A web-based laboratory information system to improve quality of care of tuberculosis patients in Peru: functional requirements, implementation and usage statistics.
BACKGROUND
Multi-drug resistant tuberculosis patients in resource-poor settings experience large delays in starting appropriate treatment and may not be monitored appropriately due to an overburdened laboratory system, delays in communication of results, and missing or error-prone laboratory data. The objective of this paper is to describe an electronic laboratory information system implemented to alleviate these problems and its expanding use by the Peruvian public sector, as well as examine the broader issues of implementing such systems in resource-poor settings.


METHODS
A web-based laboratory information system "e-Chasqui" has been designed and implemented in Peru to improve the timeliness and quality of laboratory data. It was deployed in the national TB laboratory, two regional laboratories and twelve pilot health centres. Using needs assessment and workflow analysis tools, e-Chasqui was designed to provide for improved patient care, increased quality control, and more efficient laboratory monitoring and reporting.


RESULTS
Since its full implementation in March 2006, 29,944 smear microscopy, 31,797 culture and 7,675 drug susceptibility test results have been entered. Over 99% of these results have been viewed online by the health centres. High user satisfaction and heavy use have led to the expansion of e-Chasqui to additional institutions. In total, e-Chasqui will serve a network of institutions providing medical care for over 3.1 million people. The cost to maintain this system is approximately US$0.53 per sample or 1% of the National Peruvian TB program's 2006 budget.


CONCLUSIONS
Electronic laboratory information systems have a large potential to improve patient care and public health monitoring in resource-poor settings. Some of the challenges faced in these settings, such as lack of trained personnel, limited transportation, and large coverage areas, are obstacles that a well-designed system can overcome. e-Chasqui has the potential to provide a national TB laboratory network in Peru. Furthermore, the core functionality of e-Chasqui as been implemented in the open source medical record system OpenMRS http://www.openmrs.org for other countries to use.
Blaya
Joaquin A
JA
1Division of Health Sciences & Technology, Harvard Medical School-MIT, 77 Massachusetts Ave. Cambridge, MA 02139, USA. jblaya@mit.edu
Shin
Sonya S
SS
Yagui
Martin J A
MJ
Yale
Gloria
G
Suarez
Carmen Z
CZ
Asencios
Luis L
LL
Cegielski
J Peter
JP
Fraser
Hamish S F
HS
D002984:Clinical Laboratory Information Systems / Q000458:organization & administration* / Q000706:statistics & numerical data; D006284:Health Plan Implementation; D006801:Humans; D007753:Laboratories / Q000458:organization & administration* / Q000592:standards; D008507:Medically Underserved Area; D020380:Needs Assessment; D010568:Peru; D016730:Program Development; D011635:Public Health Administration / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D013997:Time Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy