For nearly a decade I-TECH has worked in Côte d’Ivoire in collaboration with the US Centers for Disease Control and Prevention to develop and implement an electronic laboratory information system (LIS) in key laboratories. In order to respond to evolving data needs and ensure timely access to quality laboratory data, an electronic LIS requires ongoing development and continuous user training and technical support.
Previously, from 2015-2017 I-TECH worked closely with the Ivorian Ministry of Health and Public Hygiene (MSHP)’s Directorate of Informatics and Sanitary Information (DIIS) to identify, develop and reinforce the capacity of local professionals to lead and conduct LIS training, deployment, and maintenance activities in anticipation of national roll-out of the LIS at 96 general hospital laboratories. As part of this effort, and in collaboration with the DIIS, I-TECH trained users and deployed LIS at 13 national and regional level laboratories. Between 2013 and 2015, the total number of local professionals competent in LIS deployment increased to 24 local LIS support providers, while the number of in-country LIS trainers increased to 27. Within ten months, local IT providers and trainers trained over 75 health care workers to use an LIS and implemented an LIS at 36 laboratories. During supervision visits to 26 laboratories, within 4 to 6 months post-installation, 25 out of 26 (96%) of laboratories were actively using the LIS.
More recently, Côte d’Ivoire International Training and Education for Health (I-TECH CIV), I-TECH’s local partner in Côte d’Ivoire, has started working directly with CDC and DIIS and continued to engage I-TECH computer developers and deployment strategists to continue the progress with LIS.
I-TECH continues to make considerable progress with code base development for OpenELIS. For more information, visit the OpenELIS Global website.
The Digital Initiatives Group at I-TECH (DIGI) worked closely with the Mauritius Ministry of Health and Wellness (MOHW) to implement a national laboratory information system (LIMS) using OpenELIS and expanded it to create a national-level data warehouse.
The data warehouse captures all the information that has been input into OpenELIS by the two reference labs and all ten regional flu clinics and creates real-time, easy-to-read data dashboards. These dashboards are used by the MOHW staff and public health officials to track national COVID-19 cases numbers and trace ongoing and potential outbreaks of COVID-19 and other infectious diseases.
DIGI continues to support MOHW with LIMS training, LIMS maintenance, and national laboratory strengthening.
Since 2020, the Digital Initiative Group at I-TECH (DIGI) has worked closely with the Mauritius Ministry of Health and Wellness (MOHW) to deploy a national laboratory information management system (LIMS) using the OpenELIS platform. The LIMS connects the national reference laboratory to regional laboratories and flu clinics around the country to quickly process COVID-19 tests, as well as send results notifications to patients via text message or email.
The OpenELIS system, while implemented to support COVID-19 surveillance, was also designed to be able to support most routine lab workflows, including HIV viral load testing and other other infectious diseases (e.g., HIV, Ebola, Zika, Chikungunya), which ensures MOHW can quickly trace, respond to, and manage cases.
DIGI continues to support MOHW with LIMS training, LIMS maintenance, and national laboratory strengthening.
As a measure to help stop the spread of COVID-19, the Government of Mauritius began requiring that all arriving passengers submit to COVID-19 health screenings upon arrival in Mauritius. To rapidly process the influx of tests and quickly notify passengers of their results, the Digital Initiatives Group at I-TECH (DIGI) worked closely with the Mauritius Ministry of Health and Wellness (MOHW) to digitize the COVID-19 screening declaration form for all passengers arriving to the Mauritius International Airport and supported MOHW in opening a COVID-19 reference laboratory at the airport to rapidly process the tests and send notifications of COVID-19 tests passengers.
The airport laboratory is connected to the National Reference Laboratory via OpenELIS, which allows all the data captured on the digital form, such as passenger information and COVID-19 screenings/test results, to assist public health officials from all over Mauritius to carry out surveillance and contact tracing efforts.
Since opening in December 2020, the airport reference laboratory has returned over 250,000 tests and continues to process thousands of tests to passengers and citizens of Mauritius daily.
From September 2013 to September 2016, I-TECH conducted an implementation science research project to improve laboratory quality in Cambodia. The primary objective of the project was to implement a mentored laboratory quality stepwise implementation (LQSI) program to strengthen the quality and capacity of Cambodian hospital laboratories. As a result, target laboratories improved their operations in the areas of: biosafety, organization, personnel, equipment maintenance, purchasing and inventory, testing accuracy, process management, documentation and communication.
The project recruited and trained four laboratory technician to be mentors, training staff from 12 referral hospital laboratories in quality management systems (QMS), and reinforcing skills acquisition through in-person mentoring. Participating laboratories reported a 36% increase in quality management, 29% improvement in data management, and 25% improvement in specimen collection and handling. The laboratories established the foundational practices of a QMS, and the LQSI program has improved the recognition of the laboratory within the hospitals.
I-TECH’s laboratory program began in Cambodia in 2013 with the goal to improve operations and regional biosurveillance and biosecurity through improved laboratory quality assurance and management practices. In collaboration with the Cambodian Ministry of Health, the World Health Organization (WHO), and the U.S. Centers for Disease Control and Prevention (CDC), and with funding provided by the Department of Defense and DTRA, I-TECH strengthens the Cambodian laboratory system through:
Implementation of an intensive mentoring program at 12 national and provincial public health laboratories;
Leadership and management capacity building of MoH laboratory leaders;
Mentoring and capacity building the National Animal Health and Production Research Institute (in collaboration with Washington State University);
Job specific training delivered in service and through educational programs such as the Quality Assurance Certificate Course (in collaboration with the University of British Columbia);
Support for laboratory workforce development through on-site technical assistance and training;
Support for national laboratory system policy development.
Representatives from the International Training and Education Center for Health (I-TECH) attended the fourth international African Society for Laboratory Medicine (ASLM) conference in Abuja, Nigeria, on 10-13 December 2018.
The theme this year focused on the role of laboratories in preventing and controlling the next pandemic. I-TECH had seven abstracts accepted at the conference that highlighted the laboratory systems strengthening work done by I-TECH in Cambodia, Côte d’Ivoire, and Zambia. The full abstracts presented by I-TECH can be found in the ASLM 2018 Conference Abstracts Conference Book.
Below is a summary of I-TECH presentations:
Siew Kim Ong, I-TECH Cambodia Project Coordinator, was lead author and presenter for the “Improved Laboratory Compliance to Quality Standards in Cambodian Laboratories through On-site Trainings.” This abstract reviewed the effect of training in 12 I-TECH-mentored laboratories in Cambodia on laboratory processes (Page 27).
Nayah Ndefru, I-TECH Seattle Laboratory Strengthening Specialist, presented an abstract titled, “Effectiveness of Using a Mixed Approach of On-site Mentoring and Tele-mentoring for Improving Laboratory Quality Management Systems: Lessons From Cambodia.” The presentation looked at the lessons learned in the implementation of a Quality Management System (QMS) in 12 national hospital laboratories throughout Cambodia and the 2018 pilot approach to addressing the QMS gaps identified in an earlier baseline survey (Page 55).
Larissa Koffi, I-TECH Côte d’Ivoire RTCQI Specialist, presented two posters: One titled, “Analysis of EQA HIV Serology Data in Côte d’Ivoire Reveals Gaps in Quality Testing.” The second poster was “Analysis of HIV Point of Care Testing Sites in Côte d’Ivoire Reveals Gaps in Tester Competence.” The posters displayed the results of a retrospective study that can inform strategies and interventions for improved quality at HIV testing sites (Page 200).
Sylvestre Kone, I-TECH Côte d’Ivoire Laboratory Quality Specialist, presented a poster titled “Improving Quality and Capacity of the Laboratory System in Côte d’Ivoire.” The poster detailed the work the team is doing to train and mentor laboratory staff in hospital laboratories towards achieving international quality standards (Page 242).
Felicity Gopolang, I-TECH Laboratory Mentor Consultant, presented a poster titled, “Implementation of a Professional Development Program in Laboratory Leadership and Quality Management in Zambia from 2016-2018.” The poster outlined the impact of the Program on quality improvement (Page 206).
Pat Sadate-Ngatchou, I-TECH Seattle Senior Laboratory Advisor, was lead author on the poster titled “Improvement of Quality Practices within HIV Point-of-Care testing (POCT) Sites in Côte d’Ivoire Through Implementation of the Rapid Test Continuous Quality Improvement (RTCQI),” which explored the impact of the implementation of RTCQI in POCT site audits (Page 246).
About ASLM The mission of ASLM is to improve clinical and public health outcomes in Africa by enhancing professional laboratory practice, science and networks. Based on five strategic pillars, ASLM serves the community of laboratory professionals and promotes the value of strong medical laboratories to key stakeholders such as the Ministries of Health, research laboratories, and universities. ASLM is an independent, non-profit organization endorsed by the African Union and headquartered in Addis Ababa, Ethiopia.
I-TECH Kenya’s Global Health Security Agenda (GHSA)-funded programs aim to advance the GHSA goals of preventing , detecting, and responding to disease threats to health security.
