Palau celebrates six months of lab integration between SENAITE and Tamanu

Palau is celebrating six months of laboratory data exchanged between SENAITE and Tamanu electronic health record software developed and implemented by Beyond Essential Systems (BES). Since going live 35,672 lab requests have been processed for 6,962 number of patients.

What is it?

Once upon a time in Palau, SENAITE and Tamanu were not integrated. Back then, whenever a doctor ordered a lab test, the details had to be copied from Tamanu to SENAITE for processing by the laboratory staff. This was clunky and potentially error-prone. Once processed the results were printed out and sent back to the doctor - also tediously manual.

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So why not automate?

Why not indeed. An earlier integration synchronized patient demographic data between Tamanu and SENAITE - so it was a proven concept that data could be exchanged between applications. It would be relatively simple to write a quick solution where lab request details and their results could be shared between the two application but we wanted something a bit more long-term.

Think interoperability

Tamanu and SENAITE are not just operating in Palau. They are also in and planned for other Pacific Island Countries and possibly beyond, so it was important to solve this problem in a general fashion. The issue when trying to create a solution for multiple cases, especially those that don't exist yet, is that it's easy to get tied in knots with specific exceptions and anticipated edge cases. This is a common problem, one that has sparked a whole discipline in data exchange known as interoperability.

The best approach to quickly solve the general problem is to use a proven standard - we chose FHIR (Fast Healthcare Interoperability Resources). FHIR offers a series of clinical resources and recommended encodings that ensure the data flowing between Tamanu and SENAITE is structured in a clinically coherent way, one that accounts both for current usage and is extensible for future cases. Conforming to FHIR meant the integration would leverage all the community-sourced clinical wisdom used to develop the standard in the first place while still being flexible for any local variations.

Under the hood

The Request -> Result workflow as specified by FHIR was the logical starting place. In this context the Lab Request created by the doctor was mapped to a ServiceRequest Resource while the results of a lab technician when processing the sample became a DiagnosticReport. The DiganosticReport had room to store a PDF of the results in base64 format.

Standards don't only specify how the data is structured but what the data means - also known as sematics. Tamanu and SENAITE used different codes to define tests and panels - so a semantic standard was needed as a common language to ensure both systems could understand each other. The work here was to develop a common set of LOINC codes, an ontology recommended by FHIR for lab tests and then assign each tests and panel in Tamanu and SENAITE to a LOINC code.

Why LOINC? Well LOINC is extensive and free to use, particularly important for open source solutions in low income countries.

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Once this was done - it was time to code. After some back and forth between BES and Naralabs engineers it was time for user-acceptance testing. Then on June 2024 this integration went live and has been functioning with an uptime of 99%. Palau could not be happier.

What next?

Now that SENAITE and Tamanu are communicating with standards, other countries are able to use this integration with a minimal amount of configuration - if they upgrade to supported versions of Tamanu and SENAITE, they need to simply map their tests and panels to LOINC codes and they're away.

The standards will also allow for future expansions in the data sets shared. This includes plans to expand the data shared between applications to include result data, rather than just a report document. This will enable Tamanu to parse the test result data and provide clinicians with a logitudinal view of results.

Beyond the integration, how is Palau using SENAITE?

Developed as part of the Project Olangch, a SENAITE extension customises the base package for Antibiotic Susceptibility Testing (AST) for Antimicrobial Resistance (AMR) detection and surveillance. It is being used in hospitals and human health centres throughout the Republic of Palau.