APHL Annual Meeting Day 1

May 20 2012 :: Published in Annual Meeting

Climate Change & Public Health: So Much More than Drowning Polar Bears


Howard Frumkin, MD, DrPH, and Jonathan Patz, MD, MPH, of the two UWs (respectively University of Washington and University of Wisconsin), instructed, charmed and inspired a standing-room-only crowd at this session. Here are a few random takeaways:

Jonathan Patz, MD, MPH, Global Health Institute, University of Wisconsin discussing Climate Change and Public Health
- The dynamics of climate change are anything but simple. Climate change arises from complex, reinforcing feedback loops, and the pace of change is rapidly accelerating.

- Climate change is very regional in how it plays out even though it is a global phenomenon. Yes, sea levels will rise (Please note, those of you who live in lower Manhattan or Brooklyn!) but arid regions such as the US Southwest will become dryer, potentially leading to wild fires and a reduction in arable land.

- Public health practitioners, environmental scientists and climatologists must integrate their data to respond effectively to the effects of climate change. [Could public health laboratories, with their experience in developing laboratory informatics standards and systems be conveners in launching a multidisciplinary approach to data collection?]

- Urban design is public health policy. It’s difficult to exercise in your neighborhood if there are no sidewalks.

- Public health laboratories can mitigate the effects of global warming by greening their facilities. Individually and collectively, such changes do have an impact.

- We must rethink how we communicate with public audiences about the health impacts of climate change. Research demonstrates that, although the public trusts scientists as spokespeople, it is not persuaded by scientific data. What works?  Messages from celebrities and discussion of pocket book issues. I know, it’s frustrating. And we can’t use a single set of messages because popular opinion diverges widely on the issue of climate change.  We need messages for each audience.

- Climate change could be the greatest public health opportunity we’ve had in over a century. If we respond by eating less, exercising more, changing how we design our cities and reducing carbon emissions – among other interventions – we could create a healthier world.

Panel discusses newborn screening: (From left) Susan Tanksley, PhD, Texas Department of State Health Services; Alex Kemper, MD, MPH, Duke University; Michele Caggana, ScD, New York State Department of Health; Charles Brokopp, DrPH, Wisconsin State Laboratory of Hygiene

Newborn Screening: Adding New Tests

 

Newborn screening (NBS) experts from Wisconsin, New York and the Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC) gave a thorough rundown of the newborn screening process and how new conditions are added. Alex Kemper, MD, MPH, MS gave an overview of the Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children; Dr. Chuck Brokoff, DrPH, director of the Wisconsin State Laboratory of Hygiene, shared their experience expanding newborn screening testing in Wisconsin and beyond; and Dr. Michele Caggana, Sc.D., FACM discussed the Implementation of NBSG tests in New York. From ethical considerations to regulatory hoops, there’s lots to consider when expanding an NBS program. Check out the highlights:

-States choose what to screen for, but it’s informed by the committee’s evidence-based recommendations.

-Anyone can nominate a condition to be evaluated by the committee. Key criteria considered: It should be a well-defined condition, a good screening test must be available, and treatment should lead to better outcomes.

-The committee’s recently recommended conditions, like Severe Combined Immunodeficiency (SCID) and CCHD, all have similar characteristics: well-characterized condition, early intervention leads to benefit, accurate and feasible screening test, diagnosis and treatment is available. (Characteristics of conditions not recommended for addition include: uncertain benefit of early detection, challenges establishing diagnosis, and lack of diagnostic and treatment services.

-Traditional Screening Criteria: Screen for conditions that are an important health problem, the natural history should be understood, detectable at an early stage, a suitable test is available, and risks should be less than benefits.-Wisconsin conducts newborn screening for approximately 68,000 newborns a year in Wisconsin and 15,000 non-Wisconsin newborns.

-Educating parents and health care providers about the NBS process and significance of screening is key to any NBS program.

