ePortfolio/eLogbook for Consultants

[VJ]

Dear all,

 

I am hoping someone can guide me on this.  Any direction would be appreciated. 

 

Recently, it was put to me that there didn’t exist even a simple eLogbook solution for those finished out of training.  If true, it seemed odd especially with appraisals and revalidation becoming the routine, so I thought I’d investigate.

The only thing that I could find was a cobweb site of a two year pilot (2010 to 2013) from the RCS Ed:  https://www.surgeonsportfolio.org/

Even if this still going, it is appears restricted to the surgical specialties and not more inclusive of all admitting specialities.  Apologies in advance, if I have misunderstood this.

 

A several Google searches later, I couldn’t find anything else, so I thought I would ask this group if they knew anything out there and if so, whether there were any defined APIs.

I recall that we had fun trying to scrape data from the NHS ePortfolio as a way to liberate trainee data without an API, and that oPortfolio didn’t get off the ground, so I’m not holding much hope.

 

My interest is mainly in the ‘evidence of experience’ part - the logbook element (& not the whole portfolio).  Essentially, it should be able to record casemix i.e. comorbidities in addition to any procedures performed.

 

Thanks in advance,

VJ

Dr Vaibhav “VJ” Joshi

LinkedIn

 

[Jonathan Kay]

What does Doctors.Net offer?

Jonathan

[Carl Reynolds]

they may have pivoted but my understanding was that Doctors.Net offer
pharmaceutical companies access to doctors in exchange for money

and they offer doctors free email and education in exchange for access to them

don't think they have an e-portfolio service but I'm not a Doctors.Net
user because I feel uncomfortable with the exchange

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[VJ]

I've just checked to be double sure. They only offer CPD study modules plus a method of recording PDP, missing out entirely the logbook element that I am interested in. In many ways this would be true of the NHS ePortfolio too; I don't recall it having a logbook function either. I had to produce my patient logbook as an additional piece of evidence at ARCPs using my pseudonymised Excel file.

[Thanks Carl, understood about their business model, but irrespective, doctors.net are a non-starter.]

If it helps clarify my question, I am thinking of the eLogbook kind of as a 'cradle to grave' listing of what type of patients the doctor has seen, and their procedural experience. It needs to be longitudinal for the doctor and agnostic of what hospitals they have worked at over the years.

Such that I can say that (to date) in my lifetime, I have treated 33 thyroid storms, a third of whom were diabetic. Or that I have done 226 lumbar punctures but only 6 in the five years. I can actually date each event, describe the patient (age, gender, co-morbidities) and know where I saw them.

Similar extensions to other specialties: opthalmology, O&G, surgeons, anaesthetists etc.
Best wishes,
VJ

[Jonathan Kay]

Lots of doctors use Doctors.Net to accumulate records of CPD/ CME etc. I don’t know how closely this connects specifically to different types of logbook. I’d recommend anyone producing anything better to understand it.

RCPath offers something similar for Members, with easy online submission for CME each year. I would guess other Colleges do the same. Again it would be worth finding out.

Jonathan

[Jonathan Kay]

Crossed with your post, VJ.

Jonathan

> On 27 Oct 2015, at 09:18, Jonathan Kay <jonath...@ndcls.ox.ac.uk> wrote:
>
> Lots of doctors use Doctors.Net to accumulate records of CPD/ CME etc. I don’t know how closely this connects specifically to different types of logbook. I’d recommend anyone producing anything better to understand it.
>
> RCPath offers something similar for Members, with easy online submission for CME each year. I would guess other Colleges do the same. Again it would be worth finding out.
>

> Jonathan
>
>

>> On 26 Oct 2015, at 22:41, Carl Reynolds <drc...@gmail.com> wrote:
>>

[Adrian Wilkins]

On 27/10/15 09:14, VJ wrote:

> Such that I can say that (to date) in my lifetime, I have treated 33
> thyroid storms, a third of whom were diabetic. Or that I have done 226
> lumbar punctures but only 6 in the five years. I can actually date each
> event, describe the patient (age, gender, co-morbidities) and know where
> I saw them.
>
> Similar extensions to other specialties: opthalmology, O&G, surgeons,
> anaesthetists etc.
> Best wishes,
> VJ

All in all it sounds like stuff you should be able to extract from a
proper EHR with the appropriate query. Of course, here in the real world
you have to resort to double-bookkeeping.

I wonder if it would be sufficient to keep a log in something like
OneNote, or Zim[1], or TiddlyWiki if you could also assign properties to
the various entries for the purposes of reporting?


[1] http://zim-wiki.org

[VJ]

Thanks agreed, I think you are on the right track. EHR/EMR/EPR are the obvious future. However these are products that belong to a site and are for the longitudinal tracking of patients, not doctors.

This kind of presumes that a doctor only works at a single site for their entire professional career.

In the real world, we change jobs every few years or simultaneously work at multiple hospitals, each with their own computer system.

This is why I say it needs to be agnostic, however I agree entirely that it would be a major plus if it can take a feed or suck up an extract from various source systems.

Anyone know if anything like this exists?
Best wishes,
VJ

[Jonathan Kay]

Yes, and

Anyone know if anything like this exists?

no!

There’s also the problem of why a provider CIO would give this a high priority for resources. As well as the staff moving there’s the inconsistency between the requirement of the multiple Colleges and regulatory bodies and similar which makes it harder to implement.

There is something similar which they might think more important and already has pressures from the centre. There’s a large amount of performance data on individual practitioners that has to be fed to National Audits etc. Mostly surgical procedures and outcomes at the moment but increasing rapidly. This is mostly done by consultants on Sunday evenings, now computerised but basically copy typing from multiple sources. Pulling that from EPRs and similar would be a big improvement.

Jonathan

[Ian McNicoll]

That would be an interesting Hackday project. We could use the openEHR-based OSS Ripple project to play with howan EPR/EHR could interact with an ePortfolio, normal privacy rules applying.

Kind of like a Read this later function?

Ian 

Dr Ian McNicoll
mobile +44 (0)775 209 7859
office +44 (0)1536 414994
skype: ianmcnicoll
email: i...@freshehr.com
twitter: @ianmcnicoll

Co-Chair, openEHR Foundation ian.mc...@openehr.org

Director, freshEHR Clinical Informatics Ltd.
Director, HANDIHealth CIC
Hon. Senior Research Associate, CHIME, UCL

[Adrian Wilkins]

On 27/10/15 10:17, VJ wrote:
> Thanks agreed, I think you are on the right track. EHR/EMR/EPR are the
> obvious future. However these are products that belong to a site and are
> for the longitudinal tracking of patients, not doctors.
>
> This kind of presumes that a doctor only works at a single site for
> their entire professional career.
>

Or you have an EHR system that permits you to maintain local copies of
data (I think from the POV of the DPA, maintaining copies of patient
records for those patients you cared for, for your own records, is just
fine, as you have a number of genuine reasons to do so - and after all,
this is what GPs do already).

In a shiny interoperable future world where systems cooperate
sufficiently to do this, of course..

> In the real world, we change jobs every few years or simultaneously work
> at multiple hospitals, each with their own computer system.
>
> This is why I say it needs to be agnostic, however I agree entirely that
> it would be a major plus if it can take a feed or suck up an extract
> from various source systems.
>

Agreed ; as Jonathan Kay says - if there was a way of getting the data
out of EHR systems (there ought to be... really there should be APIs on
these things), there's no reason you couldn't digest raw records out
into suitably anonymized logbook supporting data and keep this for yourself.

[Marcus Baw]

On 27 October 2015 at 12:03, Adrian Wilkins <adrian....@gmail.com> wrote:

Or you have an EHR system that permits you to maintain local copies of
data (I think from the POV of the DPA, maintaining copies of patient
records for those patients you cared for, for your own records, is just
fine, as you have a number of genuine reasons to do so - and after all,
this is what GPs do already).

​From ICO/DPA point of view it would be allowed but you would need to register as a data controller. I registered with the ICO  when I was an anaesthetist and ​was keeping a personal computerised logbook, more or less for the reasons VJ suggests. You only need to register if it's an electronic logbook.

I agree with Ian McN that this would be an interesting one for a hackday - can we build a better general purpose logbook/ePortfolio? I'm extremely dissatisfied with the commercial offerings in GP land for ePortfolios (£40 a pop for a PSQ anyone?) and the RCGP one has been axed and the user base sold to Clarity Informatics.

Taking inspiration from Firefox extensions that allow you to 'Save to Evernote' would be awesome!

M

[VJ]

Forgive my ignorance. Surely it would be for the company hosting the eLogbook to be registered with the ICO.

Each doctor would sign an ISA as part of the T&Cs. Right?

Could we implement something like this in SharePoint? Or any better suggestions?
Best wishes,
VJ

[Adrian]

> Could we implement something like this in SharePoint?

These words are guaranteed to send a shudder rippling around the Open Source guys here  :-)

Not least of the problems with using SharePoint for anything is that just setting it up puts you firmly in the realms of "infrastructure" [1]. The license costs of it, and the things you need to run it, and the hardware you need to run it, are beyond the reach of "tinkering".

> Surely it would be for the company hosting the eLogbook to be registered with the ICO.

An approach was being suggested where the clinician keeps their own records. I think this is reasonable and has a number of benefits

* Relying on a third party places a lot of control with that third party

* It also makes all those records a relatively large target - when assessing security risks, you multiply the size of the prize by the likelihood of obtaining it - a large server maintained professionally might be harder to crack, but if (when?) it is, the damage is correspondingly higher than you losing e.g. an unencrypted USB thumb with your personal logbook on it

* A flexible platform kept locally can offer benefits that you would otherwise have to pester your service provider for

* While you cannot say that such an approach has no cost, it would depend on computing resources that you presumably should already have

The downsides are that you may have less consistent service - people are less rigorous about e.g. backups than you hope a third party would be.

---
[1] https://technet.microsoft.com/en-GB/library/cc262485.aspx

[Adrian]

> Firefox extensions

I like the notion of something like Zotero, instead of pinning things for research, you pin stuff to your logbook. Giving it the ability to scrape useful detail without compromising privacy would probably be essential. And it unfortunately depends heavily on the tolerance of your IT dept to allow these extensions near your EHR. And won't work on rich client software (unless you copy and paste into it).

[Marcus Baw]

VJ, think yourself lucky you are safely out of my reach for even mentioning SharePoint here! Even the people who get given it to use without having to pay (eg HSCIC employees) think it's an abomination.

I've got my eye on you.....

;-)

M

On 27 October 2015 at 18:34, Adrian <adrian....@gmail.com> wrote:

> Firefox extensions

I like the notion of something like Zotero, instead of pinning things for research, you pin stuff to your logbook. Giving it the ability to scrape useful detail without compromising privacy would probably be essential. And it unfortunately depends heavily on the tolerance of your IT dept to allow these extensions near your EHR. And won't work on rich client software (unless you copy and paste into it).

--

[VJ]

Apologies for cursing, I retract the question :-)

 

I was simply thinking in terms of a grown up version of the Excel file that we (almost) all ubiquitously carry about.  My thoughts had drifted to SQL Server and browser presentations thereof, by way of a form populating a table.  I did not intent to induce a PTSD flashback in the audience.  I recognise that we could do this more simply off a LAMP stack. 

 

I am not in favour of every doctor needing to self-administrate their logbook, as not everyone is as tech savvy (IG/IS) as us.  I’m not convinced any PID (Patient Identifiable Data) needs to be part of this but it is likely that some individuals are probably holding it, without being as through as Marcus has been.  Therefore IMHO, the risk is greater for individuals to lose something identifiable that shouldn’t have been recorded in the first place.   A template driven webform could constraint this and improve completeness of each record. 

I accept that, if hacked, individuals with rare conditions might still be identifiable due to the specific constellation of their comorbidities but they represent an edge case that will need to be thought through.

 

Which brings me back to a higher level question: is this something that all doctors should be doing i.e. keeping a log of everyone they treat, for appraisals and revalidation?  Or is this something that some of us do “because we can” and therefore, am I erroneously overestimating an unmet need?

 

Kr,

VJ

--

[Marcus Baw]

maintaining an ePortfolio by hand is a madness, but unfortunately a necessary one since you can't get this data any other way.

In a (futuristic) world with completely electronic patient records for all aspects of care in hospital, then it would be reasonable to expect that a specialist would be able to extract customised data reflecting their ongoing clinical caseload into an ePortfolio or similar. Unfortunately, I think there would also be considerable resistance from the profession itself to this level of reporting detail in secondary care, since it would almost certainly be hijacked by managers for activity/time & motion/name, blame and shame type activity. We have this level of detail in GP records but we have a lot more control over the uses of those records as GPs than you guys in hospital would have.

Worth noting that even if you have a detailed rundown of your clinical activity you would still need to add the reflection, consideration, review, learning, etc to make it a valuable learning record for appraisal and revalidation and not just an activity audit.

Getting back to reality; I forsee that for some time to come it's going to be necessary to have an ePortfolio type system, and I would agree an open one would be infinitely preferable to the weak offerings we see in either the Royal College arena or the commercial sector, not to mention an open portfolio being more likely to interface with the things we need it to, regardless of the movements of small green pieces of paper.

M

[Matt Williams]

I think for many consultants, there are electronic data sources that cover part of their practice. In oncology, we are now essentially electronic for RT (and almost all for chemo), so that is easy-ish to pull.

Other bits (e.g. clinic attendance) isn't.

Although it matters for CPD, it is actually more useful for job planning. Most of the debates revolve around how much work you are doing. Being able to show that I have done 200 hours of RT planning (i.e. enough cases, with approximate banding for complexity of planning) in 150 hours of planned time is a good way of making the job planning round less pressured.

I think the issues is that for CPD, as it stands, patient volumes aren't yet that important.

BW,

Matt