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Using Evernote for Continuous Professional Development – a view from General Practice in UK

10 Dec

Like many professional people doctors must keep track of a lot of information. From beginning of December 2012, all GMC registered doctors must engage with 5 yearly revalidation cycle.  Annual appraisal has been in place since 2004 after the Shipman scandal and its aftermath, the legal requirement for revalidation has only now been enacted.

Many different systems are available to doctors to choose from for keeping track of the required documents and learning. The Royal Medical Colleges have systems for their members (e.g. RCGP ePortfolio), the NHS has encouraged a toolkit, and some household names in medical press (eg GP, BMJ eLearning) have also jumped on the bandwagon.

However, after trying out several I have purchased the premium version of Evernote.  Evernote suits my style of learning and integrates easily with all the devices used for work and play – Windows Home PC, laptop and work PC, and android phone & tablet.  It will also work happily on iOS devices and Apple computers.

It has taken some time to get used to the powerful features of Evernote.  The Premium version allows full control of privacy settings which is clearly important for something as sensitive as professional portfolio.  Also the paid version allows up to 1GB data uploaded per month which is generous unless you are in habit of uploading videos or audio files of meetings. This data plan can be increased for another fee.  Acrobat PDF files can be read inside the programme too.  Numerous third party applications are available to expand the capability of Evernote: some are free, many are enterprise (fee paying) solutions.

I have two main folders for notebooks – Personal and Work.  One notebook is publicly shared with my patients – the link is here
My appraisal notebook can be shared with my appraiser for the current year.

Evernote provides a tool to archive twitter posts which is a boon when engaging in professional twitter chats (when you see @myEN the author is archiving post to her or his evernote notebook.  You can add an extension to Chrome or Firefox to help grab web pages or parts thereof and store in  Evernote.

Furthermore, careful use of tags will help with finding notes quickly, though Evernote does a good job with free text searching too.

Finally, the best is kept until last  – automatic adding of useful emails or social network interactions or cloud storage files. The means to do this is provided by a couple of providers which I have stumbled on.  Zapier (http://zapier.com) offers free packages for a limited number of “recipes” (5) and ifttt (http://ifttt.com) offer free packages for unlimited number of “recipes” .  Careful planning can give excellent results for busy doctors (and others).  The instructions for use are straightforward.

After nearly one year nearly 7000 notes have been collected. While not a complete and comprehensive collection of learning and interaction that some may aspire to, it is a good reflection of continuous professional development.

Calibre ebook management & Dropbox

23 Sep

                

Today was a day of discovery. A discovery which looks to help with book management using the popular Calibre e-book management tool (http://calibre-ebook.com/) and file management across several (mobile) devices and the popular cloud service Dropbox (http://www.dropbox.com ). I can now integrate these with my favourite ebook reader on Android, Aldiko (http://goo.gl/2fnCH )

Introducing dropsync (http://www.ttxapps.com/dropsync) which seems to be the answer to the prayers of many people trying to keep their cloud storage synchronised with their laptop, desktop and any other mobile devices. An amazing thing about this – it is Android only at the moment! For an extra £3.99 you can unlock the full functionality of this tool (http://goo.gl/kDAGU ).

Anyone who uses an ebook reader like the Kindle and Kobo should have Calibre on their desktop. Using dropbox on the desktop with dropsync permits 2 way real-time synchronisation with your work at home, work and on your mobile device. You have full control over the folders you wish to manage in this way.

For my ebooks, this provides a very efficient way of keeping your ebook readers synchronised (be warned this will use a lot of data on your mobile plan, so you should only sync on WiFi unless you are on an unlimited data plan. If you are like me the tablet is not always available, so it can be helpful to have the document (book) updated automatically on the phone. For aldiko, the books are saved to /sdcard/eBooks so this is the folder which is synchronised on Dropbox.

Keeping working documents synchronised is also straightforward with dropsync.

Calibre companion (http://goo.gl/FEhO3 ) is a paid app (£1.99) which efficiently keeps your ebook library on your mobile device(s) up to date with your main Calibre ebook library. Just wirelessly connect the mobile device with your PC, tell Calibre companion where to store your ebooks (I chose the Aldiko ebook directory).

So one great program for Mac or Android to exploit cloud storage (dropbox), with two fabulous programs for android only at the moment to go further with real time synchronisation of any files/folders (Dropsync) and ebook management on your mobile devices (Calibre companion).

