Lessons from the Field

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

Timothy M. Mtonga, Faheema E. Choonara, Jeremy U. Espino, Chimwemwe Kachaje, Kenneth Kapundi, Takondwa E. Mengezi, Soyapi L. Mumba, Gerald P. Douglas
African Journal of Laboratory Medicine | Vol 8, No 1 | a841 | DOI: https://doi.org/10.4102/ajlm.v8i1.841 | © 2019 Timothy M. Mtonga, Faheema E. Choonara, Jeremy U. Espino, Chimwemwe Kachaje, Kenneth Kapundi, Takondwa E. Mengezi, Soyapi L. Mumba, Gerald P. Douglas | This work is licensed under CC Attribution 4.0
Submitted: 30 May 2018 | Published: 28 October 2019

About the author(s)

Timothy M. Mtonga, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Faheema E. Choonara, Kamuzu Central Hospital, Lilongwe, Malawi
Jeremy U. Espino, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Chimwemwe Kachaje, Baobab Health Trust, Lilongwe, Malawi
Kenneth Kapundi, Baobab Health Trust, Lilongwe, Malawi
Takondwa E. Mengezi, Baobab Health Trust, Lilongwe, Malawi
Soyapi L. Mumba, Baobab Health Trust, Lilongwe, Malawi
Gerald P. Douglas, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States


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Abstract

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.


Keywords

low-resource setting; laboratory testing; laboratory information system; Malawi; informatics interventions

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