Laboratory Service Health Department in Astana Centralization is the basis for laboratory service reformation in Astana EXPERIENCE and PERSPECTIVES Leading specialist Laboratory Service Health Department in Astana Zh. Suleimenova

GLOSSARY CENTRALIZATION IS A WAY OF ORGANIZING ONE OF MEDICAL SERVICES (LABORATORY SERVICE) ACCORDING TO PLACE IN ORDER TO DECREASE COSTS RELATED TO INCREASED VOLUME OF PRODUCTIVITY. A.A. KISHKUN – “NATIONAL DAYS OF LABORATORY MEDICINE” MOSCOW (RUSSIA) 24TH SEPTEMBER 2015

International experience and tendencies in laboratory service market Centralization of laboratory research automatization of producing laboratory research – in developed countries – England, France, Germany, Italy, Japan Total quality management – Introduction of quality management system based on international experience ISO 15189 – 2012 Ensuring biological safety – WHO, CDC recommendations

Laboratory service reformation program in Astana 1 step – Centralization on ambulatory-polyclinic level – 2011 2 step – Centralization of laboratories on hospital level - 2016

Centralization on ambulatory-polyclinic level #4 City polyclinic ГП – 10 ЦПМСП – 6 Blood chemistry – 40 Immunochemistry - 82 PCR - 6

HISTORY Opening of the Center of laboratory technologies #4 City polyclinic 2011 - 2012 Opening of the Center of laboratory technologies Creating laboratory doctors society Creating clinical basis for JSC “Medical university Astana” 2013 – 2014 Republican conference “Medical laboratory management” Certification for ISO 9001-2008 standard 2015 Participation in the international assessing expert group CLSI in support of Center for Disease Control and Prevention in Central Asia CDC (USA)

International external research quality assessment Quality certificates: general clinical, hematological, biochemical, immunoenzymatic and PCR research. Based on external quality assessment conducted by the USA, the UK, France, Republic Kazakhstan among the best 4 laboratories

Laboratory service development perspectives in Astana Optimization clinical-diagnostic laboratories in hospitals and ambulatory medical organizations – maximum service centralization. Introduction of centralized quality management system in laboratory research and performance indicators assessment system in laboratory service Standardization and implementation of advanced technological methods in laboratory diagnostics, laboratory research succession planning Improvement of human resources via professional staff training at work Creating unified price space for out-of-pocket paid laboratory analysis in net of medical organizations Health department in Astana

Centralized laboratory testing quality assurance governance Laboratory technologies center Organizing performance indicators assessment system based on key performance indicators (KPI) within jurisdictional and subcontracted clinical-diagnostic laboratories in medical organizations in Astana Implementation of external quality control program through inter-laboratory comparison Organizing and conducting expert testing in complicated cases Creating unified database for laboratory data

Intra-laboratory control POST-ANALYTICAL STAGE Implementation of Targeted quality assurance indicators in laboratory diagnostics Intra-laboratory control Matching control reproducibility and accuracy PRE-ANALYTICAL STAGE Errors in identification 0,1% Number of unusable samples for testing, transportation and storage Hemolyzed samples 0,06% ANALYTICAL STAGE Intra-laboratory quality control coverage 95% Number of tests with unacceptable results according to variation coefficient 7 % External quality assessment coverage 75% POST-ANALYTICAL STAGE Inappropriate ТАТ Critical data message 99,9% Creatinine 3,15 Glucose 3,7 Urea 4,2 Erythrocyte 0,93 Leucocyte 1,97

Biosample collection places with ИМЛ IMPLEMENTATION STEPS 2015 Preparation of regulation (normative) documents Development of centralized governance system МЛ Unified tariff approval Openning biosample collection places in medical organizations in Astana Accreditation of Centralized laboratory Expert laboratory 3 level Centralized МЛ 2 level 2016 Centralization of laboratory services in medical organizations according to specialization Opening Centralized laboratory’s branches in medical organizations Creating specialized laboratory net in specialized medical centers Specialized МЛ 1 level Biosample collection places with ИМЛ