Laboratory Information System | Moana Digital Health

Overview

Moana LIS (moana-lis) is a dedicated Laboratory Information System that operates as a standalone service within the Moana platform. It manages the full lifecycle of every laboratory investigation: from clinician order creation at the patient's bedside through specimen collection, laboratory processing, result entry, quality control, supervisor approval, results dispatch, and automatic delivery back to the ordering clinician's patient record.

Laboratory systems in low-resource environments face a distinct set of operational challenges that generic health IT solutions do not address adequately. Clinicians place orders verbally or on handwritten forms, with no guarantee the order reaches the laboratory accurately or at all. Specimen tracking is manual and unreliable. Results are phoned back to wards or written in books, with no automatic connection to the patient record. Critical abnormal values are sometimes missed entirely because the notification system is a phone call that goes unanswered. Quality control is maintained in paper logbooks that no supervisor reviews until a problem has compounded.

Moana LIS was built to close each of these gaps with a production-grade digital workflow. With 90 endpoints across 18 controllers, the service is built for the operational demands of reference laboratories, hospital laboratories, and multi-facility laboratory networks where a single central laboratory may simultaneously process orders from multiple peripheral facilities.

The system is structured around a clear separation between the ordering facility and the processing laboratory. A hospital ordering a test processed by a provincial reference laboratory is a first-class workflow. A rural health post sending specimens to a district hospital laboratory is handled with the same rigour. Each organisation sees only their own data. Each laboratory manages its own test catalogue, QC programme, and billing configuration independently.

Core Capabilities

Test Order Management and Workflow

Clinicians place laboratory orders directly from the patient's encounter record in the EHR, selecting from the laboratory's published test catalogue. Orders are transmitted to the laboratory instantly, eliminating paper requisitions, verbal orders, and the transcription errors they introduce. Each order carries the requesting clinician's identity, the patient record, the clinical indication, the urgency level, and any relevant specimen collection instructions. An order approval workflow allows laboratory managers to review, approve, or reject incoming requests before specimen collection begins, with rejected orders returning to the ordering clinician with a documented reason. The approval step is configurable and can be disabled for environments where a direct order-to-collection workflow is operationally preferred.

Specimen Tracking and Chain of Custody

Every specimen is assigned a unique identifier at the point of collection. Chain of custody is maintained from collection through to result release: collection time, collector identity, specimen condition on receipt, and any rejection reason if the specimen is unsuitable for analysis are all recorded. External laboratory referrals for investigations that cannot be performed in-house are created digitally, capturing the receiving laboratory's name, contact details, reason for referral, and expected turnaround time. Referred test results, when received, are entered against the original order, maintaining the complete chain from ordering clinician to final result in one record.

Multi-Component Test Field Definitions

Laboratory test definitions use structured field definition arrays (JSONB format) that support both simple single-value tests and complex multi-component panels. A full blood count, for example, defines six or more separate result components including WBC, haemoglobin, RBC, haematocrit, and platelets, each with its own LOINC code, unit of measurement, reference range, age-specific ranges, gender-specific ranges, critical low threshold, critical high threshold, and interpretation code. Result entry uses this structure to capture each component separately, with automatic interpretation coding applied: LL for critically low, L for low, N for normal, H for high, HH for critically high, A for abnormal, and AA for critically abnormal.

Result Entry, Interpretation, and Supervisor Approval

Laboratory staff enter results against the structured field definitions for each test. Age and gender-specific reference ranges are applied automatically, so a haemoglobin result is interpreted against the appropriate normal range for a five-year-old child rather than an adult male. Results are held in a pending state until reviewed and approved by a laboratory supervisor, preventing the release of unvalidated results to clinical users. The supervisor reviews each result against the reference ranges and QC status before releasing it. Released results are immediately visible in the ordering clinician's patient record with interpretation flags and reference ranges displayed alongside the result values.

Critical Value Alerting and Acknowledgment Workflow

When a result crosses a defined critical value threshold, an immediate high-priority notification is sent to the ordering clinician via in-app alert and, where configured, SMS and email. The alert requires explicit acknowledgment by the clinician. If the alert is not acknowledged within 30 minutes of delivery, the system re-notifies every five minutes until acknowledgment is received. A supervisor dashboard displays all unacknowledged critical value alerts across the facility in real time, ensuring that supervisory staff can identify and escalate unanswered alerts before the clinical window for action closes. Every acknowledgment is timestamped and attributed to the acknowledging clinician. This workflow ensures that no life-threatening laboratory result can pass unnoticed through the clinical system.

