Dr. Isabel Pinto, Director of the National Directorate of Medical Assistance (DNAM) at the Mozambique Ministry of Health, has a clear and simple vision for the future of public health in Mozambique: quality information. “Information is key for all decisions,” she says.
Paper-based systems are the norm for tracking health information in most laboratories in Mozambique. There are backlogs of paper forms needing to be recorded into laboratory logbooks; patients waiting weeks or months for routine laboratory test results; and public health officials lacking timely disease surveillance data to inform public health responses. Simply put, paper-based systems are laborious, prone to errors and unmanageable.
Now Dr. Pinto and her team are tackling this challenge with the help of APHL’s Mozambique field team. Their goal is to move all of Mozambique’s major laboratories from paper-based to electronic laboratory information systems (LIS) to better capture and track clinical and public health data. Laboratories around the world use LIS to manage patient and public health data including ordering diagnostic tests, capturing test results, generating reports and tracking samples.
Transitioning laboratories from a paper-based system to an electronic system is no small task. Dr. Pinto and the APHL Mozambique team began this endeavor by implementing an enterprise LIS for the country’s eight main referral hospital laboratories. Each laboratory first needed to be equipped with a network server to store and transmit data, the LIS software and computers to store and retrieve data from the server, diagnostic equipment that electronically transmits patient results to the LIS and well-trained laboratory staff to effectively use the LIS to support their work. In many cases, installing an LIS even requires an overhaul of the laboratory’s workflow because certain processes often prove to be redundant when an electronic system is introduced. After several years of intensive work and funding from the CDC and PEPFAR, all eight hospital laboratories are now equipped with LIS.
Beyond the LIS, a secure central database was also created within the Ministry of Health to capture the participating laboratories’ information. Data from all laboratories using the LIS are sent to this central database on a near real-time basis allowing for rapid analyses and reporting, and the ability for national decision makers, such as Dr. Pinto and her colleagues, to provide feedback to laboratories throughout the country.
With the central database at the Ministry of Health and LIS at major referral hospital laboratories, the APHL Mozambique team, working with the CDC, turned to the country’s health centers as the next phase. For these smaller health centers, installing LIS is not yet feasible due to limited infrastructure and staff capacity, so laboratory scientists still rely on a paper-based system to track their samples and data. The paper-based system becomes especially arduous when health centers need to send samples to a referral hospital for additional testing. To address this problem, APHL, working with the LIS vendor, developed a simple software application that creates a unique barcode for each sample after it is collected and transmits the test order and patient data electronically to the referral laboratory. The health center then ships the sample to the referral laboratory where the barcode is scanned into the LIS, and the previously entered patient and sample data are matched with this barcode. Once testing is completed, the referral laboratory returns the test results to the health center via the same application. While not the ultimate solution, it is a significant step forward. This software application drastically reduces the dependence on paper-based systems, which means faster and more accurate results for patients, higher data quality for public health officials and less overwhelmed laboratory staff. Thanks to funding through PEPFAR, nearly 60 health centers across Mozambique are now using this software application, and the APHL team is working with partners to install it at an additional 100 health centers.
Many challenges still remain. Most significantly, linking rural health centers to the system poses unique logistical and infrastructural challenges given inconsistent electricity and internet connectivity in those areas. The APHL Mozambique field staff continues to work to find creative solutions that will allow even the most remote locations to order tests and track results electronically.
Project by project, Dr. Pinto’s vision for Mozambique’s public health system is taking shape. Millions of laboratory records are flowing into Mozambique’s central database. What’s more, laboratories in Zambia, Tanzania, Kenya, Ethiopia and Vietnam have looked to Mozambique as a model for their own LIS solutions.
Now Dr. Pinto and her team face a new challenge: analyzing all that data.