Highly-automated hospital labs are organized to serve inpatient testing and don’t compete for “outreach” lab business from office-based physicians in the community
DATELINE: AUCKLAND, NEW ZEALAND—In this nation’s single payer health system, clinical laboratory testing services are allotted to hospital laboratories and commercial laboratories in very specific ways. Consequently, hospital laboratories in New Zealand tend to provide testing primarily for inpatients and for outpatients seen by specialists who practice within the hospital’s facilities.
This is an interesting distinction which sets New Zealand hospital laboratories apart from hospital labs in such countries as the United Kingdom, the United States, Canada, and Australia. In each of these countries, it is common for hospital laboratories to provide some laboratory testing to the outpatient and outreach sector, particularly to primary care clinics and office-based specialist physicians.
During the past week here in Auckland, your Dark Daily editor has toured laboratories, met with pathologists, and learned more about the role of pathology and laboratory testing in the New Zealand healthcare system. Of course, Dark Daily readers are aware of the issues associated with the start-up of the newest independent pathology laboratory in the city, Labtests, which was granted an eight-year exclusive contract by the three district health boards (DHBs) in the Auckland metropolitan area. This contract involves pathology testing for general practitioners and selected other types of providers.
Dark Daily’s first hospital laboratory site visit was conducted last Friday at Middlemore Hospital in Middlemore , Manukau City, a southern suburb of Auckland. “This hospital was founded in 1947 and has 860 beds,” stated Ross Boswell, MBChB, Ph.D., Clinical Director of Laboratory Services at Middlemore. “It is one of the largest tertiary teaching hospitals in New Zealand.”
The Middlemore laboratory serves a diverse population of about 500,000 people in its service area. It introduced a paperless laboratory test reporting system in 1999 and its laboratory information system (LIS) regularly delivers results into the electronic health record (EHR) system used by the hospital. During the laboratory tour, Boswell and Kevin Tebbutt, Operations Manager, noted use of advanced automated analyzers. “We’ve been quick to adopt new automation solutions, particularly for our high volume chemistry and hematology lab,” stated Tebbutt. “Our on-site testing menu in our laboratory here is defined by contracts with the regional district health boards (DHBs).”
“Our authorized test menu is a consequence of efforts by the DHBs to create an integrated pathology and clinical laboratory service across the Auckland area,” added Boswell, “Middlemore Hospital laboratory performs a specific menu of tests on site. Most of our send-away tests [send-out or referral tests for American readers] go to another hospital laboratory here in Auckland which provides an extended menu of reference and esoteric testing for pathology laboratories throughout the country.”
The next site visit came on Monday, when Dark Daily editor Robert Michel visited the laboratory at 710-bed Auckland City Hospital. This is a major tertiary care center and teaching hospital which is located north of downtown Auckland. Its laboratory is called LabPlus. LabPlus is one of the nation’s two reference and esoteric testing centers for New Zealand.
“LabPlus is the largest reference laboratory in New Zealand,” stated Ross Hewitt, Laboratory Manager of LabPlus. “It has one of the most complex lab testing menus in Australasia. We take referral testing from other hospitals, from general practice clinics and specialists in the community, and from a wide range of healthcare providers throughout the country.
“Our test menu is comprised of about 900 assays and we perform almost 4 million tests per year,” he continued. “Our laboratory staff totals 375 FTEs and that includes 28 consultant pathologists.”
LabPlus is located in a sizable, three-story laboratory facility that is next to the main hospital. Routine testing is performed in a highly-automated, open space laboratory. Because of its role as a reference and esoteric testing center, LabPlus has analyzers and automated systems that are state-of-the-art in each department.
In New Zealand, all clinical pathology testing laboratories must be accredited. The accreditation standard used is ISO:15189:2007 Medical Laboratories. Both the laboratories at Middlemore Hospital and Auckland City Hospital/LabPlus are accredited under ISO 15189.
Pathology laboratory accreditation is administered by national body known as International Accreditation New Zealand. IANZ is a full member of the International Laboratory Accreditation Cooperation (ILAC). IANZ also complies with ISO/IEC 17011 Conformity Assessment—General Requirements for Accreditation Bodies Accrediting Conformity Assessment Bodies standard.
In contrast to the continual reduction in funding over the past decade for what is termed “community pathology services” in New Zealand [and would be known as laboratory outreach testing for office-based physicians in the United States], hospital labs in New Zealand do not seem to have experienced a comparable reduction in reimbursement. However, hospital laboratory directors do have a major concern: the availability of adequate numbers of pathologists, laboratory scientists, and technical staff.
In the short term, adequate staff is needed to maintain the existing volume of pathology testing in New Zealand. In the longer term, more pathologists and laboratory scientists will need to be trained in such emerging lab testing disciplines as genetic testing and molecular diagnostics.
It is widely recognized within the pathology profession of New Zealand that both of these needs require near-term solutions that involves more spending by the government health system. One problem is to train adequate numbers of pathologists and laboratory scientists to fill existing positions in the nation’s pathology laboratories. The second problem is to adequately fund salaries for pathologists and lab scientists so that laboratory professionals trained in New Zealand’s colleges and universities do not emigrate to accept higher-paying positions in Australia and other countries.
From Auckland, your Dark Daily Editor,
Robert L. Michel