want mobile offline data entry, we want intuitive navigation, we want reliability, we want to be encouraged and inspired, we want beauty.

Too much to ask? I hope not. 

I need to form these vague statements into some specifics between now and tomorrow. Wish me luck!

Where’s your user group?

A major contributor to trainees’ frustration with the ePortfolio has been the lack of user feedback. Trainees and trainers using the system day in day out have not had a clear and accountable way to give feedback to the Colleges which purchase the ePortfolio on their behalf. Those at NES managing the system, and the developers weaving their magic in binary don’t necessarily know how it is used on the front line. It has certainly not been an agile development process.

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But there is no point looking back. We are here and must consider how we make things better for the future. Change is slow but it is possible.

The JRCPTB/Royal College of Physicians have actively responded to the pleas of trainees and have created an ePortfolio reference group.

The objectives of the group are to:

  1. Provide feedback and appropriate consultation to the JRCPTB on issues of ePortfolio management including performance, usability and required features.
  2. Assist the JRCPTB in the prioritisation of developments to ensure they are delivered in the best order for all our stakeholders.
  3. Ensure JRCPTB is informed of changes to training that may influence how or when the ePortfolio is used
  4. Assist JRCPTB where required in creation and delivery of appropriate communication about the ePortfolio

The group comprises ten members:

  • 3 trainee representatives – one to be from CMT
  • 3 local administrators from different areas of the UK and represent both Trust and Deanery administrators
  • 3 clinicians from different specialties
  • 1 JRCPTB administrator

In fact there are 4 trainee representatives. Lucky me, I am one of them! You can get in touch with me here, or on Twitter. You can also email the JRCPTB directly with your ePortfolio-related ideas:

This is a great step forward. If you’re a physician trainee you now have a direct line of communication to the JRCPTB to influence their decisions. It’s not perfect, it’s not agile, but it’s a start.

If you are not a physician trainee perhaps you should ask your College where your user group is……

Feedback from NES events

Late last year, NES who run the NHS ePortfolio, held a series of user group meetings. The objectives included “providing an opportunity for users to speak their minds and share their ideas to improve the system.

The results of the feedback events were collated by NES, and they published a summary. So what can we learn from this?

Screen Shot 2013-01-19 at 11.07.28

Firstly we must question whether the results are representative of the users of the ePortfolio. Unfortunately the feedback events were during normal working hours and very few trainees or clinicians were able to attend. It is clear from the feedback that there were a significant number of administrators present. Their views are important but are over-represented in this sample. The sample size of the feedback events is also very small. This is important considering the large number of users and the fact that the use of the system by different Colleges varies.

Despite this there is some useful information contained in the summary, which is grouped into categories:

  • what users like about the NHS ePortfolio (mainly that an ePortfolio is better than paper)
  • dislikes about the technical implementation and website design
  • dislikes related to the educational content or usage requirements of the ePortfolio
  • dislikes relating to the governance of the ePortfolio
  • what technical changes users would like made to the system
  • what new features users would like

The results are not surprising. Many of the comments align with those on this site. Users want an app, want the site to be more intuitive to use and navigate, and want it to have better and more flexible functionality. They want interoperability with other systems and they want clarity on the purpose of the ePortfolio “is it a learning tool or a recording tool?” They also want a lower burden of assessments.

NES must be congratulated for attempting to engage users and gain feedback, and for their openness in releasing the results, but I can’t believe there is anything in the comments that they did not know already. The problem is less lack of information, and more lack of action. But as NES highlights in their post “who makes decisions about the ePortfolio?” in the bigger picture the power really rests with the Colleges. 

Is it time to rethink how we use portfolios and workplace-based assessments in Postgraduate training? How can we adapt the software we have so that it works for us and we maximise the benefits of an ePortfolio for lifelong learning?  

What do you want from an ePortfolio?

Discussion of the NHS ePortfolio has been reignited on Twitter this evening, sparked by the publication of a paper in The Clinical Teacher “Evaluation of an established ePortfolio.”

The conclusions are:

“Continued support is needed for both trainees and supervisors in portfolio-building skills and in using the e-portfolio as an educational tool. Trainee tailored feedback is needed to ensure that portfolio-based assessment promotes lifelong, self-directed and reflective learners.”

My favourite quote is:

“Trainees remain unconvinced about the educational value of the e-portfolio”

An understatement perhaps?

The NHS ePortfolio

The comments this evening included some by people who have not been part of previous Twitter discussions, but they echo many sentiments I have heard before, and many comments on this site. They include frustration about the software itself, as well as complaints relating to the burden and perceived utility of workplace-based assessments.

So, it’s 2013, a New Year. Time to take a fresh look at the world and think about how we can turn all this frustration into positive change.

  • What do you think is the purpose of an ePortfolio?
  • What do you, as a trainee, want from an ePortfolio?
  • What value do you find in workplace-based assessments?

I will be writing more as soon as I get time – on funding and commissioning, on the need for trainees to join together across specialities, and on the future in the eyes of the various stakeholders. In the meantime please leave your comments here.

We need your voice. We need a better system – sometime before I become a Consultant would be nice……