QR Codes

Calibre book management (Windows/android/Mac/Linux) (free)
Calibre companion (android) (£1.99)
Dropbox (android) (free)
Dropbox (windows) (free)
Dropbox (Mac) (free)
Dropsync (android) (free)
Dropsync Pro Key(android) (£3.99)
Aldiko ebook reader(android) (free) ($2.99 [in 2010])

eLearning Needs in NHS Sept 2012 #mobimooc

13 Sep

Mobimooc 2012 is up and running.  2 webinars have been well attended.  Regrettably the timing is not great for me – but the team has recorded the lectures 

By coincidence two new systems are due to launch in my region of UK.  An electronic prescribing system (EPS) and new telephone triage service (NHS 111)

NHS 111

http://goo.gl/ra2IE points to introduction to the system.  The NHS has also provided online introduction with accompanying slideshow here with direct link to the video Introduction to NHS 111

Here is a great example of mLearning in action but the local NHS managers insisted on practice teams send delegates to a meeting somewhere in my town.  Clearly this was a poor use of time for my practice manager.  With such a good presentation created, it is clear to me that the time taken for many people to get to the meeting would be better spent watching the slide show.  How patronising of our service managers!  There is apparently good evidence that the new system will be good for patients and reduce some of the demand on emergency services from (trivial) emergencies.

It does look like no-one locally is aware of mobile learning project management.  Here is  an excellent opportunity which has passed us by!  Notice there is no system on the website to help visitors assess their learning after reading the transcript while watching the slide show.  Why is the slide show an embedded video rather than posted on Slideshare, Brainshark, or other public cloud service?  How hard would it be to have a feedback form?

Whether the UK really needs another emergency number is a moot point now.  As a GP, this system looks to me a threat for the future primacy of General Practice as the first point of contact for health care questions by UK citizens.  This is sad.  In the not too distant future UK may come to regret the demise of the family doctor as an independent gatekeeper to healthcare services.  That is a discussion for a future post.

Electronic Prescribing System

I wish to share the following from my local medical committee concerning the roll out of the new electronic prescribing service because the rational behind it is described and the questions from my representatives focus us on another opportunity for eLearning.

NHS Bedfordshire and NHS Luton are working for Electronic Prescription Service (EPS) Release 2.  This will mean that the PCTs would then be enabled to allow practices and pharmacies to take part in EPS, if the practices and pharmacies want to.  This is part of a national programme.  We were told that EPS has been available in Hertfordshire for some time and that just under 30 practices are taking part in EPS there.  
We’ve seen documentation from Bedfordshire and Luton about what EPS is; what practices would have to do under EPS; what the criteria would be for selecting patients who could use EPS and what participating practices would need to do to support patients in making their choice; how patients would nominate which pharmacy they want to use for EPS and what the participating practice would need to do to facilitate this.

Beds LMC members recognised the positive objectives of the scheme, e.g.
It is supposed to reduce GP work load ultimately
It may be more convenient to the patient
It may reduce waste
It is understood that EPS will be optional for practices.
But Beds LMC members did have some concerns:
To what extent is it a whole new area of unfunded work in general practice?
Beds LMC members thought that EPS would create the following work:
1. GPs will be expected to identify suitable patients.
2. The GP has to look at all applications for it and make sure they do not have any of the exclusions (large groups of patients such as those on controlled drugs, anticoagulants and some others).
3. The GP or GP staff will be expected to promote and explain the process and follow this up in writing and collect a signature 
4. The practice will be expected to telephone suitable patients and offer it to them.
5. Time will be need to train GP staff.  Nothing about backfill for this.
6. All prescribers will have to use smartcards and be wary of prescribing some formulations or brands of medication which do not have a suitable barcode.  Not all practices use their “smartcards” when consulting because they cause their system to run slow and time out.  So clinicians log in and work offline.
Patients with regular repeat prescriptions tend to be patients on chronic disease registers.
On the rare occasions when patients such as this come in “just for a repeat prescription” it gives the GP an opportunity to pick up on preventative care, QoF items and other aspects of the health and wellbeing agenda.  In other words, the aspects GPs do not always have time for when dealing with acute illness in a 10 minute consultation.  Could the use of EPS actually reduce the level of care available for some patients?
Concerns that the EPS will not be a simple scheme, as some items cannot be included in EPS, so there would have to be two prescribing systems for EPS patients: one for EPS-included medications and one for EPS-excluded medications
Is there any evidence that EPS has saved time for GPs or staff in primary care?
If any Hertfordshire practices who are using EPS would be willing to share any of their experiences or would be able to answer any of the specific concerns listed, it would be very interesting to hear from you?

Here is my response:

Wow! How can such a simple idea as electronic repeat prescribing become so complex?

FIrst thoughts: I want nothing to do with a system with more bureacracy to set up. We have enough to deal with without this additional burden.

