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1. Introduction
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2. Translating data into action: essential components of a TB recording and reporting system
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3. Designing an optimal information system
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4. Recommended process of development
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5. Resource requirements
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6. Measuring the impact of the information system
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References
2.4 Optimizing use of laboratory data
Modern TB programmes rely on tests (GeneXpert, culture, smear, etc.) to diagnose TB. Tests are also used to track the progress of treatment, as both DS- and DR-TB treatments involve scheduled follow-up tests. Conversion is an important milestone in a patient’s treatment programme. Given that diagnostics are such a key part of the TB care cascade, there is much to be gained by using digital systems for lab data.
Preventing loss to follow-up
A positive diagnosis is a sign that the patient in question needs to be started on treatment as soon as possible. However, given that laboratories do not start people on treatment, a care provider needs to be informed. Systems like GxAlert and DataToCare allow for Xpert test results to be sent directly from GeneXpert machines to central servers, from which care providers can receive the information via email, SMS, or other medium. Similarly, an LIMS could be set up for any diagnostic device that allows data to be sent to an external system. This is usually done using health information exchange standards such as Health Level Seven (HL7), as described in Section 3. The same can also be done by equipping clinics with an SMS printer that receives results directly from the laboratory via SMS and prints them out.
Tracking lab performance
Having GeneXpert data (or other test data) consolidated in a single place can provide important insights into how laboratories are performing. Error rates can be remotely monitored, enabling quick remedial action if necessary; non-performing laboratories can be identified, prompting the move of diagnostic devices to locations where they may be better utilized; inventory of consumables (e.g. GeneXpert cartridges) can be monitored; and device warranties can be tracked so that scheduled service and maintenance are carried out in a timely manner, increasing uptime e.g. user errors can be differentiated from machine errors allowing programmes to rectify the problem through training or repair/replacement.
Digital information systems can also be used to ensure that samples are correctly labelled and recorded (spot vs. morning, diagnostic vs. follow-up, type of specimen), and that the information is automatically available to lab technicians who then test the sample. Alternatively, if sputum was not collected, it may be important to record (and then report on) the reason why. In sputum transport networks, a digital system could be used to track the sample as it moves between locations in the same way that courier systems enable the tracking of deliveries. Lost, contaminated or low-quality samples can also be recorded in these systems, providing an important indicator for evaluating sputum collection and transport methods. (The Global Laboratory Initiative’s guide on diagnostics connectivity provides very valuable insights into sputum collection and transport (12).) In addition to making labs more efficient, aggregated diagnostics data can also give early insights into how disease indicators are changing in the communities.