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J Am Med Inform Assoc 18:11-16 doi:10.1136/jamia.2010.005280
  • Research and applications

Full impact of laboratory information system requires direct use by clinical staff: cluster randomized controlled trial

Editor's Choice
  1. Hamish S F Fraser1,2
  1. 1Partners In Health, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Socios en Salud Sucursal Peru, Lima, Peru
  4. 4DISA V Lima Ciudad, Lima, Peru
  5. 5DISA IV Lima Este, Lima, Peru
  6. 6Instituto Nacional de Salud, Lima, Peru
  7. 7Division of Biomedical Informatics, University of California, San Diego, California, USA
  8. 8Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Dr Joaquin Blaya, Partners In Health, Division of Global Health Equity, Brigham and Women's Hospital, 641 Huntington Avenue, Boston, MA 02115, USA; jblaya{at}hms.harvard.edu
  • Received 9 July 2010
  • Accepted 3 November 2010
  • Published Online First 27 November 2010

Abstract

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.

Footnotes

  • Funding Harvard Global Infectious Diseases Program, David Rockefeller Center for Latin American Studies. JAB received a MIT Public Services Center grant, the MIT Hugh Y Hampton Fellowship, and a National Research Service Award from the NIH.

  • Competing interests JAB is cofounder of eHealth Systems, a Chile-based company providing health informatics consulting and implementation work.

  • Ethics approval This study was conducted with the approval of the Brigham and Women's Hospital and the Peruvian National Institute of Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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