Second: The system is doomed unless bandwith of broadband connections is increased to cope with the demand from our desktops (and mobile devices). Currently broadband speed is around 10megabits per second down and 0.5 mb/s up, at least in Watford. Divide this by 8 prescription terminals and you can see the speed drop makes the system inoperable.

Third: Barcodes are not immune from corruption; at least several times a week a popup warns there has been a problem and the barcode should be scratched out. How do you do that with an electronic script?

Fourth: The main benefit of EPS is prescribing from mobile devices. With 4G/LTE imminent this seems practical so long as all prescribers have feature phones with the necessary hardware. I fear the powers that be are focussing on the wrong systems. We need secure login systems for iPhones/iPads and android devices to make EPS useful (e.g. prescribing urgent scripts on home visits, or residential facilities)

FIfth: How are pharmacists supposed to be persuaded to adopt this?

Sixth: Prescribing2U is already available. How does this differ from EPS 2?

Seventh: All HCPs who access clinical system must log in with NHS Smartcard. If there are hardware problems managing this, the IM&T teams across our area must fix these before rolling out EPS.

This system is being imposed on us on the background of a longterm agenda to cut the printed script costs.  There is also an agenda to improve security of prescribing.  Since proposed several years ago, IM&T systems and devices have evolved.  Mobile devices are so much more capable than before.  For example, my smartphone (HTC One X) is more powerful computer than my desktop system 10 years ago!

There is nothing in my local medical committee concerns nor in the NHS EPS background documents to indicate any desire to develop a mLearning project to aid in the implementation of this system.

Conclusion

Two new systems are being implemented shortly with the intention of improving patient care in an NHS region.  Two sophisticated organisations are responsible for the roll out of NHS 111 and EPS.  Neither seems to embrace education technology which, in my opinion, would ease the pain involved in changing behaviour of health care professionals and the public.

There is clearly a very long way to go to embed eLearning into the NHS.  This is a terrible state of affairs for a developed society.  It is ironic that some countries with large health care burdens (e.g. sub-Sahara Africa countries; South America countries) may be receiving superb instruction in mLearning systems.

I would love to see some discussion about the particular systems described above – your experiences of similar systems in your country, ideas on how to improve implementation, or anything else you think would be interesting.

Thank you in advance…

What does MobiMOOC 2012 offer me?

8 Sep

The gauntlet has been thrown.  MobiMOOC 2012 starts this weekend.

Two essays have me thinking – “what does MobiMOOC 2012 offer me?”; “why have I signed up for this activity?”

Michael and Rebecca have written well on their hopes and objectives.  So why shouldn’t I do so too?

Why am I signed up for MobiMOOC 2012?

The simple answer is the 2011-2012 annual appraisal concluded with my Appraiser advising I should be more active sharing what I do and know about eLearning technology and resources with my colleagues.

This sounded easy, but how do you go about demonstrating competence in an area which remains poorly defined, at least in medical education.  Yes, I use android tablet and phone. Yes, I use the cloud to share resources with my students and colleagues. However, this seems trivial when reading all about the activities of many of the facilitators and students in this year’s MobiMOOC 2012.

MobiMOOC 2012 notice turned up on Google Plus I thought this is what I think I need to gain sufficient skills, knowledge and understanding to encourage my colleagues and students to explore the education technologies available to improve the effectiveness and efficiency of their continuing professional development.

What does MobiMOOC 2012 offer me?

Well the simple answer for what is offered is contained in the introduction from Inge

There is a wealth of information and applications and contacts.  But this is worth nothing if I do not implement some of the learning points and engage with my colleagues and students to attempt to persuade more to invest some time and effort into using education technology.

So this gets me to the heart of the matter.  How do you overcome the reluctance of peers to embrace new technology to improve patient care?  Actually, is there evidence that eLearning does improve patient outcomes?  How much additional effort is needed to learn the new tools? What sort of investment?  What is the best device? Why are some patient settings so difficult to work with to improve point of care education and decision tools?

There are probably many more questions. And I hope that the discussions over the coming weeks and beyond will help me overcome the pain points which obstruct progress in the uptake of elearning tools in healthcare.

David

‘Drama of Life Before Birth’: Landmark Work, Five Decades Later

23 May

Iconic pictures which celebrate human life.

Getting Better: 200 Years of Medicine

18 May

See on Scoop.itOf human kindness

Getting Better is a short documentary that explores three remarkable stories of medical progress: Cancer, HIV/AIDS, Surgery. The film looks at the role of re…

See on www.youtube.com

Kinda Learning Stuff: If this then that…

4 Mar

Kinda Learning Stuff: If this then that…. by Sarah Horrigan

I don’t see many people mentioning this, but it’s something I came across a while ago and it is brilliant.