Westgard Quality Control and Levey-Jennings Charts

Laboratory quality control is managed using the internationally recognised Westgard multi-rule method. Six rules are implemented: 1-3s (one control result exceeding three standard deviations), 2-2s (two consecutive results exceeding two standard deviations), R-4s (range between two consecutive results exceeding four standard deviations), 4-1s (four consecutive results exceeding one standard deviation on the same side), 10x (ten consecutive results on the same side of the mean), and 1-2s as a warning rule. QC runs are recorded against each analytical run and plotted automatically as Levey-Jennings control charts. When a QC rule is violated, patient results for the affected run are automatically blocked from release to prevent the reporting of potentially erroneous results. A supervisor override with documented reason is required to release patient results from a failed QC run, maintaining the audit trail.

External LIS Integration and Equipment Connectivity

Moana LIS connects to external laboratory information systems via REST, FHIR R4, HL7 v2, and SOAP interfaces. Test catalogues from connected external systems are synchronised automatically on configurable schedules: hourly, daily, or weekly. Per-connection health checks and utilisation statistics allow administrators to monitor the availability and performance of every external integration from a single management interface. Laboratory analysers that support direct result transmission can send results to Moana LIS electronically, eliminating the manual transcription step that introduces the majority of data entry errors in laboratory workflows.

Multi-Laboratory and Multi-Facility Scoping

The LIS is architected around a clear distinction between a facility (the hospital or clinic placing the order) and a laboratory (the entity performing the analysis). Every order record carries both a facilityId and a laboratoryId. This means that a hospital ordering a test processed by a reference laboratory is fully supported, with the hospital seeing its patient orders and the reference laboratory seeing its processing queue, with strict data isolation between organisations. A new laboratory can be added to the network without any code changes. Facilities browse a directory of available laboratories and select their preferred lab for each test type.

LIS-Side Billing and Revenue Analytics

Laboratory billing operates in three configurable modes. LIS_LOCAL mode manages the complete billing lifecycle within the LIS itself, including invoice generation, payment recording, and revenue analytics by test type, department, and sending facility. BACKEND_ONLY mode delegates invoicing to the main EHR billing module, with the LIS emitting billing handoff messages via an outbox queue for the EHR to process. HYBRID mode runs both, with the LIS tracking its own billing while also notifying the EHR, which then syncs payment status back to the LIS. This flexibility accommodates the financial architectures of public health facilities, private laboratories, and donor-funded reference laboratory programmes.

Results Dispatch and Communication

Completed, approved results enter a dispatch queue from which laboratory staff can mark results as delivered, send results directly to the ordering clinician by email with a formatted PDF laboratory report attached, and generate printable PDF reports for physical delivery where electronic communication is not available. Every dispatch event is recorded with a timestamp and the dispatching staff member's identity, maintaining a complete chain of communication from result release to clinical receipt.

Who Uses This Module

Laboratory Technicians and Scientists

Manage the day-to-day laboratory workflow: receive orders, record specimens, enter results, run QC checks, and manage the dispatch queue.

Laboratory Managers and Supervisors

Approve or reject incoming orders, review and release pending results, manage QC programmes, review Levey-Jennings charts, monitor critical value acknowledgment dashboards, and manage external laboratory connections.

Ordering Clinicians

Place orders directly from the clinical encounter. Receive real-time critical value alerts. Access approved results linked directly to the patient record without manual retrieval.

Finance and Administration

Manage laboratory billing in the appropriate mode for the facility's financial structure. Access revenue analytics by test type, department, and facility.

How This Connects to the Rest of Moana

Laboratory orders are created from Clinical Care Management encounters and are linked to the patient record from the moment of ordering. Approved results are written back to the patient record automatically, making them immediately available to the ordering clinician and to any other authorised clinician reviewing the patient's history. Critical value alerts are delivered through the platform's multi-channel notification system. Laboratory billing entries feed the Billing and Financial Management module. Aggregate laboratory result data feeds the Public Health Surveillance System for communicable disease surveillance, NCD indicator tracking, and laboratory programme performance reporting.

Standards and Interoperability

Laboratory results are structured to FHIR R4 Observation, DiagnosticReport, and ServiceRequest resources, with LOINC coding applied to all test definitions and result fields. The FHIR Poller Service runs on a 30-second cadence, automatically importing new ServiceRequests from the HAPI FHIR server and converting them to LIS laboratory requests. HL7 v2 ORU R01 messaging supports result transmission to legacy hospital information systems. Bidirectional FHIR synchronisation with conflict detection ensures that the LIS and the central FHIR server remain consistent at all times.