e-LITE

e-LITE (electronic Laboratory Information to Everyone) is committed to empowering patients and healthcare workers through the provision of real-time health-related messaging and result return, stemmed from centralised data collected across a tiered laboratory value chain (from point-of-care to centralised testing laboratories). Furthermore, e-LITE empowers custodians of national priority programs to remotely monitor the performance of diagnostics supporting priority diseases. e-LITE consists of a front-end mobile application and back-end, pre-authenticated Business Intelligence/Operational Dashboards. Should e-LITE be scaled up globally, it could impact individuals requiring accurate diagnosis and regular ongoing treatment monitoring, such as those living with HIV (25.7million), diabetes (>20million), hypertension (~200million), tuberculosis (2.5million) or COVID19 (>3million). Innovations remain central to strengthening the pathology value chain and include new diagnostic tests, clinical/laboratory workflow reengineering, improved testing algorithms, alternative, less invasive specimen collection, faster result delivery, improved access to results and overall improved service efficiencies within a tiered, networked laboratory system.

Barriers to pathology and laboratory medicine in Africa include; access to affordable diagnostics and real-time laboratory resulting, well-informed healthcare practitioners and patients, as well as limited infrastructure for optimal workflow and services. A tiered laboratory network includes testing sites from point-of-care to centralised. e-LITE was born from the need to remotely monitor the performance of a tiered laboratory network, couple with near real-time results delivered into the hands of the healthcare workers. This empowerment is being extended to patients through health-related messaging, thereby equipping patients to take the appropriate action, at the right time. Furthermore, the remote monitoring (pre-authenticated back-end Business Intelligence & Operational Dashboards) of the tiered network decreases turn-around-times and specimen rejection rates, improving cost efficiencies. Lack of data integration hinders decision making at patient and programme levels. e-LITE thus enables ministries of health and local governments to timeously respond to the performance of their priority disease programs. 

e-LITE is based on an existing innovation developed by our group called eLABS that addresses gaps at the laboratory-clinic-patient interface to access accurate and timeous HIV viral load (VL) results. It is a mobile digital solution (application for android devices) supported by operational dashboards. The whole journey (specimen, courier, healthcare workers) are time stamped, with all data recorded in real-time and visualised on these dashboards. Results that require action (rejection, abnormal, invalid) are returned to the healthcare worker with a notification and grouped accordingly for ease of access. Patients will receive health-related messaging on their own mobile devices. e-LITE will leverage the eLABS technology backbone for integration web service communication (HL7). This technology provides a backend integration engine for system interoperability with legacy laboratory systems and connected testing instruments across tiered laboratory networks. e-LITE will benefit from the already established centralised data command centre (DCC) that provides workstations for effective and efficient ways of supporting end-users. Technical resources in the DCC provides central proactive and reactive technical support to all the live facilities. In addition to dashboards, the DCC has an inbound call centre which allows for calls to be received for recorded assistance and needs analysis.

e-LITE, leveraging eLABS’ system, aims to close healthcare gaps by linking stakeholders across the pathology value chain through data integration: (1) Patients will be empowered, using direct messaging, to respond to healthcare recommendations, promoting patient-centred care; (2) Healthcare providers will have decreased workloads (electronic result return, specimen self-collection and minimised clinic visits), integrated POCT and laboratory results, and complete and accessible patient records for improved patient management; (3) Specimen transport logistical data will inform courier routes and delivery schedules, in addition to monitoring the specimen from clinic-to-laboratory; (4) Laboratories will be better able to plan resources, identify gaps to improve quality of specimen integrity, testing and results, and provide POCT oversight; and (5) Decision-makers will have access to real-time, relevant and accurate data in the form of dashboards to inform decisions, emergency responses and policy. Ongoing support is available to all stakeholders through experienced technical advisors who provide ongoing training, site visits and remote assistance channels. Stakeholders are engaged regularly, particularly ahead of new module design, and the user experience (UX) surveys and forums continue to guide and inform system improvements. The system development roadmap is endorsed through governance structures, including specialist advisory boards and product forums. 

e-LITE will extend diagnostics to the last mile of the laboratory value chain; the patient. COVID-19 has taught us, globally, that the general population demands increased access to rapid and accurate diagnostics, result return and education around their health. Extension of laboratory services to the patient includes; self-sample collection, self-testing, and self-monitoring (through smart wearables); all data collected on a centralised platform, to monitor potential pandemics through intelligent analytics. In turn, custodians of the health system (including primary healthcare workers), are empowered with near real time information to take the right action at the right time, within their communities.

