Developing an Electronic Medical Record for Interlinked Care Services in Haiti.

A large clinical care and research organization in Haiti required an electronic medical record system (EMR) to serve the needs of its 30 interlinked clinical programs. After assessing available open source software, the local team designed and implemented a modular proprietary EMR that is improving data quality and patient care. Despite the many benefits of existing open source medical record systems, clinical centers with complex workflow patterns--even those in resource-limited settings--should consider developing sustainable, local systems that fit their care model.

Cuba's Salgen: a provincial informatics network for genetic services to pregnant women and newborns.

The Sancti Spíritus Provincial Medical Genetics Network has been using the Salgen IT platform since 2009 for health care, administrative and research activities concerning pregnant mothers and newborns. The network uses the national Infomed backbone to provide real-time connection between community-based polyclinics in primary health care and the Provincial Medical Genetics Reference Center. The platform has records for 23,025 pregnant women and sequential clinical data on genetic risk assessment in early pregnancy, first trimester ultrasound, sickle cell anemia screening, alpha-fetoprotein levels, cytogenetic antenatal diagnosis, second trimester ultrasound, delivery and newborn characteristics, neonatal metabolic screening, and infant clinical assessment. The system makes health care results immediately available and provides health alerts to enable timely preventive care for pregnant women. It also provides guidelines for processes and practices, and streamlines administrative and monitoring activities through statistical reports. The database generates indicators for assessing fetal growth and applies international standards for antenatal ultrasound quality control. Salgen provides a new source of information for medical research and knowledge management, and its use in this case fulfills Cuba's criteria for an integrated health services network.

ImmunoDB: a web based tool to analyze preclinical data.

Often researchers find it difficult to interpret and correlate the results obtained from several experiments thus the development of a system that would allow storage, display and data analysis would be very useful. A web based interface is presented that allows people from a laboratory to submit the collected data and to compare results within different experiments. The interface was designed to be user-friendly and to be a basis of a flexible tool for performing analysis in an intuitive manner.

Federating clinical data from six pediatric hospitals: process and initial results for microbiology from the PHIS+ consortium.

Microbiology study results are necessary for conducting many comparative effectiveness research studies. Unlike core laboratory test results, microbiology results have a complex structure. Federating and integrating microbiology data from six disparate electronic medical record systems is challenging and requires a team of varied skills. The PHIS+ consortium which is partnership between members of the Pediatric Research in Inpatient Settings (PRIS) network, the Children's Hospital Association and the University of Utah, have used "FURTHeR' for federating laboratory data. We present our process and initial results for federating microbiology data from six pediatric hospitals.

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.

High sensitivity for tuberculosis in a national integrated surveillance system in Finland.

Little is known about the sensitivity of surveillance for tuberculosis after integration of formerly dedicated tuberculosis surveillance and control into the general health care system, an integration which took place in Finland in 1987. We compared routine laboratory notifications to the National Infectious Disease Register (NIDR) for Mycobacterium tuberculosis from January 1, 1995, to December 31, 1996, with data collected independently from all laboratories offering M. tuberculosis culture, and with data from patient records. 1059 culture-positive cases were found. The overall sensitivity of the NIDR was 93 % (984/1059). The positive predictive value of a culture-positive case in the NIDR to be a true culture-confirmed case was 99%. For the culture-confirmed cases in the NIDR, one or more physician notification forms had been submitted for 89%. A highly sensitive notification system for culture-positive tuberculosis can be achieved in an integrated national infectious disease surveillance system based on laboratory notification.

Information system issues facing clinical laboratories serving complex integrated delivery systems.

Laboratory information systems (LISs) have evolved into complex applications to meet the specialized needs of laboratories. As integrated delivery systems (IDSs) continue to emerge as a dominant model for healthcare delivery, clinical laboratories serving them face two imperatives that affect IS decisions. First, laboratories in IDSs must consolidate to reduce costs and duplication yet deliver service across a region in both inpatient and outpatient settings. Second, laboratories that successfully perform reference laboratory testing will increase revenue, generate referrals, and leverage excess capacity, and may provide a competitive advantage for the IDS. This article examines laboratory information management in complex IDSs, presents options for IS support of consolidating or integrating laboratory operations, and reviews functionality requirements for laboratory outreach activities.

Laboratory systems evolve to meet data demands.

As provider organizations consolidate and confront managed care pressures, they're looking for laboratory information systems that go beyond the basics. They want lab systems that can integrate with other computer systems, make data available at the point of care, and exchange information over the Internet or intranets. Systems integration efforts, however, are proving troublesome for some CIOs.

The clinical services manager: a curriculum for the 21st century.

The dynamism of change in the evolution of integrated health-care systems is driving change in the skills and competencies required to manage diagnostic services. Formal educational preparation and practical experience in a wider array of disciplines will be essential to the backgrounds of those who will be chosen for these new and ever more complex roles. Curricular elements relevant to this educational challenge are outlined herein. This article is intended to expand on the position of CLMA as reflected in the position paper "New Path for Health-Care Leadership: Clinical Systems Management," issued in August 1997 (1).