county, to the prefecture, to the province, to the national level—across the country.
A participant pointed out that the ideal situation is to get data from laboratories to clinicians rapidly so that treatment can begin. In some countries, this information flows via cell phone, although provisions must be made to ensure privacy. Also, private practitioners and laboratories need to be integrated into public systems.
Nordenberg responded that the most efficient way to scale up communications is through web-based systems. Implementing thousands of information systems across laboratories of varying capacity is difficult. But the problem of connectivity can be and is being solved through web-based communications. In the short term, cell phone infrastructures can suffice, particularly if systems are set up using passwords to protect privacy, according to Nordenberg. It is also important, he said, for laboratories to share best practices. For example, if different diagnostics have differing sensitivity and specificity, how does that affect estimates of incidence? How can data be shared within or across countries? How are reporting forms designed?
A workshop participant asked whether the widely varying results of drug susceptibility testing in China argue for the use of individualized rather than standardized treatments for MDR TB. Nordenberg asked whether the laboratory results are fed into the patient information system. Li responded that the patient data are referred to the TB dispensary. Nordenberg also pointed out that, despite the excellent patient information system, the lack of an integrated laboratory system in China makes it difficult to look at population trends in resistance. The challenge, he said, is to run a program focused both on resistance patterns and on patients.