Five years and counting

The premise of the collaboration is simple: it leverages the strengths of each organization's platform - for BES it's Tamanu, their offline-first EHR designed for the Indo-Pacific while for Naralabs it's SENAITE, the only FOSS enterprise-grade LIMS.

Both Naralabs and BES provide open-source software to avoid expensive vendor lock-in that often plagues low-resource settings. Beyond that, our shared objectives are clear: promote sustainability and skills transference to train local experts and improve clinical workflows in the region.

Day-to-day, Naralabs and BES collaborate regularly, with BES's lab implementation team reporting new requirements to Naralabs who improve and extend SENAITE features in PNG, Palau, Narau and Kirbati. Much of this new functionality becomes available to the wider SENAITE implementation community.

Interoperability out-of-the-box

This partnership has also unlocked potential particularly with regards to interoperability. New countries implementing both systems can share demographic data, lab requests and results between platforms using FHIR standardised workflows. These integrations are available out-of-the-box but can still be adapted to the specifics of each context allowing for rapid deployment in countries wishing to implement both softwares.

This year

Collaboration between Naralabs and BES has been a busy space over the past 12 months. Some highlights include:

• BES and Naralabs continue to expand FHIR integrations in Palau, Nauru, Samoa. These allow both patient data and lab requests to be shared from Tamanu to SENAITE, where they are processed, with results returned to practitioners in Tamanu. Over the past 12 months 48,500 samples have been registered through this integration. According to BES's SENAITE Program Manager Sahar Etesam:

Now that Tamanu and SENAITE are connected, we no longer have to enter patient information or re-enter lab requests. It's saved us time and significantly reduced errors in our workflow.

• Naralabs have also implemented a telemetry layer to monitor the flow of data between systems. This ensures lab requests and results are tracked between systems and there is visibility into the volume of requests and patients.

• A new deployment went live in Kiribati last September. 

• A range of instruments have been integrated in SENAITE instances including hematology analyzers (XN-100 & XN- 550), the glycemic monitor DCA Vantage and GeneXpert, a nucleic acid amplification tester. This allows instrument to be captured into SENAITE directly, expediting analyses.

Department Views

One issue impacting efficiency in the lab was all requests were visible together in the same view. This made it difficult to segment by department and added noise to the daily work in labs. The solution was to enable lab assistants to view requests only from their department. Naralabs built these views then deployed to production in January which has had a marked improvement in processing within labs.

Up next

There are numerous other projects on the boil for the next year including:

• Expanding SENAITE - Tamanu integration to include quantitative results: At present results are returned as PDFs but the next step will be SENAITE providing raw tests data to be parsed by Tamanu. This will enable pracitioners to automatically see results longitudinally in Tamanu, set alerts for acceptable bands etc.

• New sites for request/results integration: Samoa, Kiribati and Nauru are slated to have SENAITE/Tamanu integration working in the next 12 months.

• SENAITE - Vesalius Integration: Vesalius is a patient management system. With the integration in place, clinicians and scientists can save time by avoiding duplicate data entry. It also helps reduce errors when registering samples and entering test results.

• Extending instrument interfacing: To add a Chemiluminescence detector Vitros and clinical chemical analysers Cobas e 311 and e 411 to instrument that can be interfaced with SENAITE.