title: Clinical decision support system to enhance quality control of spirometry using information and communication technologies.
abstract: BACKGROUND
  We recently demonstrated that quality of spirometry in primary care could markedly improve with remote offline support from specialized professionals. It is hypothesized that implementation of automatic online assessment of quality of spirometry using information and communication technologies may significantly enhance the potential for extensive deployment of a high quality spirometry program in integrated care settings.
  
  
  OBJECTIVE
  The objective of the study was to elaborate and validate a Clinical Decision Support System (CDSS) for automatic online quality assessment of spirometry.
  
  
  METHODS
  The CDSS was done through a three step process including: (1) identification of optimal sampling frequency; (2) iterations to build-up an initial version using the 24 standard spirometry curves recommended by the American Thoracic Society; and (3) iterations to refine the CDSS using 270 curves from 90 patients. In each of these steps the results were checked against one expert. Finally, 778 spirometry curves from 291 patients were analyzed for validation purposes.
  
  
  RESULTS
  The CDSS generated appropriate online classification and certification in 685/778 (88.1%) of spirometry testing, with 96% sensitivity and 95% specificity.
  
  
  CONCLUSIONS
  Consequently, only 93/778 (11.9%) of spirometry testing required offline remote classification by an expert, indicating a potential positive role of the CDSS in the deployment of a high quality spirometry program in an integrated care setting.
authors.affiliation: Hospital Clinic - IDIBAPS - Ciberes, Respiratory Diagnostic Center, University of Barcelona, Barcelona, Spain. fburgos@ub.edu.
authors.forename: Felip
authors.identifier: http://orcid.org/0000-0002-4938-4581
authors.initials: F
authors.lastname: Burgos
authors.forename: Umberto
authors.identifier: http://orcid.org/0000-0003-3033-0505
authors.initials: U
authors.lastname: Melia
authors.forename: Montserrat
authors.identifier: http://orcid.org/0000-0002-2031-3261
authors.initials: M
authors.lastname: Vallverdú
authors.forename: Filip
authors.identifier: http://orcid.org/0000-0003-0301-5788
authors.initials: F
authors.lastname: Velickovski
authors.forename: Magí
authors.identifier: http://orcid.org/0000-0001-6926-7190
authors.initials: M
authors.lastname: Lluch-Ariet
authors.forename: Pere
authors.identifier: http://orcid.org/0000-0002-2301-8153
authors.initials: P
authors.lastname: Caminal
authors.forename: Josep
authors.identifier: http://orcid.org/0000-0002-4650-8542
authors.initials: J
authors.lastname: Roca
keywords: information communication technologies; primary care; quality control; spirometry; telemedicine