10/11/2011
THE EARTH
INSTITUTE
TROPICAL LABS INITIATIVE
AT
COLUMBIA
UNIVERSITY
MVG-Net Labs Module
Casey Iiams-Hauser, Francis K. Frimpong, Eric Akosah, Yanis Ben
Amor
Tropical Labs Module for MGV-Net
Version 1: Revision3
Labs Module for MVG-Net
Purpose:
This system will serve as a way for clinics to submit laboratory requisitions using a mobile device. This
information will be received by the laboratory in a dashboard, the dashboard will facilitate the
organization of pending samples in the laboratory, verify that the samples reach the laboratory and will
transmit the results of completed test results back to the originating clinic automatically. It will also act
as a repository of test results linked to patient medical records and produce basic reports. The system
will require integration with multiple systems and workflows and will therefore be implemented in
stages. The first milestone is to be completed by November 8, 2011.
Milestone 1: Will enable clinics to send lab requisitions to the Lab, the lab to print a list of Pending
Samples, and the Lab to send results via SMS.
Issue Date: Sept 12 2011
Author: Casey Iiams-Hauser
Document Status: Draft
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Tropical Labs Module for MGV-Net
Version 1: Revision3
Workflow:
Current:
Issue Date: Sept 12 2011
Author: Casey Iiams-Hauser
Document Status: Draft
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Version 1: Revision3
Proposed new workflow with CC+TLI:
MVG-Net
Issue Date: Sept 12 2011
Author: Casey Iiams-Hauser
Document Status: Draft
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SMS Based system without lab GUI (Milestone 1):
1. The system will utilize the existing MVG-net IDs used currently for the OpenMRS and
ChildCount+ system.
2. See appendix 1 for the lab requisition form
 CHEWs are already trained on the formatting used for ChildCount+, we should keep
the same syntax for SMS and keep the forms in the same format as other CC+ forms.
(e.g., for a sickling test for a person with the HealthID of ED1R, sending one blood
tube with insurance: ED1R +Q SK +SP 1 0 0 0 0 +INS 42589658745. All data elements
are properly encoded in the OpenMRS database through xforms).
3. When a lab requisition is sent, the confirmation should include an automatically generated
accession number in the format CLINIC-YEARMONTH-SAMPLENUMBER. So the first
monthly sample from Datano sent in Sept 2011 will read DA-1109-001.
The code for the clinics is as follows;
Keniago KE
Assamang AS
Datano DA
Tontokrom TO
Watreso WA
Aboaboso AB
Akyerekyerekrom AK
4. This means that the second sample from Tontokrom from September, 2011 would return a
message saying: ”Lab sample for TEST for PATIENT NAME successfully registered, please
label tubes TO-1109-002 and deliver to lab”. The requisition will be pushed over via the
xform module to the OpenMRS system for later analysis or reporting. We will link the
sample number to the accession number.
5. When the requisition is recorded in the ChildCount+ Database, a “status” flag will be
created, this flag will have five states: Incoming, In Progress, Stalled, Cancelled, Result.
6. A new “Labs in Progress” Report will be available which will also be included in an
abbreviated way via google docs. This I think would violate our privacy protocols, so I don’t
think it would work unless we just display the sample number and no identifying
information. Labs in progress report would be available to be run from the CC+ Dashboard,
this would look like the report in appendix 2.
7. The result entered into the field +QR would be texted into the CC+ server, the system
checks it against a range of possible values and ensures that it is valid, if not, it sends an
error back to the phone saying “test result outside of valid range, expected values should be
ACCEPTABLE RANGE”, if correct, the result should be sent to the clinic phone which
originated the sample.
 RESULT SMS FORMAT: “Lab result for HEALTHID req REQUISITIONID
TESTNAME RESULT” (EG: Lab Result for EG123, req TON-092011-008 Sickling
Test: Negative) If the test type has a reference range it should be put after the result,
if it is within the reference range, it should read RESULT (REFRANGE), if outside the
reference range, it should read RESULT (REFRANGE) H or L for high or low. EG:
Lab Result for EG123, req TON-092011-055 HB: 7.0 (12-18) L
8. The lab results will be transferred by a special “lab result” form to OpenMRS via the xforms
module.
Issue Date: Sept 12 2011
Author: Casey Iiams-Hauser
Document Status: Draft
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Version 1: Revision3
Lab user interface (Milestone II): Functional Requirements


To have be able to view easily:
 Incoming tests (requisitions generated by clinics and not yet received by the
lab) and check them in or mark them as having insufficient sample
quality/quantity,
 in progress tests and enter results,
 and search for past or current test results,
 a list of stalled lab results and move them back into “in progress” state.
The lists should be able to be sorted by health ID, date test originated, requisition ID,
originating clinic, Health ID, patient name.
1. The Lab User interface: Functional Specifications: The Lab will have a user/password protected 5 tab user interface, accessed with a browser on any computer on the same
LAN as the server, with a universal search feature to find tests in any state, this should be
contained within a box in the top right hand side of the screen.
 4 of the 5 tabs should be: Incoming, In progress, Results and Stalled
 These should have 6 columns in them Date of Request, Sample Code, Clinic,
Health ID, Test Type, Patient name. These should be sortable by clicking the
column header.

