Lab Matters Fall 2016 - Page 12

feature APHL staff and members with Vietnam team APHL is now transitioning the LIMS support to Kenya’s MOH. The next step is to create one seamless uber-system for data exchange among laboratories, hospitals and national health officials, and a technical working group is already meeting to figure out the details. A second APHL initiative is laboratory mapping—documenting the capabilities and testing capacities of all laboratories in Kenya, so, said Ochieng, “if there is an outbreak in any part of the country, the MOH will know the nearest facility that has the capability to test that specimen [for the outbreak pathogen].” A questionnaire focusing on priority diseases—cholera, measles, anthrax, brucellosis and others—has been developed and an electronic survey system selected. Data collection will begin late 2016. A third critical activity centers on data quality—instituting a system for external proficiency testing to gauge the accuracy of test results and identify training needs. APHL has been managing the effort for the past two years and has achieved a laboratory participation rate of 95%. Ochieng and Nyaga are now in discussion with the MOH regarding the creation of a national repository for all external quality assurance data. We want to provide a good solution for all these [provincial] laboratories to refer these samples up even before the physical specimen arrives [at the Institut Pasteur] and to be able to securely get results back. Vietnam—“All they need is a computer and an internet connection.” Vietnam was one of the first countries APHL worked with under PEPFAR and one of the first to begin work under the GHSA. This populous nation of 93 million has long borders and a busy commercial life, with $159 billion in exports in 2015, including textiles, seafood, rice and electronics. 10 LAB MATTERS Fall 2016 Ken Landgraf, MS, a CDC advisor from the QED Group consulting firm, has been working in-country here for the past 2.5 years. He said, “One of Vietnam’s biggest trading partners is the United States, but there’s also lots of trade with China, a lot of poultry crossing borders and lots of opportunities for new flu strains to arise in the region. Antibiotic stewardship is very limited.” Strengthening the country’s disease surveillance, said Landgraf, is a “win for everyone.” As in Kenya, a hallmark APHL activity has been LIMS implementation. Reshma Kakkar, MA, APHL’s global health LIMS manager, said when she arrived here in 2005, “all of the laboratories we saw used paper-based systems,” including the national public health laboratory. “Nobody knew what a LIMS was.” She said, “[T]hey were already fairly organized and somewhat standardized. . . . What we sensed was they didn’t necessarily want a proprietary LIMS they would have to keep paying for in the long run. We had to figure out an optimal solution that was sophisticated enough to support a variety of tests, but that also could be in a sense owned by them, so they would have control over it.” The answer was OpenELIS, an open source LIMS designed by three US public health laboratories. Fast forward to 2016, and that system is now in 39 Vietnamese laboratories. During a March 2016 visit, Kakkar met with the laboratory director in a large, pediatric hospital in Ho Chi Minh City. The hospital’s 400 doctors and 800 nurses see between 5,000 and 8,000 patients each day. The laboratory—now accredited under ISO 15189—performs seven million hematology tests per year. When samples arrive at the laboratory, they are tagged with the same barcode appearing on the accompanying paperwork with patient information. Doctors no long write test requests out longhand. Transcription errors are way down, and test data is searchable: “You don’t have to flip through books. Now they can actually do some analysis of the data.” PublicHealthLabs @APHL