The eLABS system, was developed through user-centred-design engagement. To date the data system manages >20000 users across 2502 facilities (Zambia and South Africa) and is undergoing uptake in Mozambique and Nigeria. Success is measured through facilities and users enrolled, tests ordered, results returned, decreased result turnaround time, decreased specimen rejections and overall increased virological suppression, thereby contributing towards achieving global HIV targets (>95%). The system was modified for COVID19 with rapid uptake to increase contact tracing, giving confidence to the team that e-LITE has a stable data backbone and is ready for growth. Further areas of growth identified are integration with point-of-care testing (POCT), patient specimen self-collection, self-testing and self-monitoring data. This system growth will initially target South Africa where POCT and digital health security policies are in place. Lessons-learned will then be translated to partnering African countries already using the eLABS data conduit.

e-LITE is an African solution developed by African problem solvers living in countries facing immense public health threats. The eLABS system rapidly gained traction because of its unique offering: interoperable with legacy laboratory information systems (LIS); standalone where there is no LIS; completely modular and laboratory instrument/POCT/mobile device agnostic; anti-disease silo as pathogen agnostic (ready for HIV, TB, COVID and non-communicable diseases); operates across the entire pathology value chain (patient-specimen-driver-laboratory-resulting) and all incremental developments are performed through user-centric design and engagements; and responsive to demand creation with an agile system, with the rapid adaptation for the COVID19 pandemic as an example. eLABS is well demonstrated and proven at scale in real-world settings in at least two countries (with language translation), showing an experienced team with implementation know-how and ability to engage with key opinion leaders in-country and allow feedback for product enhancements. The team is bold and confident to expand this formula beyond the clinic-laboratory interface and apply eLABS technology in a new way through e-LITE: directly with patients. LIS, middleware and patient messaging Apps do exist, but a modular system encompassing ALL these gaps for the entire spectrum is unique, designed for resource-limited settings and makes e-LITE’s eLABS stand apart. 

e-LITE (through eLABS) is currently serving the following: SOUTH AFRICA: Provinces (6); Districts (22); clinics (1680); healthcare workers (15,823); courier drivers (292); centralised testing laboratories (17). ZAMBIA: Provinces (8); Districts (76); clinics (899); healthcare workers (531); courier drivers (323); centralised testing laboratories (2).  In one year, we intend to increase to the following: SOUTH AFRICA: Provinces (8); clinics (2500); healthcare workers (21,563); courier drivers (300), patients (1000). For the current NIGERIA (65 facilities) and MOZAMBIQUE (8 facilities) implementation - these are at pilot phase. e-LITE will extend its services in South Africa only. In five years, it is intended to expand the services to over one million patients in South Africa, together with the Ministry of Health. The main objective of e-LITE is to leverage from the existing implementation (integration) with the laboratory-clinic interface, to reach the one million population within 5 years. These services will then be demonstrated into other African countries, beginning with Zambia, Nigeria and Mozambique.

Impact is measured by assessing key performance indicators (KPI) against baseline. The rapid assessment tool allows swift overview of KPI status quo. KPI for successful program impact cover pre-analytic, analytic and post-analytic processes across the pathology value chain. These include specimen rejection rates, result TATs, percentage test coverage for affected populations, proportion of clinicians using the implemented systems, proportion of patients using patient support modules and number of patients reached by the implementation roll-out. Specific KPI (e.g. HIV suppression rate) are created per solution.

Each project has or will have a detailed monitoring and evaluation (M&E) plan guided by a comprehensive work plan, which will extend beyond year 3. A logic framework for each implementation will link activities to the intended KPI and a data management plan (DMP) that ensures continued quality improvement will be implemented. Progress will be monitored daily, weekly and monthly, with quarterly reports developed for feedback.

Successful examples of existing M&E for eLABS include >90% HIV suppression rates, decreased TAT (>90 days to 23 days) and >90% results acknowledged in Zambia, >90% HIV VL results returned in <96 hours in South Africa, and <2% rejected rate (target of <5%) in both countries. 

