Laboratory data timeliness and completeness improves following implementation of an electronic laboratory information system in Côte d’Ivoire: An interrupted time series analysis on 21 clinical laboratories from 2014-2020 (Preprint)

Abstract

The Ministry of Health in Côte d'Ivoire and the International Training and Education Center for Health at the University of Washington, funded by the United States President's Emergency Plan for AIDS Relief have been collaborating to develop and implement an open-source enterprise-level laboratory information system (OpenELIS) to improve HIV-related laboratory data management and strengthen quality management and capacity in clinical laboratories across the nation.

This impact evaluation aimed to quantify the effects of implementing OpenELIS on data quality for laboratory tests related to care and treatment of people living with HIV.

This evaluation used a quasi-experimental design to perform an interrupted time series analysis to estimate the changes in the level and slope of three data quality indicators (timeliness, completeness, and validity) after OpenELIS implementation. CD4 testing records for 48 weeks before until 72 weeks after OpenELIS adoption were collected using paper and electronic records from 21 laboratories in 13 health regions that started using OpenELIS between 2014-2020. We analyzed the data at the laboratory facility level. We estimated odds ratios (ORs) comparing the observed outcomes with modeled counterfactual ones when the laboratories did not adopt OpenELIS.

There was an immediate five-fold increase in timeliness (OR=5.27; 95% confidence interval [CI]: 4.33, 6.41; p<0.001) and an immediate 3.6-fold increase in completeness (OR=3.59; 95% CI: 2.40, 5.37; p<0.001). These immediate improvements were observed starting after OpenELIS installation and then sustained until 72 weeks after OpenELIS adoption. The weekly improvement in the post-implementation trend of completeness was significant (OR=1.03; 95% CI: 1.02, 1.05; p<0.001). The improvement in validity was not statistically significant (OR=1.34; 95% CI 0.69, 2.60; p=0.38), but validity did not fall below pre-OpenELIS levels.

These results demonstrate the value of electronic laboratory information systems in improving laboratory data quality and supporting evidence-based decision-making in healthcare. These findings highlight the importance of OpenELIS in Côte d'Ivoire and the potential for adoption in other low- and middle-income countries with similar health systems.