For the past 8 years, I-TECH Kenya has had a cooperative agreement with US Centers for Disease Control and Prevention (CDC) to work closely with the Kenya Ministry of Health (MOH) on multiple projects related to health security. The key objectives of these activities are preventing and reducing the likelihood of disease outbreaks, improving the efficiency and accuracy of the detection of communicable diseases, strengthening surveillance capacity and national and county levels for a rapid and effective response, enhancing Infection Prevention and Control (IPC) practices to prevent the emergence and spread of pathogens and antimicrobial resistant bacteria.
Use IPC practices to combat antimicrobial resistance (AMR) and other microbial threats:
Building capacity for IPC in health care facilities is a critical part of disease outbreak and AMR preparedness and prevention. In Kenya, I-TECH has partners with the CDC National Center for Emerging and Zoonotic Infectious Disease and Kenya MOH to support two model hospitals in developing capacity for quality improvement measures for strengthening evidence-based IPC practices, infrastructure, and tools including hand hygiene, waste management, injection safety, surgical site infections, and antimicrobial stewardship. As part of this IPC work, I-TECH created and piloted e-learning modules for IPC. The modules aim to build clinical skills and technical knowledge in infection prevention and control and antimicrobial stewardship among health care workers in low-resource settings, and have now been adopted by WHO.
With the onset of the COVID-19 pandemic, I-TECH Kenya was able to play a leadership role in the country in assessing and improving facility readiness at the national and local level to handle COVID-19 cases and maintain the health care workforce.
Current IPC activity is focused on surveillance for surgical site infections, an important cause of hospital acquired infections (HAIs).
Disease Prevention through Immunization Program Strengthening:
I-TECH collaborated with the Kenya MOH, CDC Global Health Protection Division, and the CDC Global Immunization Division, to build and roll out an online mobile platform for capturing immunization data at the point of care.
Laboratory Information Systems Strengthening:
In Kenya, I-TECH collaborated with the MOH and National Public Health Laboratory Services to enhance and strengthen laboratory information systems at the facility and national levels to improve timeliness and efficiency of testing and reporting results, specifically for AMR testing.
Disease Surveillance and Response:
I-TECH supports the Kenya MOH Surveillance Unit in the rollout of trainings for health care workers to routinely and consistently use the real-time surveillance reporting system in Kenya.
As a key member of the Kenya electronic medical record (EMR) system technical working group, I-TECH works to implement and standardize the EMR systems used in the management of national HIV and AIDS care and treatment data. Similar efforts have focused on ensuring that different electronic systems can communicate with one another (interoperability) and that health care workers, administrators, and staff are well trained to use and maintain them.
Nancy Puttkammer is an Acting Assistant Professor within the Department of Global Health at University of Washington and is the faculty co-lead of the Digital Initiatives Group at I-TECH (DIGI). Her interests are in strengthening health information systems and promoting data use and for quality improvement of health programs in resource-limited settings. She is trained as a health services researcher, specializing in using observational, routinely-collected data from electronic medical records (EMRs) to strengthen HIV care and treatment programs.
In her capacity as a Research and Evaluation Advisor at the International Training and Education Center for Health, Dr. Puttkammer works with informatics and training projects in Haiti, Kenya, and South Africa to improve large-scale implementation of EMRs, evaluate data quality and data use, support data analyses, and develop capacity for data use and implementation science research among colleagues and counterparts. Dr. Puttkammer has a PhD in Health Services from the University of Washington and an MPH in Community Health Education from the University of California, Berkeley.
In partnership with CDC, CHARESS helps the Haitian MSPP to implement the national care improvement program, HealthQual, by training providers on quality improvement concepts and using data from the EMR, iSanté, for clinical decision making and improved care ... Read More
The Digital Initiatives Group at I-TECH (DIGI) worked closely with the Mauritius Ministry of Health and Wellness (MOHW) to implement a national laboratory information system (LIMS) using OpenELIS and expanded it to create a national-level data warehouse. The data warehouse captures all the information that has been input into OpenELIS ... Read More
The overall goal of the Enhancing Quality of Healthcare Activity (EQHA) program in Cambodia is to improve the quality of public and private health services in national and sub-national health systems by August 2023. The project, funded by the US Agency for International Development (USAID), is being implemented by Family ... Read More
Electronic medical record (EMR) systems have the capacity to improve clinical decision making and quality of care at site level but can also be leveraged to make data-driven, population-level public health decisions. At the request of the MSPP ... Read More