The 5th tab is Reports. This should have a list of reports which can be generated on
demand
1. Incoming: a list of tests requested by a clinic, these should be sorted into 5 sortable
columns:
Date of
Requisition
Clinic
Patient
Test Type
Patient
Request
Number
Health ID
name


When a test is clicked, a box comes up with a checkbox for "received", one
checkbox for "cancelled" and a drop down where one can check:
 Good
 Insufficient Quantity
 Bad Quality
 Wrong type
 No Sample Sent
When "OK" is clicked, if the good button was checked, it moves to "in
progress", If one of the other drop down boxes was checked, it is moved to
the "Stalled" tab and if it was cancelled it is moved to "results". With the state
cancelled in the result field. Also allow cancel for the dialog to return to the
list.
2. In Progress: This is where the lab can find the tests that they have in process, these
should be sorted into 5 sortable columns:
Date of
Requisition
Clinic
Patient
Test Type
Patient
Request
Number
Health ID
name
Issue Date: Sept 12 2011
Author: Casey Iiams-Hauser
Document Status: Draft
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Tropical Labs Module for MGV-Net
Version 1: Revision3


This is where the result of the test is entered, the type of data entry box
depends on the type of test (list of test types and expected format of results is
in appendix 2). Once the result is entered and Ok is pressed, the system
checks it against a range of possible values and ensures that it is valid,
creating an error saying “test result outside of valid range, expected values
should be ACCEPTABLE RANGE”, the result should be sent to the clinic
phone which originated the sample.
RESULT SMS FORMAT: “Lab result for HEALTHID req REQUISITIONID
TESTNAME RESULT” (EG: Lab Result for EG123, req TON-092011-008 Sickling
Test: Negative) If the test type has a reference range it should be put after the result,
if it is within the reference range, it should read RESULT (REFRANGE), if outside the
reference range, it should read RESULT (REFRANGE) H or L for high or low. EG:
Lab Result for EG123, req TON-092011-055 HB: 7.0 (12-18) L
3. Results: An archive of previously completed tests, these should be sorted into 5
sortable columns:
Date of
Requisition
Clinic
Patient
Test Type
Patient
Request
Number
Health ID
name
when clicked it should display the result and the date requested and date completed,
along with an option to resend the result which should have a dropdown that defaults
to the original clinic but could be changed to send to a different clinic if need be.
4. Stalled: this tab contains a list of tests which have been stalled for bad sample quality
5. Reports: this tab contains a list of reports which can be run
6. (Future version): Supplies tracker, shows the number of tests utilizing each supply
since the last change of the supply. Think of this like the way a printer estimates the
usage of ink since the last cartridge change. It would be a simple counter which
would raise an alert when a certain set threshold is passed, giving the lab time to
ensure that they have a replacement for that consumable.
Clinic user interface (Milestone III): Functional Requirements
TBD
Issue Date: Sept 12 2011
Author: Casey Iiams-Hauser
Document Status: Draft
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Version 1: Revision3
Approvals
Prepared By
Casey Iiams-Hauser
(eHealth Solutions Coordinator)
This document requires the following approvals:
Approved By
__________________________________
(Matt Berg)
__________________________________
(Yanis Ben Amor)
Approval Date __________________________________
Issue Date: Sept 12 2011
Author: Casey Iiams-Hauser
Document Status: Draft
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Version 1: Revision3
Appendix 1
Issue Date: Sept 12 2011
Author: Casey Iiams-Hauser
Document Status: Draft
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Version 1: Revision3
Appendix 2: Tests in Progress Report
Issue Date: Sept 12 2011
Author: Casey Iiams-Hauser
Document Status: Draft
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Version 1: Revision3
Appendix 3: Results Types
Test
Sickling Test
Code
SK
Results type
Units
NA
Ref Range
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
g/dl
cel/ul
NA
12-18 [M], 1116 [F]
NA
NA
NA
NA
Positive
Negative
Blood group
BG
A+
AB+
BAB+
ABO+
O-
Rhesus factor
RF
Positive
Negative
Syphilis (VDRL)
SY
Hepatitis B- HBsAg
HP
Haemoglobin (Hb)
CD4+ test
Malaria Parasites (MPs)
HB
CD
MP
G6PD
G6
Widal test
Fasting Blood Glucose
Reactive
Non-reactive
Poor quality sample
Positive/Negative
Negative
Positive
Indeterminate
decimal number
decimal number
not seen/present +++
Negative
One plus
Two plus
Three plus
Total defect/partial
defect/no defect
No defect
Partial defect
Total defect
WT
FB
Reactive
Non-reactive
decimal number
NA
NA
mmol/l
(3.6-6.4)
OMRS Concept
ID
160225
703
664
300
690
692
694
696
1230
1231
699
701
160232
703
664
299
1228
1229
1304
159430
664
703
1138
21
5497
1366
664
1362
1363
1364
160226
160233
160234
160235
306
1228
1229
160053
Issue Date: Sept 12 2011
Author: Casey Iiams-Hauser
Document Status: Draft
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LOINC c
Tropical Labs Module for MGV-Net
Version 1: Revision3
Random Blood Glucose
ESR (erythrocyte
sedimentation rate)
RB
decimal number
mmol/l
ES
decimal number
Platelets
White Blood Cells
(WBC): T
PL
decimal number
WB
decimal number
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
mm/h
x109/l
(10e9)
x109/l
(10e9)
%
%
%
%
%
NA
SPUTUM FOR TB (AFB)
STOOL R/E
URINE R/E
TB
ST
UR
Negative
One plus
Two plus
Three plus
Short message
Short message
NA
NA
(3.2-11.0)
3-5 [M], 4-7
[F]
887
855
729
150-4000
678
(2.5-8.5)
(40-75)
(25-40)
(1-6)
(2-10)
(0-1)
NA
1336
1338
1339
1340
1341
307
664
1362
1363
1364
NA
NA
Issue Date: Sept 12 2011
Author: Casey Iiams-Hauser
Document Status: Draft
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