-Elements of a genetic screening program: Availability to all babies, education of parents, timely follow-up on positive results, appropriate diagnostic workup and treatment, cost-effective assessments, continuous monitoring of program.

-Lab characteristics of a good screening test: Simple, rapid, safe, reliable/precise, accurate

-Ethical Considerations: Should genetic screening be conducted? Should NBS be mandatory? Can screening specimens or DNA be saved for later use?

-Screening for SCID has a high potential for successful treatment. Early intervention leads to better outcomes, more than 97% survival.

-Key considerations when adding a new condition to an NBS panel: input from experts and constituents, consider conducting a pilot study, public and professional education for the public, validation of screening method.

-Wisconsin implemented routine screening of SCID in January 2008 – and later, the Secretary’s committee added it to the core screening panel for all states, Jan 2010.

-How are new tests added? By legislation or commissioner’s signature. The lab’s NBS program puts together a package (the condition, outcomes, cost data, etc), sends to regulatory affairs at the dept of health, and the executive secretary and governor’s office signs off.

- In new York state, on average 1,000 babies born a day.

-New York added Krabbe Disease to their panel: substantial preparation, put together regulatory impact statement/package, conducted feasibility and pilot studies, ensured supplies of reagents for daily testing, and ensured follow-up procedures were in place. They commenced testing in 2006.

-When adding a new condition to a panel, clinical community buy-in early on is key, and they must remain engaged.

Top 5 Tweets


@APHLnews Mary Selecky is singing to us about Washyourhandsington– I’m not even kidding. What a cool Secretary of Health! @wa_deptofhealth #APHL

@MHeintzAPHL Dr. Conti: “everything we do is environmental health.” #APHL

@meganlatshaw For every 1°C increase in temperature, saw 7% increase in diarhheal disease in Peuvian hospital. – Jonathan Patz #APHL

@Go_Vikes PulseNet helped detect at least 8 of 10 of the past decade’s largest national foodborne outbreaks! #APHL

@ShariShea23 Metrics! Metrics! Metrics! They are becoming increasingly important to demonstrating the value of foodborne illness programs. #APHL

See more of the top tweets here!

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One World. One Health… and the Vector at Our Back Door

May 20 2012 :: Published in Annual Meeting, Environmental Health, Food Safety, Global Health, Infectious Diseases, Laboratory Systems and Standards, Newborn Screening and Genetics, Partners, Public Health Preparedness & Response, Public Policy

You don’t have to explain to public health laboratorians that the health of humans, animals and the environment are inextricably linked. HIV/AIDS, SARS, 2009 H1N1, West Nile Virus: laboratorians know the inner workings of these enterprising pathogens that travel (from jungle, field or suburban neighborhood, etc.) to animal hosts (chimpanzees, bats, birds, field mice, etc.) and on to us.

One World One HealthAnd they know that more of these smart bugs are coming our way. Population growth, climate change, deforestation, diminishing species diversity and changes in land use are all interfering with established patterns of interaction among people, animals and the environment. Vectors that were once in a distant forest are now at our back door. Already the majority of emerging infectious diseases affecting humans (approximately 75%) are of animal origin.

This dynamic has broad implications for public health as well as human medicine, veterinary medicine and environmental science. In a world where the interface between animals, humans and the environmental is in flux, it’s perilous for health and science professionals of any stripe to operate in professional silos. To protect the health of all species, those of us in public health must join with our colleagues in veterinary science, human medicine and environmental science to adopt a holistic approach to disease surveillance, detection and control. To put it simply, we must be about one health, not several.

At the 2012 APHL Annual Meeting, “one health” will be center stage. Participants will have the opportunity to meet leaders in the One Health movement – including James Hughes, MD; Lisa Conti, DVM, MPH; and Terry McElwain, DVM, PhD – and discuss actions required to operationalize One Health objectives. Here are a few questions to get you started with these discussions. How can we:

  • Expand and improve national and global surveillance networks, particularly those that capture the animal-human interface?
  • Enhance sentinel event coordination to detect and reduce environmental health threats?
  • Build efficient global reporting and sample submission systems to support surveillance systems?
  • Communicate the benefits of investment in surveillance? (Too often disease surveillance is viewed as an old-school public health function, one that’s not sexy enough to warrant sustained investment.)
  • More effectively employ animals as sentinels for human health—and humans as sentinels for animal disease risk?

For an introduction to the “one health” concept, see the websites of the One Health Initiative and CDC’s One Health Office.

And a parting thought: When was the last time you took your state veterinarian or your colleague in environmental science to lunch? It’s a small step, but remember: One Health is collaborative; you can split the check.

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Welcome to Washyourhandsington!

May 20 2012 :: Published in Annual Meeting

By Dr. Romesh Gautom, Director of the Washington State Public Health Laboratories

Welcome to the 2012 APHL Annual Meeting and 6th Environmental Laboratory Conference in what we now call WashYourHandsingTon!  Just to make our laboratorian colleagues feel at home, we’re experiencing Washington’s worst outbreak of Bordetella Pertussis in decades at this time. So, anyone with free time after sessions is expected down at the state lab to assist with accessioning of specimens.  We’ll bus you over.

SeattleAnd take the hint — wash your hands frequently and cover your cough — and enjoy Seattle. If you haven’t been here before, I think you’ll find it to be a friendly, highly walkable city where there is no shortage of good restaurants, interesting attractions and, of course, great coffee. Seattle also offers a fine public transportation system.

The Westin Hotel is located in the center of downtown close to Pike Place Market, the waterfront and ferry terminal, and the Olympic Sculpture Park.  The Space Needle and the EMP Museum (Rock on, Jimi!) are minutes away on the monorail. If you are staying in the city after the conference, I highly recommend a trip to Deception Pass, a large state park where the saltwater flows like a river and the views of Puget Sound are stunning. To get there, you can rent a car or join a bus tour. No, we will not divert the bus to the lab, despite the pertussis outbreak. I’m available to provide additional recommendations of local sites should you want them.

I look forward to talking with my long-time colleagues and meeting attendees who are here at the APHL Annual Meeting for the first time. Speaking of which, give a special welcome to the delegates attending from Japan and the US Associated Pacific Islands.

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Get Immersed in New Technology at the Industry Workshops

May 17 2012 :: Published in Annual Meeting

By Linette Granen, APHL Director, Membership & Marketing

While at the APHL Annual Meeting in Seattle, you may be wondering how to learn more about technology that is on the cutting edge, is easily implemented in your laboratory and is a new way of thinking about analysis in general.  The answer is by attending the Industry Workshops!  These workshops will be held after the sessions on Monday, May 21 from 5:30-8 pm.  The first four will run concurrently from 5:30-6:30 pm.  Do not fear, there will be refreshments between sessions from 6:30-7pm.  At 7:00, the next three workshops will take place.  All are on the 2nd and 3rd floors of the Seattle Westin.  Check out page 15 of your program for more information!

Leading off the pack at 5:30 pm will be Abbott, QIAGEN (Cellestis)), Life Technologies, and PerkinElmer.

  • Abbott: Their workshop will focus on their PLEX ID, and the speakers will be our own members, Robyn Atkinson (UT), Dee Pettit (VA) and Billie Ann Juni (MN).  The presentations will highlight how the PLEX ID can be a tool for broad detection and surveillance.
  • QIAGEN (Cellestis): Although not generally known, Cellestis is now a QIAGEN company. Their workshop will about the implementation of Quantiferon testing for TB in public health laboratories.  The two speakers will be Jim Beebe (San Luis Obispo PHL) and Scott Lindquist (WA State TB Consultant).
  • Life Technologies: If you haven’t heard of low cost, rapid sequencing, you should attend the Life Technologies presentation on their Ion Torrent with a myriad of uses in influenza typing, bacterial identification and newborn screening.  Brian Kelly from the company will be presenting.
  • PerkinElmer: A hot topic in newborn screening, the screening for lysosomal storage disorders, will be presented by Alex Cherkasskly of PerkinElmer.  An informative, interesting workshop should be on tap there.

