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Tour of Korean Labs Has Plenty to Teach - The Dark Intelligence Group

Tour of Korean Labs Has Plenty to Teach

Greater willingness to use automation to boost productivity and improve quality

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CEO SUMMARY: Faster turnaround times and better quality seem to be some common motivations for installing automation in the three Korean labs visited by THE DARK REPORT last month. All the laboratories were extra clean and neat, relative to most North American labs. Each of the laboratories visited reports a high degree of satisfaction with the performance of its laboratory automation solution.

ONE HIGHLIGHT OF THE TRIP TO KOREA was a day spent visiting three laboratories in the Seoul area. Two were hospital labs and one was a national reference/esoteric lab.

There is no better way to understand how a laboratory is organized and operated than to visit it during operational hours. This was true of the site visits to these three Korean laboratories. Site visits allow one to see many key details that would probably not be mentioned during a speech or similar presentation.

First stop on the tour was the laboratory at Konkuk University Hospital in Seoul. The host was Yeomin Yoon, M.D., Ph.D., Chief and Professor, Department of Laboratory Medicine. Konkuk is a 750-bed hospital that is expanding to 850 beds. The population of Seoul is about 12 million people and the region is served by 13 university hospitals.

The hospital facility is new and boasts an unusual feature. It is the only hospital in Seoul that is directly connected to the subway system. People can get off a train and walk right into the hospital.

Since the hospital serves 2,500 outpatients per day, this is an attractive feature. In Korea, outpatient clinics and hospitals are operated together. These patients are all served by the hospital laboratory. So the combined volume of inpatient and outpatient testing is often substantial.

TLA In The Laboratory

“This laboratory performs about 250,000 tests per month,” noted Dr. Yoon. “The TLA [total laboratory automation] system performs about 26% of this testing and the hematology line accounts for 12%.”

The laboratory has automation in several areas. The phlebotomy center adjacent to the laboratory has an automated system for bar code labeling and tray delivery to the phlebotomists. (See pages 9-10.) Once collected, a system transports the specimens directly into the laboratory.

Here a pre-analytical modular system (PAM) takes over. Specimen processing is automated, including an input buffer module, automatic centerfuge, destopper, on-line aliquoter, barcode labeler, and output buffer module.

Chemistry and immunoassay analyzers are connected directly to the PAM. These include two Toshiba 200FRs, a Bayer Centaur, and a Roche E170. “Once a specimen is received and registered, the system takes about 14 minutes to produce aliquot tubes,” explained Yoon. “On average, it takes 30 minutes to produce chemistry results and 40 to 60 minutes to produce immunoassay results.”

As specimens finish in this section, there is an automated system for storage and retrieval. Konkuk University Hospital has a paperless information system and the laboratory uses an LIS from AGK, a Korean company. Its point-of-care network is interfaced directly with the LIS.

Laboratory Staff

The laboratory occupies 850 square meters, about 9,200 square feet. It is a new facility and immaculately clean. “Staff consists of three physicians, 27 technical FTEs and two assistants,” said Yoon. “On the day shift, our technical staff works 12-hour shifts. We staff four technical people at night.”

Next stop on the laboratory tour was Seoul National University Bundang Hospital. It is a new hospital, opened in May 2003. It is designed to perform transplants and serve the growing geriatric needs of the population. It has 833 beds and serves over 3,000 outpatients per day.

Host for this tour was Junghan Song, M.D., Ph.D., Assistant Professor of Clinical Chemistry and Biochemical Genetics. This laboratory performs about 500,000 tests per month. Dr. Song did say that his lab counts a CBC (complete blood count) as five tests.

The Bundang Hospital laboratory has an extensive TLA system, designed and built by A & T Corporation. This company now sells in the United States and maintains an office in Irvine, California. In Asia, A & T Corporation has a major presence. It has automated systems in more than 100 laboratories throughout the Pacific Rim.

Bundang’s TLA starts with pre-analytical processes. Sequentially, there is a start stocker, on-line centerfuge, decapper, and aliquoter. Connected to the automated line, in order, is an Abbott Architect i2000, a Roche Elcsys, two Toshiba 200Frs, and a rerun buffer. At the end is a terminal stocker. Hematology is handled separately with an integrated Sysmex automation line. There was a separate stat lab, which included two Ortho-Clinical Diagnostics’ Vitros 5.1Fs.

According to Dr. Song, the TLA line for routine chemistry and serology is run by five FTEs. This staff covers reception, urine chemistry, HbA1c, immunoassay, and serology. Total staff in the laboratory is: two M.D./Ph.D.s, two residents, one registered nurse, 35 full time techs, and seven part time techs. To handle outpatient phlebotomy, there are nine phlebotomists on Monday and five for Tuesday through Friday. As a final note, this hospital of 833 beds has four anatomic pathologists.

