IT tools line up to support revalidation

Authors: Jonathan Gornall 

Publication date:  05 Mar 2013

Jonathan Gornall describes the electronic packages now available to aid appraisal and revalidation

Self confessed Luddite Andrew Goddard might not seem the ideal person to put in charge of an expensive and complex information technology (IT) support project designed to ease the revalidation process for up to 90 000 members of eight medical colleges.

However, Goddard, a consultant gastroenterologist at the Royal Derby Hospital and director of the medical workforce unit at the Royal College of Physicians, says it was precisely his “natural suspicion of anything you click” that qualified him for the job. The work entails developing for a cohort of royal colleges what could be the largest single online system in support of revalidation.

“There are many doctors working in the United Kingdom who are fearful of IT and electronic tools and the thinking was to get people who were not necessarily IT enthusiasts to try to push all of this through, so we would hopefully get a system that most people would be able to use,” he says.

Whether or not they have been successful will begin to emerge in the next few weeks, once the online portfolio on which Goddard and colleagues have been working for the past three years finally goes live. In doing so it will potentially answer a question of particular interest to individual doctors, responsible officers, and medical organisations alike: are the various electronic packages now available to aid appraisal and revalidation essential?

Certainly, the NHS revalidation support team has thought so from the outset. It has produced two simple electronic tools to support revalidation. One is the Medical Appraisal Guide (MAG), an interactive PDF that allows a doctor to have an appraisal ready for revalidation. The other is the Responsible Officer Dashboard, which enables responsible officers to maintain a list of doctors for whom they have responsibility and track their progress through the revalidation cycle.

“In a revalidation system these two separate functions would be integrated into a single system,” says Anita Donley, medical director of the revalidation support team. “In Information Management for Medical Revalidation in England, the RST [revalidation support team] has provided a suggested specification which will help IT providers develop solutions that are consistent with GMC [General Medical Council] guidance and support the model of medical appraisal described in our Medical Appraisal Guide. There is also advice for purchasers of appraisal and revalidation software so that they know what to ask for before they make a decision about which system to buy.”

NHS doctors, responsible officers, and medical organisations in Wales and Scotland have been spared the need to go shopping for such systems. NHS Wales has its own Medical Appraisal and Revalidation System (MARS) and the NHS north of the border is served by the Scottish Online Appraisal Reporting system (SOAR). However, the lack of such support in England has created a competitive market for online systems, with about five IT providers competing for the business.

Not that every organisation has deemed it necessary to seek an off-the-shelf solution. The Royal College of Surgeons of England decided more than three years ago to develop its own, in-house system in collaboration with the other three royal colleges of surgeons in the UK and Ireland. Its online portfolio went live a year ago, after two years of piloting.

“Revalidation was coming and we thought it would be of benefit to our members to provide them with a tool to be able to collect information about their professional lives—for revalidation, but also for the wider purpose of being able to collect information about themselves, for appraisal purposes and other wider reasons,” says Jeremy Brooks-Martin, project manager for the Royal College of Surgeons of England.

At the time, no suitable off-the-shelf product was available. “Although many of the systems are now quite mature, they certainly weren’t then,” he says. He therefore led the in-house IT team that developed its own solution.

The Royal College of Surgeons system is available for every member and fellow of the college to use. Although many surgeons will be served by systems operated by their own trusts, or by the NHS in Wales and Scotland, there are currently 3100 registered users.

“We would not wish to force all members to use it,” says Brooks-Martin. “It’s a tool for them to use if they wish.”

The Royal College of General Practitioners has also developed its own tool. By December its Revalidation e-Portfolio (ReP), “designed by GPs [general practitioners] for GPs,” was being used by 25 000 general practitioners. It is, the college says, “the only tool of its kind with fully integrated GMC patient and colleague questionnaires, with self assessment and benchmarking facilities, all free of charge to RCGP [Royal College of General Practitioners] members and primary care organisations.”