After you’ve attended one of the preceding workshops, migrate to the foyer of the second floor where libations and light cuisine awaits for your drinking and eating pleasure.  At 7 pm the second round of workshops will begin.

  • Roche’s Carol Hausrath will discuss the newly FDA approved Roche cobas® CT/NG Test.
  • Luminex will offer information on improving efficiency in newborn screening, enhancing RVP surveillance and GI pathogen screening utilizing the company’s newest multiplex analyses.  The speakers will be Susan Neill and Charudutt Shah from Luminex, and Sanjib Bhattacharyya (Milwaukee).
  • ThermoFisher will be offering a presentation on sensitive determination of hexavalent chromium in drinking water, with Brian Luckenbill from Thermo as the speaker, for all of the environmental laboratory folks who are interested.

I am confident that the companies have some surprises for all of us during the presentations, so I cannot wait to attend!  Also, be sure to visit these companies and all of the rest of the exhibitors in the exhibit hall beginning on Sunday afternoon.  As always, there will be a raffle and you must complete your entry card before 3:30 pm on Monday to enter the prize drawing for a whole host of exciting prizes.

APHL would like to thank the companies presenting these workshops for their on-going support through their membership and partnership, and we extend that appreciation to all of APHL’s sustaining members!

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Join us at the 2012 APHL Annual Meeting from Wherever You Are on May 20-23

May 16 2012 :: Published in General

During the APHL Annual Meeting, May 20-23, our blog will be your center for session recaps, commentary, attendee profiles, photos, video and a daily Twitter summary. Whether you are on-site in Seattle or back at your office or laboratory in Boston, Tampa or Santa Fe, you can join us at the annual meeting.

Join the conversation

Look for regular postings on our Twitter, Facebook, Pinterest and Vimeo sites. Please feel free to leave comments or questions on any of those sites!

If you will be at the annual meeting and if social media is not your forte, APHL is here to help. APHL Communications staff will provide pointers on using social media at the APHL booth (located adjacent to the APHL registration desk) from 12:30 – 4:30 pm on Monday, May 21. We look forward to chatting with you there.

Those of you who aren’t packing your bags for Seattle can follow the meeting in real time on Twitter even if you don’t have a Twitter account. Simply search on Twitter for the annual meeting hashtag, #APHL.

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With Sincere Gratitude: Brody’s Parents Say Thanks for Newborn Screening Test

May 07 2012 :: Published in Newborn Screening and Genetics

Below is an actual letter sent by parents of a baby boy born with a genetic disorder that was caught by a routine newborn screening test.  It was published here with permission from the family and the State Hygienic Laboratory at the University of Iowa.  We love a happy ending.  

____________________________

Baby Brody

Iowa Newborn Screening Program
Pediatrics/Medical Genetics
University of Iowa Children’s Hospital
200 Hawkins Drive
Iowa City, IA 52242

Dear Doctor,

We were overjoyed at the birth of our first child, Brody, on October 12, 2011.  As a school psychologist who works with children with educational challenges on a daily basis, I did everything possible to give my child a healthy start.   With a full-term pregnancy and a successful natural delivery, we took our newborn home from the hospital believing he was completely normal.  However, we were shocked when Brody was diagnosed with profound Biotinidase Deficiency at one week of age.

If it had not been for Iowa’s newborn screening test, we would have been completely unaware of Brody’s genetic deficiency.  Never did we imagine as healthy adults, we were both carriers of this recessive gene. The gene has been unknowingly passed down for generations on both sides, as Brody is the first child in both of our families to have the genetic deficiency.

