Multi-drug resistant tuberculosis (MDR-TB) patients in resource-poor settings experience large delays in starting appropriate therapy and are often not monitored appropriately due to an overburdened health care system, communication delays, and missing or error-prone data. This causes increased morbidity to patients, as well as further transmission of this deadly disease. This proposal is to develop, implement and formally evaluate medical information systems in a resource poor setting for institutions with and without internet. We hypothesize that applying these technologies will decrease delays and communications error to improve the health of those affected by this re-emerging infectious disease. In this study, we propose to create and quantitatively evaluate two laboratory information systems. The first provides electronic communication and reporting of tuberculosis (TB) laboratory information within a networked group of institutions to ? reduce the communication times of laboratory results, accelerate the startof treatment of high-risk patients and decrease the frequency of errors. The second creates a system of electronic collection of TB laboratory information from a physically distributed group of non-networked laboratories to reduce delays, errors and costs. These two complementary systems seek to verify the same hypothesis in two types of resource-poor scenarios, those with and without internet. There are six specific aims. 1) To develop and implement a handheld-based data system to collect TB bacteriological results from multiple sites lacking internet. 2) To evaluate the impact of this electronic system on the delays, errors, user perception and costs of the collection process by performing a randomized prospective and historical cohort study. 3) To develop and implement a web-based TB laboratory information system to enable health centers to access test results from the national and regional laboratories. 4) To evaluate the impact of this laboratory system on communication of results and costs compared to the current paper system by performing a randomized prospective and historical cohort study. 5) To investigate the impact of this system on the clinical outcome of high-risk patients. 6) To assess users' perception of this system and its potential use at a national level using a standardized survey instrument. This research will provide electronic information systems to decrease the morbidity of tuberculosis, a reemerging infectious disease which kills over 1.5 million people annually. It will evaluate these systems to formally prove their benefits for locations with and without internet. This will provide guidelines for other programs worldwide to implement these technologies. ? ? ?
