Technological advances permeate the world today and the Internet has become an almost ubiquitous commodity. These assets have revolutionized the global economy and have change the way the world communicates and does business. Direct applications to the medical field, however, have been lagging behind corporate applications due to confidentiality constraints and lack of appropriate software. These restrictions have recently been overcome utilizing proprietary software developed by iCanSP ( a subsidiary of Computer Associates). The software, utilized by The Smile Train, a charitable organization that funds cleft care and research in over 40 countries, allows for an online cleft patient record database known as the Smile Train Express. The Smile Train has funded over 50,000 cleft cases and the photographic and clinical records of these patients are stored and maintained at a central cache by The Smile Train staff. At monthly intervals, 10 percent of the records received per month (approximately 300 charts), are reviewed by a cleft surgeon who receives and downloads the data via Internet from a secure Smile Train website. The records are graded according to outcome and an overall score for each sponsored center is generated. In this way an independent reviewer can assess the level care and the quality of work generated by each center. Recommendations regarding continued educational needs and the continued participation within the Smile Train sponsored program are made and implemented based on reviewer results. In this way distant surgical sites are held accountable for their results and quality patient care is emphasized. To the best of our knowledge, The Smile Train program represents the only system of long term, comprehensive, ongoing; Internet based quality assessment available in distance surgery. We believe that this level of self-assessment sets a new standard that must be offered to all patients who are candidates of missionary or distance surgery for without this type of self-assessment we are destined to repeat mistakes or foster a level of care that is not up to our own recognized standards.
This discussion will present the Smile Train system, outline the method of review utilizing patient examples and outline the system response to successful and unsuccessful outcomes.