Because Biotinidase Deficiency is 100% treatable with early detection and continuous treatment, we expect Brody to live a completely normal and healthy life. Without the newborn screening which was performed within his first few days of life, Brody would have likely began exhibiting serious symptoms including developmental delays, loss of hearing, loss of vision, coma, and even possibly death. We are humbled and grateful to live in the state of Iowa which offers newborn screening which saved Brody from experiencing significant delays and problems.  He now has a chance to live a quality life full of joy, health, and opportunity. Without Iowa’s newborn screening, Brody’s future would be in jeopardy and our family could be in crisis.

Thank you so much for believing in the importance of providing this screening to Brody and all newborns of Iowa.  Families, like ours, are testimonies of how this screening has positively affected our lives.  We are thankful and most appreciative of Iowa’s newborn screening program.

With sincere gratitude,

Nicholas and Kelsey, parents of Brody

Kelsey, Brody and Nicholas

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Building and Sustaining an Efficient Laboratory through the Laboratory Efficiencies Initiative

Apr 26 2012 :: Published in Laboratory Systems and Standards

This week is National Medical Laboratory Professionals Week and National Environmental Laboratory Professionals Week.  APHL is honoring the many individuals working public health and environmental laboratories around the world.  Stay tuned for blog posts this week featuring the work of many of those unsung heroes working to protect the public’s health.
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By Sadira Daher, Senior Specialist, Quality Systems, APHL

State Public Health Laboratories have been facing serious financial cutbacks. Many laboratories have had to reduce staff by nearly 25%, affecting testing services. Lab directors are concerned about having difficulty maintaining services, which could potentially hinder the state’s outbreak investigation, emergency response, surveillance and public health prevention programs.

In response to these hardships, APHL and CDC developed the Laboratory Efficiencies Initiative (LEI). The goal of LEI is to help labs maintain their public health testing services despite decreased funding in an effort to build a sustainable public health laboratory system in the United States.

Public Health Laboratory, Richmond, VA

Through LEI, representatives from public health labs, APHL and CDC have met to begin implementing a framework for an efficient data gathering and reporting process; to identify models to improve purchasing of laboratory equipment and supplies; and to provide input on ideas on methods of improving the delivery of public health laboratory services.

Many laboratories already have processes in place to improve efficiencies. Some examples include participation in Lean activities and the creation of a group of laboratories as a consortium with neighboring states. The laboratories within the consortium stay in touch through scheduled periodic conference calls where they can exchange ideas and discuss processes and practices that have been working well.

The consortium has also been useful for education and training. The labs have set up training workshops together and have shared their programs with other states through a variety of modalities. They are keeping track of what is going on in their region through this increased communication.

The strengthening relationships between the labs have made it easier for them to share services as necessary. For example, when a lab had unexpected problems with some of its equipment, it could easily send specimens for testing to a neighboring state.

Another laboratory used Lean to identify inefficiencies in its receiving process for newborn screening specimens. The laboratory addressed the problems and was able to decrease turn-around time. On the first day of implementing the new process, a newborn screening sample arrived after what had previously been the cut-off time for processing, but because the new more efficient system was in place, it was processed.  The test returned an abnormal result which was able to be reported to the baby’s pediatrician a day earlier than if they had used their previous process.

An important part of the LEI is the sharing of experiences and lessons-learned with other public health laboratories.

 

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Public Health Laboratories: A Critical Component of the Public Health Puzzle

Apr 26 2012 :: Published in Public Health Preparedness & Response

This week is National Medical Laboratory Professionals Week and National Environmental Laboratory Professionals Week.  APHL is honoring the many individuals working public health and environmental laboratories around the world.  Stay tuned for blog posts this week featuring the work of many of those unsung heroes working to protect the public’s health.
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By Sikha Singh, MHS, Senior Specialist, Laboratory Response Network, APHL

Photographer: Jim GathanyDate:Description: CDC laboratory workerCategories: Health Occupations; CDC Buildings and Facilities; CDC Laboratorians Jim GathanyDate:Description: CDC laboratory worker

