Tag Archives: investment

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..

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.

You can help by leaving a comment. Go on….

A vision of a better (ePortfolio) world

When I log into my ePortfolio it looks like this:

wow. inspiring.

I would like it to look more like this :

 

Wow! At least a little more inspiring!

This example is just an afternoon’s cut and pasting in an attempt to highlight small changes that could be made, using existing content within the site that would improve the experience for users. There is a much bigger debate around the concept of the portfolio, WBAs, and how we train, test and inspire trainees; but I’ll save that for another post…

The Bigger Picture

The NHS ePortfolio started as a local pilot project. It’s use was then expanded and expanded. There was no budget for this, and no vision for how trainees might want it to look and feel. It fulfills it’s purpose, is functional and allows trainees to record meetings and assessments. But is “functional” really good enough?

Here are some quotes from the ePortfolio site, and the JRCPTB (who fund the Physician version):

The NES (NHS Education for Scotland) ePortfolio has grown rapidly since its inception in August 2005 and now comprises over 20 versions for over 35,000 healthcare trainees within Scotland (Nursing, Midwifery, Dentistry and Pharmacy), across the United Kingdom (Medicine), and The Republic of Ireland (Medicine).

This ePortfolio is designed to support learning by providing a secure record of appraisal discussions, an ongoing personal development plan, workplace assessments plus reflection on clinical and other learning events. The ePortfolio links to the relevant GMC approved curricula appropriate to your stage of training.

The ePortfolio is designed to help gather and organise evidence in a way that is trainee centred and user friendly. The emphasis for this is on you as the trainee with support from your supervisor.

If the emphasis is on the trainee to gather and organise evidence, then the emphasis should be on the trainee to determine how that is done. There has been a lack of investment in the ePortfolio which has resulted in the current slow, unimaginative, frustrating version. This needs to change. As trainees we need to demand more.

Direct feedback to developers is needed to bring about improvements in day to day usability. Feedback to Royal Colleges etc is needed to communicate the need for investment in the overall structure and function of the system. We need an app and we need an overhaul of how the ePortfolio works in order to encourage trainee  and supervisor engagement. There is no obvious way in which this feedback can be given, hence this site….

Practice what you (aspire to) preach

What I don’t think the Colleges etc realise is that the ePortfolio is the only concrete thing we see as a result of handing over large amounts of money in JRCPTB fees.  Therefore in surveys it is said to be “poor value for money.”

Even more importantly the ePortfolio itself is a reflection of how training is currently viewed. It feels to many that we are aiming for competence – how uninspiring! What happened to striving for excellence? What happened to valuing the diversity and individuality of talent and interest amongst trainees? What happened to mentorship? Many trainees feel like just a number on a rota spreadsheet, getting through the day, jumping through hoops for assessments that often become tick-box exercises of no educational value. Of course competency in the required knowledge and skills is essential, but competency is a MINIMUM requirement. It often feels that this is all that is expected. Many trainees do extraordinary things but their supervisors and deaneries would never know this. One trainee’s portfolio looks just like any others, the only difference being whether they have done 6 mini-cex’s or 7.

If we want to inspire excellence, we need to show this in everything we do, and in every system we create. Trainees need a system that allows them to not only demonstrate that they have reached the minimum standard to progress, but that they are so much more than the sum of a few WPBAs. They need to be proud of their portfolio. Currently the system is failing them, with the danger of producing uninspired, undervalued, underachieving, burnt out doctors. Bad for trainees, bad for Trusts, bad for patients.

Time for a fresh look at what we expect of trainees, and what trainees can expect of the system.