Laboratory information management systems (LIMS) are critical to the laboratory-clinic interface and the optimal utilization of diagnostic results for patient management. LIMS also support the real-time monitoring of healthcare programs, facilitating the improvement loop and the continuous quality improvement of services. In the May ECHO session, Kumbirai Chigudu, a technical specialist for Wits University/National Health Laboratory Services (NHLS) in South Africa, and Lindiwe Nchimunya, the eLabs application coordinator in Zambia, shared their experience in implementing a LIMS package in support of national HIV control programs in their respective countries.
Mr. Chigudu emphasized that electronic LIMS (as opposed to paper-based systems) can reduce the turn-around time for return of results for viral load (VL) testing. In addition, LIMS offer an array of benefits that include monitoring instrument performance, workflow tracking, reagent usage and batches/lots, centralized storage of data and data tracking support, as well as interfacing with other instruments of health-related information systems for improved laboratory and health systems efficiency.
Key considerations when selecting the most appropriate LIMS package for a particular setting include, but are not limited to; types of testing instruments; needs for testing integration; and issues such as ease of use and security. Chigudu further detailed the efficiency, cost-effectiveness, and sustainability of certain options. For example, the affordability of an open-source LIMS or an in-house LIMS can be counterbalanced by the complexity of maintaining and updating the platforms. Meanwhile, more expensive commercial options offer more efficient services.
South Africa implements a commercial LIMS, Intersystem TrakCare, in its national laboratory health systems. Key steps that were taken in the implementation process involved: site assessments, site-specific system configuration, project management, user training involving champions per site, management changes to ensure successful implementation, rolling out with on-the-job end-user training and post-implementation support.
The experience in Zambia is quite different. Up to 17 different LIMS packages supported by various implementing partners operating in the country are now in place. Nchimunya described how eLabs, an innovative commercial mobile application developed to improve the VL testing value chain, ensured the real-time tracking of specimens and electronic delivery of results to healthcare facilities. Some of the key features of eLabs include: the ability to flag results that need action, result acknowledgement by the clinician, and a dashboard that helps monitor the performance of clinicians who act on results.
The LIMS implementation in Zambia resulted in a >70 percent increase in testing volume over 7 months, and in a decrease in result turnaround times from 90 to less than 15 days across 222 facilities. Moving forward, efforts to integrate the different LIMS platforms into an interoperable system will be needed to support proper program monitoring at the national level.