Informatics solutions for bridging the gap between clinical and laboratory services in a low-resource setting

Design and implementation of a clinical laboratory information system in a low-resource setting

BACKGROUND

Reducing laboratory errors presents a significant opportunity for both cost reduction and healthcare quality improvement. This is particularly true in low-resource settings where laboratory errors are further exacerbated by poor infrastructure and shortages in a trained workforce. Informatics interventions can be used to address some of the sources of laboratory errors.

OBJECTIVES

This article describes the development process for a clinical laboratory information system (LIS) that leverages informatics interventions to address problems in the laboratory testing process at a hospital in a low-resource setting.

METHODS

We designed interventions using informatics methods for previously identified problems in the laboratory testing process at a clinical laboratory in a low-resource setting. First, we reviewed a pre-existing LIS functionality assessment toolkit and consulted with laboratory personnel. This provided requirements that were developed into a LIS with interventions designed to address the problems that had been identified. We piloted the LIS at the Kamuzu Central Hospital in Lilongwe, Malawi.

RESULTS

We implemented a series of informatics interventions in the form of a LIS to address sources of laboratory errors and support the entire laboratory testing process. Custom hardware was built to support the ordering of laboratory tests and review of laboratory test results.

CONCLUSION

Our experience highlights the potential of using informatics interventions to address systemic problems in the laboratory testing process in low-resource settings. Implementing these interventions may require innovation of new hardware to address various contextual issues. We strongly encourage thorough testing of such innovations to reduce the risk of failure when implemented.

Assessing Perceived Challenges to Laboratory Testing at a Malawian Referral Hospital

Adequate laboratory infrastructure in sub-Saharan Africa is vital for tackling the burden of infectious diseases such as human immunodeficiency virus and acquired immune deficiency syndrome, malaria, and tuberculosis, yet laboratories are ill-integrated into the diagnostic and care delivery process in low-resource settings. Although much of the literature focuses on disease-specific challenges around laboratory testing, we sought to identify horizontal challenges to the laboratory testing process through interviews with clinicians involved in the diagnostic process. Based on 22 interviews with physicians, nurses, clinical officers, medical students, and laboratory technicians, technologists and supervisors, we identified 12 distinct challenges in the areas of staff, materials, workflow, and the blood bank. These challenges underscore the informational challenges that compound more visible resource shortages in the laboratory testing process, which lend themselves to horizontal strengthening efforts around the diagnostic process.