The laboratory occupies 1,711 square meters, or 18,400 square feet. This hospital has a paperless information system and another unique feature. Physicians are equipped with PDAs. These cannot yet receive lab test data, but the PDAs are used as cell phones.

Reference Testing Lab Firm

The third laboratory on the tour was Green Cross Reference Laboratories. This is a commercial laboratory company. It was founded in 1992 and it pro- vides reference and esoteric test to hospitals and outpatient clinics in Korea.

In many respects, Green Cross is the same business model as ARUP Laboratories and Mayo Medical Laboratories in the United States. Approximately 80% of its specimens are referred by hospitals and academic center laboratories. The remaining 20% comes from clinics.

Green Cross operates 20 branches in Korea. In 1995, it earned accreditation by the College of American Pathologists (CAP). In 1999, it was certified as ISO-9000 compliant.

Green Cross established an Institute for Molecular Genetics in 1997. It also has an Institute of Metabolism for newborn screening and is expanding into TDM (therapeutic drug monitoring) and metabolic analysis.

New Lab Built In 2004

Host for our tour was H. R. Moon, M.D., CEO of Green Cross Reference Laboratory. Dr. Moon discussed the history of the company, noting that the new laboratory was built in 2004 to expand capacity, improve turnaround time, and support ongoing cost reduction initiatives.

Green Cross has 300 employees and 10 physicians. The laboratory occupies several floors in a new building of 9,900 square meters (about 106,000 square feet). The lab runs 24/7. On a daily basis, it handles about 10,000 samples and performs 30,000 tests.

“The decision to install laboratory automation was due to increased growth in specimen volumes,” stated Eun Hee Lee, M.D., Ph.D., Vice President at Green Cross. “Our laboratory had reached maximum capacity and we projected continued growth.”

Green Cross opted for the Bayer ADVIA Lab Cell solution. It has sample managers, three chemistry analyzers (ADVIA 1650 and ADVIA 2400) and three immunoassay analyzers (ADVIA Centaur 3).

“There have been several benefits from our new automation,” observed Lee. “The number of tests per FTE jumped 28%, from 1,250 tests per to 1,600 tests per FTE. Because this system operates from single primary tubes, the number of tubes has been reduced by 40%.”

Overall, these three site visits provided fascinating insights into the similarities and differences between laboratories in South Korea and the United States. The hospital facilities we toured were quite new. Laboratories are well-designed and equipped with state-of-the-art instruments and equipment.

These laboratories would look familiar to any laboratorian working in the United States. Test menus are similar, instrumentation is similar, and basic work flows within the laboratory are similar. Because of extensive use of automation, these laboratories are highly efficient with labor.

The most interesting difference may be that healthcare in South Korea is organized around a system that integrates hospitals and outpatient clinics. This places hospital labs at the center of diagnostic testing. It also means that laboratory testing is a community-based resource, since there are no commercial lab competitors in Korea.

What remains unanswered after this day of laboratory tours is a simple question: are the highly-automated laboratories in Korea equal or better than their American counterparts in two areas: lowest average cost per test and added-value to clinicians? Maybe a side-by-side case study at a future Executive War College between a Korean lab and an American lab would reveal an answer!

Automation Summary For Three Site Visit Labs

THREE LABORATORIES IN SEOUL, KOREA hosted site visits. Each was using automation in different ways. Here’s a summary of the automation seen at each site.

KONKUK UNIVERSITY HOSPITAL:

Hitachi PAM System–connected system

• Centerfuge unit

• Decapping unit

• On-line and off-line aliquotting unit

• Two chemistry analyzers (Toshiba 200-FR)

• Two Immunoassay analyzers (Roche E170, Bayer Centaur)
Sysmex hematology Automation
System–connected system

• Two hematology analyzers (Sysmex XE-2100)

• One slide maker (Sysmex SP1000i)

SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL:

A&T CLINILOG System–connected system

• Centerfuge unit

• Decapping unit

• On-line aliquotting unit

• Three chemistry analyzers (Toshiba 200-FR, A&T 502X)

• Two Immunoassay analyzers (Roche E170, Abbott Architect i2000)

• Two electrolyte analyzers (A&T EA07)
Sysmex hematology Automation
System–connected system

• Two hematology analyzers (Sysmex XE-2100)

• Two slide makers (Sysmex SP1000i)

GREEN CROSS REFERENCE LAB:

Bayer ADVIA LabCell Modular System–connected system

• Sample manager, three units

• Three chemistry analyzers (ADVIA 1650, ADVIA 2400)

• Three immunoassay analyzers (ADVIA Centaur 3)

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