NHS Hackday and the oPortfol.io

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

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!

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….

What to do with all that data?

I encourage you all to read the blog of NHS ePortfolio developer @zingmatter, and look at the presentation he presented at AMEE 2012 (a recent Medical Education Conference) “Assessing NHS ePortfolio behaviour: variations in the online activity of doctors as they progress through training.”

With thanks to http://www.acunu.com/ for the badge!

I was at the presentation at AMEE 2012 and, although the presentation title may nor sound gripping, I was fascinated to hear what could be learnt from the vast amounts of data ready and waiting to be analysed on NHS ePortfolio site use. The development team (including @zingmatter) had done a great job of drilling down into some of the data, using Google Analytics and internal tracking,  in order to filter out some meaningful information from the thousands and thousands of logins and episodes over a year.

The Prezi can be seen in the “elastic elephant” blog

However, my first thoughts on seeing the conclusions of the presentation were “they’re asking the wrong questions” and “if they wanted to know that they should have just asked the trainees.” Many of the peaks and troughs seen on the graphs were entirely predictable (ie pre-ARCP), and some of the conclusions drawn by the developers on “depth of use” were weak. I could explain away many of the findings, as I know how trainees use the site is a function of what hoops are put in front of them to jump through. I was also sceptical about the conclusion that trainees change their behaviour in relation to the ePortfolio over the course of their training. FYs and ST6s may interact differently with the site, but there are so many confounders that a snapshot comparison is not a valid way to assess this: a longitudinal study would be required.

Despite these reservations, reading @zingmatter’s blog gives me hope for the future, as the developers at NES are committed to engaging with the needs of users. In our often passionate discussions on social media (including this blog and twitter) we must remember that we come from very different perspectives, and have unique sets of knowledge and skills.

As @zingmatter points out:

“There is a balance between college needs and trainee needs in the design of an e-portfolio and possibly this type of data can help inform this debate.”

We also have to make sure we are not misdirecting our frustration at the wrong people, and potentially alienating them:

“while I’m happy to ask simple questions about user flow, user experience and so on, questions about the educational implications of this data have not been well addressed as it’s not really in my sphere of knowledge (or in my job description). I would see the research I presented at this conference as a ‘this is the kind of thing we can do’ exercise that should lead on to better designed questions that will allow us to understand how best to develop an e-portfolio that supports effective learning and development through the effective delivery of a training programme.”

I really hope we can work together to ask the right questions and use all the data we have to inform the process. All we need now is the Royal Colleges on board and we can really maximise the potential of the ePortfolio.

Just imagine a world in which trainees didn’t hate the NHS ePortfolio. It has the potential to be a useful tool to encourage self-directed learning, provide evidence of experience and achievements, act as a showcase for job applications and excellence awards, and strengthen the relationship between trainee and trainer. This world is far away, but perhaps we are starting to see the path forward…

Why is it so slooooooooooow?

The site is very, very slow. It does not look like a complex site; there are no videos to run, there is only one page loaded at a time, it is not running complex algorithms. My IT/tech knowledge is in the “below expectations” category, but I gather there are a few issues that need to be resolved:

• Some pages are big (even though they may not look it) – the lovely tech people are working on making them smaller so that they will run quicker
• They way the site is constructed makes any individual action slow to complete  as it requires multiple clicks and refreshes – this is being addressed for the infamous linking process, but needs addressing for all functions
• NHS computers are slow. The lack of IT investment is staggering, considering the amount of data we deal with in health care systems. But I don’t think I can fix the entire NHS’s IT systems so you will have to continue to struggle on your desktop at work. However, much of the ePortfolio content is generated at home, where most people have decent broadband speeds. If I can run twitter, BBC iPlayer, Waitrose online shopping and Ottolenghi’s recipes at the same time with no problems why is the ePortfolio site still so slow….?

• ……apparently the ePortfolio is hosted on the NHS network. This is old, slow, and limits the speed of the site. It also has very limited capacity to cope with surges (which are inevitable ie pre-ARCP). A great option would be to move it to a Cloud. This is what everyone is doing these days. Big data needs big storage and there’s a lot more space in the Cloud. So what’s the problem? Let’s do it! To move the hosting to a Cloud needs investment, ie money. We need to persuade the Colleges that they need to fine some spare cash to sort this out. And soon.

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