Web-based system for training and dissemination of a magnification chromoendoscopy classification.

AIM: To evaluate the use of web-based technologies to assess the learning curve and reassess reproducibility of a simplified version of a classification for gastric magnification chromoendoscopy (MC). METHODS: As part of a multicenter trial, a hybrid approach was taken using a CD-ROM, with 20 films of MC lasting 5 s each and an "autorun" file triggering a local HTML frameset referenced to a remote questionnaire through an Internet connection. Three endoscopists were asked to prospectively and independently classify 10 of these films randomly selected with at least 3 d apart. The answers were centrally stored and returned to participants together with adequate feedback with the right answer. RESULTS: For classification in 3 groups, both intra- [Cohen's kappa (kappa) = 0.79-1.00 to 0.89-1.00] and inter-observer agreement increased from 1st (moderate) to 6th observation (kappa = 0.94). Also, agreement with reference increased in the last observations (0.90, 1.00 and 1.00, for observers A, B and C, respectively). Validity of 100% was obtained by all observers at their 4th observation. When a 4th (sub)group was considered, inter-observer agreement was almost perfect (kappa = 0.92) at 6th observation. The relation with reference clearly improved into kappa (0.93-1.00) and sensitivity (75%-100%) at their 6th observations. CONCLUSION: This MC classification seems to be easily explainable and learnable as shown by excellent intra- and inter-observer agreement, and improved agreement with reference. A web system such as the one used in this study may be useful for endoscopic or other image based diagnostic procedures with respect to definition, education and dissemination.

Monitoring the integration of hospital information systems: How it may ensure and improve the quality of data.

Integration of hospital departmental information systems (HDIS) has become a common but difficult issue. In May 2003, the Department of Biostatistics and Medical Informatics implemented a Virtual Electronic Patient Record (VEPR) for the Hospital S. João (HSJ), a university hospital with over 1350 beds. The system integrates clinical data from 10 legacy HDIS plus the Hospital Administrative Database (HAD), aiming to deliver all patient information to health professionals. Currently, around 500 medical doctors use the system on a regular basis and the HSJ-VEPR retrieves an average of 3,000 new reports per day, in PDF or HTML formats. This paper describes and discusses the role of monitoring in the assurance and improvement of data quality. Three approaches were put in place: (a) monitoring the HSJ-VEPR concerning the frequency of clinical records retrieved from the DIS by checking if the daily number of reports sent by the HDIS fell in the normal range from similar week days; (b) monitoring inconsistencies in the patient's identification by cross-checking between HDIS and HAD; and (c) monitoring the integrity of clinical records delivered to medical doctors through the HSJ-VEPR by checking their digital signature. During 2005, the monitoring system detected 53 unusual frequency patterns of which 44 corresponded to real problems. Over a 6 months period, more than 400 alerts were generated concerning inconsistencies in the patient's identification found in laboratory reports. Nevertheless, a significant reduction in the number of these inconsistencies occurred - from 116 in July to 10 in December 2005--due to implementation of preventive measures by the DIS. Finally, report's integrity was checked each time the report was asked to be visualized i.e. in more than one hundred thousand times during a one year period. In conclusion, all information available in hospital information systems can and should be used to trigger alerts of malfunctions and inconsistencies, in order to improve data quality and ensure a better health care.