Personal Digital Assistants Help Track Tuberculosis Data Faster

Researchers from the Harvard-MIT Division of Health Sciences and Technology (HST, Cambridge, MA, USA; hst.mit.edu) conducted a cluster randomized controlled trial in 93 health establishments in Peru. The researchers first collected baseline data over a period of 19 months. Four districts were then randomly assigned to intervention (PDA) or control (paper) groups, and further data were collected for another six months. Comparisons were made between intervention and control districts and within-districts before and after the introduction of the intervention.

The results showed that the PDA-based system had a significant effect on both processing times and errors. In the between-districts comparison, the median processing time for cultures was reduced from 23 to 8 days, and for smears was reduced from 25 to 12 days. Additionally, the proportion of cultures with delays of over three months was reduced from 9.2% to 0.1%, and the number of errors was decreased by 57.1%. The intervention reduced the work-hours necessary to process results by 70% and was preferred by all users. The new tracking system was published early online in the December 12, 2008, issue of the International Journal of Infectious Diseases.

"You can really prevent patients from falling through the cracks,” said project launcher Joaquin Blaya, a Ph.D. graduate student at HST. "Getting timely and accurate lab results is essential to determine if a patient is responding to treatment and, if not, to alert physicians to the possible need for medication changes.”

Under the old patient tracking system, a team of four healthcare workers would visit more than 100 health care centers and labs twice a week to record patient test results on paper sheets. Twice a week, they returned to their main office to transcribe those results onto two sets of forms per patient - one for the doctors and one for the health care administrators. The process took an average of more than three weeks per patient; in some extreme cases, results were temporarily misplaced and could take up to three months to be recorded. There was also greater potential for error because information was copied by hand so many times.

Under the new tracking system, health care workers enter lab data into their handheld PDAs, using medical software designed for this purpose. When the workers return to their office, they synchronize the PDAs with their computers. The Peruvian health care workers enthusiastically embraced the program, which started in two of Lima's districts and has now been expanded to all five. In addition to saving time, the handheld devices are also more cost-effective than the older paper-based system.

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Harvard-MIT Division of Health Sciences and Technology