‘It’ being the website ifttt

Okay, so brilliant is a nerdy kind of brilliance but nevertheless for helping to make connections between bits of yourself on the web, it’s fabulous.  The basic premise is built on the idea of recipes.  You combine tasks to create recipes.  And the tasks are attached to various services – called channels – from Twitter to Facebook, SMS to email.

You then use the formula ‘if this then that’ (if this then that = ifttt – geddit?) to combine those tasks to get it to do brilliant stuff.

For example, whenever I post something to this blog, I want it to appear on Twitter.  I just set up a recipe that says ‘when there’s a new entry on the RSS feed… put out a Tweet that looks like that’ and away it goes.  I want to know when it’s going to rain… I create a recipe that says ‘when this website says it’s going to rain tomorrow in my region… send me a text message to remind me to take a brolly’.  Favourite a Tweet and the link automatically gets saved to your Diigo account etc… save something on Diigo with a particular tag and a Tweet broadcasts it or it appears on your Facebook page.  Want to backup your Instagram photos to Dropbox then ifttt can do that automatically.  Got the idea?

Blogging is a bit like an ifttt recipe – if I see something I want to share then I’m going to blog about it – only ifttt automates the bit in the middle! It’s the combining of services and tasks which makes this just a genius little site.  Oh, and you don’t even have to do the combining yourself… people also publish ‘recipes‘ which you can reuse / tweak.

‘if this then that’ – a little combination of words I never knew I needed until I started using them!

An interesting essay

29 Nov

from www.lastwordonnothing.com

Break through

By Virginia Hughes | November 29, 2011

This past summer, I spent two weeks sitting, working and, once, sleeping next to a hospital bed, trying and failing to communicate with my father.

He had called for an ambulance on the evening of July 25 because he couldn’t breathe. With end-stage emphysema, he often couldn’t breathe, but apparently that night he was frightened enough to call for help. At the hospital, the doctors intubated him and doused him with the sedatives one needs to withstand a hard plastic tube down the throat. My sister and I never knew if he had agreed to the intubation, or if he was too weak or panicked to voice a clear opinion. Over the next few days in the ICU, although still heavily sedated, he sometimes acted in ways that seemed deliberate: he would open his eyes wide, or furrow his brow, or nod to a question or squeeze my hand. But I was never really sure. I wasn’t sure if he would have wanted us to agree to the tracheostomy procedure, on August 2, or remove the ventilator, on August 9.

What if I could have been more sure?

I couldn’t help but think about that a couple of weeks ago while having coffee with Jon Bardin at the Society for Neuroscience meeting in Washington, D.C. A few years back, Jon left the science magazine where we both worked to pursue a PhD in neuroscience. He joined the lab of Nicholas Schiff, an expert on the neural basis of consciousness, and began studying the brain activity of people with severe brain injury. And now at the conference, Jon told me, he would be presenting a poster of unpublished data suggesting that brain waves can reveal whether a somewhat conscious person is tuning in when other people speak.

Later I found Jon’s poster, one of thousands pinned on boards in the basement of the convention center. The star of his data was patient M1, a 57-year-old woman whom I’ll call Janet. Seven years ago, Janet had a stroke that left her in a ‘minimally conscious state’ until she died about a year ago. During that long hospital stay, she sometimes responded to other people — by tracking objects with her eyes or following simple commands — but never initiated an action and never spoke.

About three years ago, using a technique called electroencephalography (EEG), Jon and his colleagues put a few dozen electrodes on Janet’s scalp and recorded the brain waves emitted over a 72-hour period. Brain waves represent the synchronous activity of thousands or millions of neurons and are measured in frequency units called Hertz, or cycles per second. On a raw EEG read-out, low-frequency brain waves look fat, like a mountainscape, whereas high-frequency waves are skinny and sharp, like blades of grass. Waves of different frequencies have been tied to different biological functions. For example, somewhat slow ‘alpha’ waves, 8 to 13 Hertz, appear when eyes close.

Many things happened around Janet during those three days of recording: her family came in and out, her neighbor watched television, monitors beeped, nurses gabbed. Most relevant for the experiment were the seven minutes when the researchers played a recording of her sister telling a story about a family trip to Paris. Here’s what Janet’s brain waves looked like in the seconds before and after the onset of the recording (green)…follow link to read more

Illusions of Autonomy

Where medical ethics and human behaviour meet

Enjoying every second

Cada lugar, cada rincón, cada momento compartido arreglando el mundo entre imprescindibles

The Commonplace Book

Jim McManus blogs on public health, ethics, books, theology and more