Three years ago, the Academy of the Medical Royal Colleges invited bids from the royal colleges for financial support to buy or develop revalidation systems. Seven colleges, led by the Royal College of Physicians and joined last year by the Royal College of Psychiatrists, joined forces to form a revalidation portfolio cohort steering group. In November 2011, the colleges signed a contract with a specialist company, Equiniti 360° Clinical, to provide an online portfolio to support doctors through appraisal and revalidation.

“We went down the electronic route,” says Goddard, who has led the project, “because the NHS national revalidation support team made it clear they felt electronic support was going to be necessary and that they were not necessarily going to provide a long-term tool to do that.”

Goddard, whose own revalidation date is in August 2014, has done his first electronic based appraisal, “so from the point of view of revalidation I’ve been dragged kicking and screaming into the 21st century.” His verdict? “It’s not quite as ghastly as some people might have us believe.”

Patrick Walker, a consultant with the NHS for 25 years, is offering his services as a responsible officer to a large company with several private hospitals in London, and over the next three years has to be in a position to make a positive affirmation on 252 doctors. He too is working with Equiniti’s online system, on to which more than 190 of his charges have now been loaded. “I just can’t see why anybody would want to do it any other way,” he says.

It’s also now his personal choice for his own appraisal process. “What I’ve tended to do over the years is, if I go to a meeting I keep the agenda, and put it in a paper-based folder; if I publish a paper I print it off and stick it in the folder; and so on, so over a period of time I will put together a small folder of supporting information which shows what I have been doing.

“Now, I could just keep that. But what I do now, and what most people will do eventually, is sit down with my secretary, who scans those documents and then uploads them into an appraisal IT system.”

Doctors can grant access to their online portfolio, complete with uploaded supporting material and multisource feedback, to their appraiser, who can see all the information that’s available—and spot any holes in it before the appraisal meeting.

“When you sit down together you can quickly bring up on the screen any of these documents and the reflection upon it, and when you’ve filled out the boxes for the four key statements from the appraiser that you’re ok, and a little summary is agreed between you, you can press the button and send it off to me, the RO [responsible officer],” says Walker. “Now, you could do all of that by hand, but imagine the difficulty.”

It was imagining that difficulty that led Equiniti 360° Clinical to develop its Revalidation Management System, which is designed to help responsible officers manage the appraisal and revalidation process and which incorporates the electronic portfolio in which doctors can store supporting information.

Goddard says the journey of the cohort of royal colleges towards unveiling the revalidation support software has been “long, winding and not without its travails.” This process has been guided by “doctors saying ‘This is what we need’, rather than IT people,” he says. “The product in its final iteration will be much better for that collaboration,” he adds.

He is looking forward to the next six months, he says, “with interest.” The project cohort board will be monitoring helpdesk feedback and making any necessary changes.

“I’m sure our members and fellows will not be backwards about coming forward with any issues. If it works perfectly for everybody, first time around, I will be staggered, because I’m not aware of any project of this size in the NHS that has gone smoothly with no problems.”

Not all the college members will use the portfolio provided by the cohort—some, for example, will work for trusts that have developed their own systems—but that, he says, isn’t a real concern.

“My trust at the moment uses just the MAG form, but they may well purchase a revalidation tool in the future. Now, if that is the RMS [Revalidation Management System], great, because I’m used to using that because I’m using the cohort portfolio.

“But if my trust decides to go for another provider, I am able to download all my revalidation information which I’ve been collating and organising within my portfolio into a PDF version, which I can then just plug into my trust-provided revalidation system.”

That’s not quite good enough for Brooks-Martin, at the Royal College of Surgeons of England.

“We seem to have a product which our members like, but we are now in the process of speaking to the other seven systems providers about inter-operability,” he says. “I would be even happier if each of them would all talk to each other and us and with the physicians and the GPs about ensuring that doctors don’t have to duplicate any data.”

Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.

Jonathan Gornall freelance journalist London, UK

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