Blaya Joaquin A, Shin Sonya S, Yagui Martin J A, Yale Gloria, Suarez Carmen Z, Asencios Luis L, Cegielski J Peter, Fraser Hamish S F
1Division of Health Sciences & Technology, Harvard Medical School-MIT, 77 Massachusetts Ave. Cambridge, MA 02139, USA.
BMC Med Inform Decis Mak. 2007 Oct 28;7:33. doi: 10.1186/1472-6947-7-33.
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.
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.
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.
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.
资源匮乏地区的耐多药结核病患者在开始接受适当治疗方面存在很大延误，而且由于实验室系统负担过重、结果传达延误以及实验室数据缺失或容易出错，可能无法得到适当监测。本文的目的是描述为缓解这些问题而实施的一个电子实验室信息系统及其在秘鲁公共部门的扩大应用，并探讨在资源匮乏地区实施此类系统的更广泛问题。
秘鲁设计并实施了一个基于网络的实验室信息系统“e-Chasqui”，以提高实验室数据的及时性和质量。该系统部署在国家结核病实验室、两个区域实验室和十二个试点卫生中心。通过需求评估和工作流程分析工具，e-Chasqui旨在改善患者护理、加强质量控制以及提高实验室监测和报告的效率。
自2006年3月全面实施以来，已录入29944份涂片显微镜检查结果、31797份培养结果和7675份药敏试验结果。卫生中心已在线查看了其中超过99%的结果。高用户满意度和高使用率促使e-Chasqui扩大到其他机构。总的来说，e-Chasqui将为一个为超过310万人提供医疗服务的机构网络提供服务。维护该系统的成本约为每份样本0.53美元，占秘鲁国家结核病项目2006年预算的1%。
电子实验室信息系统在改善资源匮乏地区的患者护理和公共卫生监测方面具有巨大潜力。这些地区面临的一些挑战，如缺乏训练有素的人员、交通有限和覆盖面积大等，是设计良好的系统可以克服的障碍。e-Chasqui有潜力在秘鲁提供一个国家结核病实验室网络。此外，e-Chasqui的核心功能已在开源医疗记录系统OpenMRS（http://www.openmrs.org）中实现，供其他国家使用。
