Open-source LIMS in Vietnam: The path toward sustainability and host country ownership☆
Introduction
The United States President’s Emergency Plan for AIDS Relief program (PEPFAR) enabled a rapid scale-up of HIV testing and treatment in Vietnam. To effectively manage the increased volume of testing and accompanying data needs, health laboratories in Vietnam required support to strengthen data management. Laboratories services in Vietnam, and particularly testing for HIV care and treatment, are provided in a wide range of facilities (i.e. high and low throughput, automated and manual testing methods, urban and rural settings). The Government of Vietnam desired a laboratory information management system (LIMS) that was both flexible and scalable. The US Government required all PEPFAR-funded programs to have a focus on sustainability, which meant that ownership and financing of these programs would be transferred to the country government over time.
Therefore, in 2006, the U.S. Centers for Disease Control and Prevention (CDC) and the Government of Vietnam (GVN), “the stakeholders”, set out to create a sustainable national open source LIMS program in Vietnam in clinical and public health laboratories.
Section snippets
Background
Health services in Vietnam fall into two parallel, tiered systems: preventive medicine—managed by the General Department of Preventive Medicine (GDPM) – and medical services – managed by the Vietnam Administration for Medical Services (VAMS). Specialized (e.g. disease-targeted) programs, often with substantial donor funding, operate alongside these systems with separate leadership and program management structures. The medical services system includes 1100 hospitals from the national,
Research methods
Qualitative methods are particularly useful in IS research when studying a process as it develops and emerges [21]. Published research on LIMS implementation in developing settings, and the contribution of open-source software to sustainability in this context, are limited. Sources of qualitative data for IS research can include documentation, archival records, interviews, direct observation, and physical artifacts [22], [23].
This case report relies primarily on monthly progress reports from
Establishment and management of the national LIMS program
The U.S. Centers for Disease Control and Prevention (CDC) and the Government of Vietnam (GVN), began planning for a national LIMS program in 2005. An advisory group was convened in 2006 consisting of the Ministry of Health and its affiliated agencies, national and regional institutes, provincial AIDS committees (PACs) and hospitals. Subgroups were created and provided program-specific guidance including standardization of report forms and system requirements. Stakeholders began by reviewing the
Key factors contributing to sustainability
In the context of information systems, sustainability has been defined as the characteristics of a system that ensure its ability to continue operating without significant interruptions [33]. As the implementer and stakeholders reviewed the LIMS program during its expansion, several factors were identified that contributed to sustainability of this program in Vietnam. These factors were formalized into a sustainability model, which has guided stakeholder decisions as the program has matured:
Conclusion
Laboratories providing clinical testing services in resource-constrained settings often struggle to ensure healthcare providers receive quality laboratory results within acceptable timeframes. Recent national and international quality improvement initiatives are encouraging laboratories to pursue accreditation [43]. While data management and record keeping are an important part of the accreditation roadmap, it can be intimidating to consider implementing a LIMS in addition to routine laboratory
Competing interests
Kenneth Landgraf is a personal services contractor assigned to the U.S. Centers for Disease Control and Prevention Vietnam country office. The Association of Public Health Laboratories, Ho Chi Minh City AIDS Committee, and the VAAC-US.CDC Project are recipients of grants from CDC through the United States PEPFAR program.
Author contributions
Kyle Bond, former chief of the CDC-Vietnam laboratory branch, guided the LIMS program for six years and provided significant input into the development of the sustainability plan. Paul Jankauskas served as the CDC-Vietnam LIMS advisor for four years, facilitating the expansion of the LIMS program and working closely with Duong Thanh Tung and Nguyen Thi Hoa on the transition of costs in Ho Chi Minh City. Reshma Kakkar served as the first CDC-Vietnam LIMS Advisor and, with Michelle Meigs,
Acknowledgements
The authors would like to thank the following organizations and individuals for their valuable contributions to the project: the staff at the Vietnam Administration for AIDS Control; Pham Hai Phong from HCMC-PAC, for his significant efforts supporting OpenELIS sites in HCMC; Sherrie Staley and Lucy Maryogo-Robinson from the Association of Public Health Laboratories, for their valuable program management support; the Minnesota Public Health Laboratory, for supporting the training of LIMS
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The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention. This project has been supported by the President’s Emergency Plan for AIDS Relief (PEFPAR) through the Centers for Disease Control and Prevention (CDC) under the terms of cooperative agreements #U2GGH001097, #5U2GGH001016, and #5U2GPS003241.