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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 ( offers free packages for a limited number of “recipes” (5) and ifttt ( 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.

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 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.


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.


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

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