BackgroundReducing laboratory errors presents a significant opportunity for both cost reduction and healthcare quality improvement. This is particularly true in low-resource settings where laboratory errors are further exacerbated by poor infrastructure and shortages in a trained workforce. Informatics interventions can be used to address some of the sources of laboratory errors.ObjectivesThis article describes the development process for a clinical laboratory information system (LIS) that leverages informatics interventions to address problems in the laboratory testing process at a hospital in a low-resource setting.MethodsWe designed interventions using informatics methods for previously identified problems in the laboratory testing process at a clinical laboratory in a low-resource setting. First, we reviewed a pre-existing LIS functionality assessment toolkit and consulted with laboratory personnel. This provided requirements that were developed into a LIS with interventions designed to address the problems that had been identified. We piloted the LIS at the Kamuzu Central Hospital in Lilongwe, Malawi.ResultsWe implemented a series of informatics interventions in the form of a LIS to address sources of laboratory errors and support the entire laboratory testing process. Custom hardware was built to support the ordering of laboratory tests and review of laboratory test results.ConclusionOur experience highlights the potential of using informatics interventions to address systemic problems in the laboratory testing process in low-resource settings. Implementing these interventions may require innovation of new hardware to address various contextual issues. We strongly encourage thorough testing of such innovations to reduce the risk of failure when implemented.

BackgroundTo address challenges related to medication management in underserved settings, we developed a system for Prescription Management And General Inventory Control, or RxMAGIC, in collaboration with the Birmingham Free Clinic in Pittsburgh, Pennsylvania. RxMAGIC is an interoperable, web-based medication management system designed to standardize and streamline the dispensing practice and improve inventory control in a free clinic setting. This manuscript describes the processes used to design, develop, and deploy RxMAGIC.MethodsWe transformed data from previously performed mixed-methods needs assessment studies into functional user requirements using agile development methods. Requirements took the form of user stories that were prioritized to drive implementation of RxMAGIC as a web-application. A functional prototype was developed and tested to understand its perceived usefulness before developing a production system. Prior to deployment, we evaluated the usability of RxMAGIC with six users to diagnose potential interaction challenges that may be avoided through redesign. The results from this study were similarly prioritized and informed the final features of the production system.ResultsWe developed 45 user stories that acted as functional requirements to incrementally build RxMAGIC. Integrating with the electronic health record at the clinic was a requirement for deployment. We utilized health data standards to communicate with the existing order entry system; an outgoing electronic prescribing framework was leveraged to send prescription data to RxMAGIC. The results of the usability study were positive, with all tested features receiving a mean score of four or five (i.e. somewhat easy or easy, respectively) on a five-point Likert scale assessing ease of completion, thus demonstrating the system’s simplicity and high learnability. RxMAGIC was deployed at the clinic in October 2016 over a two-week period.ConclusionsWe built RxMAGIC, an open-source, pharmacist-facing dispensary management information system that augments the pharmacist’s ability to efficiently deliver medication services in a free clinic setting. RxMAGIC provides electronic dispensing and automated inventory management and alerting capabilities. We deployed RxMAGIC at the Birmingham Free Clinic and measured its usability with potential users. In future work, we plan to continue to measure the impact of RxMAGIC on pharmacist efficiency and satisfaction.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3517-8) contains supplementary material, which is available to authorized users.

Background: Availability of complete, accurate, and timely information is essential for efficient planning and purchasing of medications. This is especially important in remote low-resource clinics that are often difficult to access, have limited health personnel, and receive supplies infrequently. Appropriate application of information technology can help address challenges in the availability and quality of data used for making decisions about purchasing medical supplies.Methods: We used a phased deployment of electronic information systems to address challenges in quantification of the available medical supplies at the clinic in San José. First, we deployed a patient identification system to ensure that all medicines dispensed in the system were associated with a specific patient. This was followed by the deployment of an electronic dispensing and inventory management system that tracks available medicine and automatically deducts from these counts during electronic dispensation.Results: Twenty months post-deployment of the patient identification application and electronic dispensing and inventory management system, 3,238 unique patients have been registered and 22,236 dispensations have been recorded. Of these dispensations, 226 unique drugs have been recorded with acetaminophen being the most prescribed medication followed by adult multivitamins.Conclusion: Electronic interventions show significant promise for dispensaries in limited resource settings globally. However, strong user value propositions are needed to ensure continued usage.