Despite ongoing budget decreases, public health laboratories continue to support prevention and population-based surveillance activities.  Each component of the public health system including first responders, sentinel laboratories, epidemiologists, clinical hospitals and the public health laboratory perpetuate the continuum of sustained population health.  These components of the system are greater than the sum of their parts, with each being an essential contributor to public health victories.  These victories include support offered during a variety of events including:

  • Pandemics like the 2009 Influenza A H1N1 pandemic
  • Deliberate attacks  like the 2001 Anthrax attacks
  • Resurgence of vaccine preventable diseases
  • Unintended consequence of natural disasters like the 2010-2011 cholera outbreak in Haiti following a massive earthquake

However, even in the absence of major events such as those listed above, public health laboratories work behind the scenes to perform daily activities ensuring that population health is maintained.  Business as usual, even during challenging economic times, involves public health laboratories performing a wide array of services including, but not limited to, newborn screening, emergency response, disease surveillance and detection, strain typing, identification of emerging diseases, environmental testing, and so on.

It cannot be stressed enough that public health laboratories keep the public safe and remain an essential element of the public health system.

 

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Hydraulic Fracturing and Laboratories: What Does it Mean for You?

Apr 26 2012 :: Published in Environmental Health

This week is National Medical Laboratory Professionals Week and National Environmental Laboratory Professionals Week.  APHL is honoring the many individuals working public health and environmental laboratories around the world.  Stay tuned for blog posts this week featuring the work of many of those unsung heroes working to protect the public’s health.
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By Michael Heintz, Senior Specialist, Environmental Laboratories, APHL

With the increasing interest in our nation’s energy supply, natural gas mining is getting more attention. Advances in hydraulic fracturing, or “fracking,” now make it possible to reach and extract previously inaccessible stores of natural gas. The Energy Information Administration estimates there are 750 trillion cubic feet of natural gas locked in shale deposits in the lower 48 states. Fracking may allow recovery of up to 86% of that total; enough to meet the country’s demand for the next 100 years.

Drilling a Marcellus Shale well in the State Game Lands in Roulette, Pennsylvania

Originally developed in 1947, but becoming more widespread, fracking is a method of gas extraction that drills horizontal wells into gas-containing shale formations and injects millions of gallons of water, sand, and chemicals to create pressure pockets that fractures the shale. When the shale fractures, it releases the natural gas contained within the rock, which is then recovered through the well. Typically, fracturing fluid is 98% water and sand and 2% chemicals, although specific mixtures vary by location and operation. With up to five million gallons of fluid needed to fracture a well, 100,000 gallons can be chemicals.

Fracking fluid can contain any number of chemicals and solutions to aid in the fracturing process. Currently, 11 states require – or are proposing – registration of the chemicals in fracturing fluids used at individual wells. However, because formulas and compounds can be protected as trade secrets, registrations sometimes only include chemical families or CAS numbers, not the specific material or amount present in the fluid.  In addition to the chemicals used in the process, other liquid products return up through the well during drilling and fracturing, including brine, metals, and hydrocarbons. This “produced water” must be treated before recycling or disposal. Consequently, fracking is not without potential effects on human health and the environment, with groundwater contamination being the primary concern.

Because the wells necessarily pass through aquifers to reach the deeper shale deposits, opinions differ on whether there are impacts to groundwater resources. EPA is studying fracking and groundwater resources, but the results are years away. There are reports of groundwater contamination near mining operations, but connecting the drilling directly to the contamination is difficult. In the meantime, some say keep drilling, while others say stop until we better understand the issues. In addition to groundwater contamination, there are other potential impacts, including air and dust emissions from the drilling equipment, produced water overflows from surface tanks and storage ponds, and well casing leaks.

Environmental and public health laboratories already find themselves involved with the issue. As fracking becomes more widespread, laboratories will increasingly be asked to test groundwater, surface water, soil and air samples in the areas around drilling sites. Moreover, laboratories may not be able to avoid the developing political debate. In Pennsylvania, for example, doctors may ask to see fracking fluid recipes, subject to confidentiality agreements, but are not allowed to share the specifics with patients. Is this a gag order on doctors or trade secret protections? Where will laboratories find themselves in the discussion?

Fracking will continue to dominate the energy and environmental debate. Until the science catches up with the technology, we cannot know the true costs and benefits.

 

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Using Technology to Combat HIV/AIDS in Swaziland

Apr 25 2012 :: Published in Global Health

This week is National Medical Laboratory Professionals Week and National Environmental Laboratory Professionals Week.  APHL is honoring the many individuals working public health and environmental laboratories around the world.  Stay tuned for blog posts this week featuring the work of many of those unsung heroes working to protect the public’s health.
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Computerized information systems make work easier in many fields, including laboratory practice. But can a laboratory information system (LIS) help make a dent in one of the world’s worst HIV epidemics?

Laboratory and health experts in the Kingdom of Swaziland are betting the answer is yes.

Swaziland, a geographically small, landlocked nation bordering South Africa and Mozambique, has been home to human inhabitants since at least the early Stone Age 200,000 years ago. Today, however, the country’s population of 1.2 million is seriously threatened by the highest HIV prevalence rate on the African continent. An estimated one of every four adults is infected with HIV, and many of those are co-infected with TB or multi-drug resistant TB, both of which are also highly prevalent.

Swaziland

Health experts know that HIV prevention, education, testing, counseling and treatment programs are essential to reverse such a daunting public health crisis. Swaziland has responded with a campaign to reduce HIV transmission by circumcising HIV-negative men aged 15-49, and with greatly increased access to testing at voluntary counseling and testing centers and other Ministry of Health (MOH) laboratories. Yet these efforts have been complicated and slowed by reliance on paper-based systems.

Marie-Claire Rowlinson, PhD, a former senior APHL global health specialist, said an electronic LIS “is important for quality of testing and therefore for the quality of patient services.” She continued, “It enables laboratory technicians to test samples more efficiently and with fewer errors in the testing process. For example, because the LIS is integrated with testing instruments, there are fewer manual transcription errors, and quality control procedures can be monitored more easily.”

All of this has a positive impact on testing quality, speed and volume. Technicians are able to spend more time generating potentially life-saving test results, rather than entering data by hand. And the test data can be retrieved in seconds.

Rowlinson added, “A common issue for the labs in Swaziland is that patients will get the same test two days in a row when they only need one, which wastes much needed resources. With a paper-based system, it is much harder to track what tests a patient is getting, but with an electronic LIS this can be monitored.”

Fortunately, the advantages of electronic information management will be coming to Swaziland Ministry of Health (MOH) laboratories soon. APHL completed a laboratory assessment in Swaziland last year and is assisting the MOH with development of an LIS strategic plan for the country. Previously APHL helped MOH stakeholders in the selection of an LIS software vendor.

In 2012, the new electronic LIS system will be installed in the national reference laboratory, the Mbabane Government Hospital National Reference Laboratory, and five other MOH laboratories. It is hoped that the new LIS system will eventually be installed in all 18 MOH laboratories, and the current stand-alone systems made interoperable to enable real-time data exchange.

“In addition to improving quality and expanding test volume, the LIS can be used to centralize data and support MOH decision making,” said Ralph Timperi, MPH, a senior advisor for laboratory practice and management at APHL. He explained, “You can put personnel data on a central database so you can see where your technicians are, their ages and education. You can determine whether you need to provide training for people in one location or if key people are nearing retirement.” He added, “You can store supply information and equipment information, so you know: Where is the equipment? How old is it? An LIS gives you the ability to accurately keep track of things in real time. That’s a very helpful thing.”

In the end, said Timperi, it all comes down to one critical trade-off that can indeed make a difference in a HIV epidemic:  “Putting out quality test results versus moving paper.”

 

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