Full-time: Operations, Wendy Stevens, Pedro da Silva. Digital Health Innovations:  Lynsey Stewart-Isherwood. iLEAD (BMGF)Lead: Lesley Scott. Program Leads: Portia Sejake, Kumbirai Chigudu, Fadzai Marange, Andani Phaswana. M&E Specialists: Blessing Gorodo, Veronica Mkuyamba. Informatics Engineer: Graeme Dor.

Part-time: Clinical: Right-to-Care, Ezintsha, WitsRHI

Contractual: Economists, statistics, GIS: HE2RO. Software Design: Mezzanine

e-LITE is a multidisciplinary team with >20 year’s experience in laboratory (National Health Laboratory Service) and clinical (Right-to-Care, Vida) medicine addressing priority diseases in Africa and implementation science within RLS. The team comprises health-care practitioners, laboratorians, scientists/technical experts, information/data specialists, implementation program managers, and M&E specialists. The grant life-cycle team (WHC) has >300 grants management/legal oversight experience. e-LITE is entirely African-centric with joint-appointment academic members based at the University of the Witwatersrand  ensuring mentorship/capacity building. The teams have worked in >10 African countries across levels of stakeholders (facility managers to MoH) and partner with in-country organisations for key engagements (e.g. EQUIP). They have a deep understanding of target populations, clinic-laboratory interface and healthcare delivery by implementing national laboratory/treatment programs for HIV/TB and recently COVID19 vaccine program, self-collection and HIV self-testing. The team agility adjusts workstreams to ever-changing disease landscapes, as proven by COVID-19 diagnostic evaluations in partnership with South African Health Products Regulatory Authority (in-country regulator) and implementers for rapid response. Knowledge dissemination is a strong component with >400 peer-reviewed publications (including policy guidelines) and key messaging disseminated to partners such as the African Society for Laboratory Medicine. 

We at e-LITE (eLABS) are part of a broader community within the University of the Witwatersrand in Johannesburg, South Africa. We are a diverse team and pride ourselves in empowering each other in equitable access to learning opportunities (i.e. access to further formal education, sharing of lessons learned). Our belief is; learn, teach and empower. We are also an equal opportunity employment culture. Our tangible goals are addressed through individual performance plans that include our KPI's (for both the business and for our personal growth). More information can be provided upon request.

Our team is applying to Solve to primarily access a community of like-minded colleagues who share a common goal of improving access to improved global health through digital health innovations. Through this community, we will engage, learn from each other and hopefully gain access to other partners who will assist us in leap frogging our technology through global access mechanisms. Furthermore, we are hoping that Solve would be able to assist us with partners who can help in investing in sustainable revenue modelling for e-LITE. 

Albeit we have a technology partner, we our ambition is bring our digital health innovations in-house (to be managed by ourselves). This means that we would need to invest in an in-house software development talent. Our solutions should ideally be agnostic to technology companies, to ensure global access. Although we have our own IT experts – we do not have in-house software coders – we need a team to ‘scrum’ and iterate our solution for long-term sustainability. We also need experts in the development of our own business models, as we solely rely on our existing technology partner to do so. 

eLITE envisages partnering with Microsoft and/or Google to assist in increasing global access, provide mentorship to the eLITE technical team, provide insights for potential streamlining digital processes, strengthening data security protocols and visual graphic design. Parenting with an independent entity like Discovery Health who are governed by the medical schemes act could strengthen eLITE’s inclusion of wearable devices interfacing with eLABS for patient-monitoring.  eLITE sees real value in continuing their long-standing partnership with CHAI, to further leverage their costing and technical information expertise, and reach across the African continent. Continued partnership with BMGF and the onboarding of Imperial College could greatly increase our access to diagnostic and other digital technology innovations for continued growth of eLITE and ensure relevance. This suggested multi-partner approach will synergise and streamline collaborations and  minimise duplication of efforts. As a not-for-profit organisation, eLITE depends on grant funding. Sponsors (USAID, CDC and BMGF) have provided the backbone to ongoing innovation development and implementation, which we would like to continue. This also includes ongoing stakeholder engagements with in-country Ministries of Health and implementing partners.