Full impact of laboratory information system requires direct use by clinical staff: cluster randomized controlled trial.
OBJECTIVE
To evaluate the time to communicate laboratory results to health centers (HCs) between the e-Chasqui web-based information system and the pre-existing paper-based system.


METHODS
Cluster randomized controlled trial in 78 HCs in Peru. In the intervention group, 12 HCs had web access to results via e-Chasqui (point-of-care HCs) and forwarded results to 17 peripheral HCs. In the control group, 22 point-of-care HCs received paper results directly and forwarded them to 27 peripheral HCs. Baseline data were collected for 15 months. Post-randomization data were collected for at least 2 years. Comparisons were made between intervention and control groups, stratified by point-of-care versus peripheral HCs.


RESULTS
For point-of-care HCs, the intervention group took less time to receive drug susceptibility tests (DSTs) (median 9 vs 16 days, p<0.001) and culture results (4 vs 8 days, p<0.001) and had a lower proportion of 'late' DSTs taking >60 days to arrive (p<0.001) than the control. For peripheral HCs, the intervention group had similar communication times for DST (median 22 vs 19 days, p=0.30) and culture (10 vs 9 days, p=0.10) results, as well as proportion of 'late' DSTs (p=0.57) compared with the control.


CONCLUSIONS
Only point-of-care HCs with direct access to the e-Chasqui information system had reduced communication times and fewer results with delays of >2 months. Peripheral HCs had no benefits from the system. This suggests that health establishments should have point-of-care access to reap the benefits of electronic laboratory reporting.
Partners In Health, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. jblaya@hms.harvard.edu
Joaquín A
JA
Blaya
Sonya
S
Shin
Carmen
C
Contreras
Gloria
G
Yale
Carmen
C
Suarez
Luis
L
Asencios
Jihoon
J
Kim
Pablo
P
Rodriguez
Peter
P
Cegielski
Hamish S F
HS
Fraser
D002984:Clinical Laboratory Information Systems / Q000458:organization & administration*; D017598:Efficiency, Organizational; D006801:Humans; D033181:Information Dissemination; D057194:Intention to Treat Analysis; D020407:Internet; D009096:Multi-Institutional Systems / Q000458:organization & administration*; D009313:National Health Programs / Q000458:organization & administration; D010568:Peru; D019095:Point-of-Care Systems / Q000458:organization & administration*; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis