Money makes the world go round

It’s been a while since I blogged, but that doesn’t mean that nothing has been happening. I continue to participate in the RCP ePortfolio group with our next meeting coming up in July so please pass on anything you want me to feedback to them. Also, the teams behind Meducation and Podmedics have joined forces and launched a kickstarter to start developing Oportfolio: a free, open source ePortfolio, designed by doctors for use from medical school to retirement. Is this a game-changer? It could be….

All doctors need a way to log their achievements and learning. But an ePortfolio should be more than a collection of paperwork mandated for an appraisal or revalidation. It should support an individual in a constant process of self-reflection and improvement, and enhance something that is at the heart of learning – a relationship. The day when trainees and supervisors talk with enthusiasm and joy about their ePortfolio will be a happy one. I can’t wait to see this happen, but looking around at the software available across all specialities and all levels of training it feels a long way off. Why?

Money, money, money

One of the biggest barriers to change is constrained resources. We all know there is not much cash around at the moment in the NHS, and education in particular has suffered. Trainees have complained that the ePortfolio they use is not good value for money, but there is a limited amount that the Colleges (who hold the purse strings) can invest. So how much does the ePortfolio cost?

Photo credit: Images_of_Money http://www.taxbrackets.org/(Creative Commons)

In 2012 the NES ePortfolio (the biggest provider) cost it’s customers (Royal Colleges,the Foundation Programme etc) over £600,000. That was just one year. Good software costs money: it is created by talented professionals whose time and expertise is valuable. Putting a number on what good value is for the ePortfolio would be arbitrary  However, if the users think it’s not good value, then it isn’t. They don’t value it, and therefore are less likely to engage with it. Disaster.

Due to the current way in which medical ePortfolios are funded, the only way to make them better, add features and speed up the development of the app would be to pour lots of money in. This is because the funding model depends on the customers (Colleges) individually specifying changes and paying for them in terms of developers’ time. These costs are on top of the day to day running costs. Unless this funding model radically changes, NES will never be able to deliver the kind of ePortfolio doctors are clamouring for. The team at NES have been fantastic in engaging with trainees and encouraging calls for change, but they are constrained by their location in an NHS Scotland Health Board and their lack of power over their own organisational and financial structures.

Don’t be shackled to the past

An important point made by Ben, a NES developer on an open Linked.in thread is that trainees only see one part of structure of the ePortfolio. There is a lot behind the sterile pages of mini-cexs, in terms of levels of access, account types, administration and data reporting. But the counter-question to this is, is that where we should be directing our money? Should we be paying for complicated layers of access structures, or should we trade this for better functionality? It is time for a fundamental shift in our conception of an ePortfolio, putting the learner at the centre. We have the opportunity to re-imagine what an ePortfolio could be and mustn’t let the structure of the current system dominate our thinking.

Open source – what’s all the fuss about?

Some are fearful of open source projects but there is already precedent in the NHS for open source software; for clinicians working directly with software developers to iteratively create things of beauty. If you have not seen OpenEyes before, click and behold! OpenEyes even holds patient data securely, so any alarmist worries about trainee data in an open source system can stop right here. It is fantastic to see new, agile ways of working emerging as successful – and anything has to be better than the NHS’s previous track record on IT projects!

Oportfolio

The Oportfolio team are creating an open source ePortfolio. This means the code will be open for anyone to use. They are not in it for the money. Their motives (paraphrased by me after many conversations with Ed and Jeremy at NHS Hackdays and online) are:

• a wish to help those who work in the NHS (for the ultimate benefit of patients)
• an interest in how technology can support education
• a passion for creating beautiful software.

Oportfolio will available to any doctor in the NHS, including those who are currently not affiliated to a College and therefore have no ePortfolio at all. The potential gains to the NHS are huge in terms of money, and doctor-time. More intangible benefits include: trainee and educator happiness; and more fulfilling postgraduate training.

Ultimately, happier, more reflective, better educated and informed doctors give better patient care. And that’s something you can’t put a price on. 

So whether Oportfolio becomes the best thing since sliced bread and is adopted by all healthcare professionals in the NHS, or whether it is never adopted but creates  pressure for change in the current systems that can no longer be ignored, it will have been a success.

The plan is for the end product to be free to users, but to get started they need a little seed money. I’ve just put my money where my mouth is to help get it off the ground. I hope you do the same.

What can you do?

• Add your comments to this site
• Tweet about #Oportfolio and follow for news
• Help fund the Oportfolio by joining the kickstarter
• Sign up by email for news of the Oportfolio 
• Join the Googlegroup and add your ideas
• Listen to the Digital Doctor podcast where I discuss ePortfolios in medicine with the Digital Doctor team

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….

All ePortfolios are equal, but some are more equal than others

The NHS ePortfolio is not the only kid on the block. Since starting this site I have been pointed in the direction of some alternatives (thanks for all suggestions). There are specific requirements for NHS trainees which mean that it is more likely we will always all have to use the same software, rather than being able to break out and use different versions. Most obviously this is the need to collate standard Workplace Based Assessments. However, we can window shop, and return with a long shopping list…

1. The GPs didn’t just get mad, they got creative

This site seems to have been created due to a need for a FREE ePortfolio tool that could do 360 degree appraisals, and have the ability to log a number of different types of CPD activity. Clearly very GP focused, and I can’t get in to see how user-friendly and intuitive it is. The testimonials make it sound great! Likely to be limited in scope, flexibility and future directions as created for a specific purpose and audience. I get the impression it’s aimed at GP Partners more than trainees (who have to use the NHS GP Portfolio).

2. Pebblepad

Claims to be able to fulfill multiple functions which sounds good:

• Assessment (formal and informal)
• Advancement (promotion or transition)
• Appraisal (self – peer – 360)
• Accreditation (professional bodies)
• Application (course, job, funding)
• Articulation (informative story telling)

Looks quite corporate, not easy to move from different areas of content. Seems to have been well thought out and to have considered the need to be able to display the contents in a useful way, and export this for multiple purposes. Has flexibility in terms of what content can be stored, including files, pictures and links. But somehow still doesn’t feel like what I’m looking for.  

3. Mahara

Aims to be a learner-centred Personal Learning Environment. Specific features include the ability to choose which aspects of the portfolio are public and private; the ability to create a digital CV; a blogging area (maybe it’s better than calling it reflection?) and the ability to interface with Moodle. Also, it’s Open Source. We love Open Source! Mahara ticks a lot of boxes for me, especially the fact that there has been some thought about how to display features in a very visual way, but it feels a little juvenile. And it is difficult to see content – it requires lots of clicks to do anything. The fewer the clicks the lower my frustration levels!

4. Googlios

Of course, why did I not realise that Google would be ahead of the game on this? The Googlio comes the closest to my idea of how the NHS ePortfolio should look and feel.  It is easy to navigate, with different sections accessed in multiple ways, meaning very few clicks to do anything. It presents an individualised “showcase” of what’s inside with a standard set of bits of information, but with the ability for the individual to highlight their most significant achievements and curate their own “front page”. It works with Googledocs, Word and Excel so the information contained within it is exportable for other purposes, and documents can be dynamic (I’m thinking about the great potential for a log-book here). It is easy to embed links, blogs, and other content from all sorts of different applications, and they are displayed in a helpful way. It’s not perfect as it needs a timeline amongst other things. But they completely sold me by using Leonardo da Vinci as inspiration. “The Googlio philosophy could transform 21st century education, using 21st century tools. This has the potential to stir a return, a revolution, a rebirth, a revival of educational renaissance.” I’m not really sure what this means but I’m excited. This is the kind of model the NHS ePortfolio team should follow. ePortfolio Gods, please look at this!

I have now used Googlios (or Google sites as it’s also called) to create my own teaching portfolio. Having spent a while getting to grips with the interface I remain a big fan. The NHS ePortfolio has a lot to learn about user satisfaction…

I was also directed to the Academy of Medical Royal Colleges project MIPS, which aims “to develop an initial set of ePortfolio standards to encourage modularisation of systems and secure interoperability between ePortfolio systems (NHS, Collegiate and others).” I think this is a word-y way of saying they want to lay down some ground rules for how ePortfolios should work, and how they should work together. Sounds great! And it’s so great to see a project like this working across Colleges and specialities. We all have a core set of very similar needs, so should be pooling resources and ideas. I can’t see any signs of progress or deadlines on the site, however. Hopefully there’s lots going on with this project in the  shadows…

Know of an ePortfolio you think is better? Have experience of using one of those featured above? Comment below.

NB. Since writing the original post I have also been directed to an NHS Hackday presentation on standards for an ePortfolio and  a site defining  Government IT standards, which look like great starting points for agreeing standards that must be achieved in using data, including that in the ePortfolio. Lots to think about.