For discussion
on 3 October 1997
FCR(97-98)39
ITEM FOR FINANCE COMMITTEE
HEAD 37 - DEPARTMENT OF HEALTH
Subhead 603 Plant, vehicles and equipment
Members are invited to approve a commitment of $33 million for installing a Laboratory Automation System in the Department of Health.
PROBLEM
The existing manual process of preparing specimens for laboratory tests cannot keep pace with the increasing demand for laboratory service and is lagging behind developments in the practice of laboratory medicine.
PROPOSAL
2.The Director of Health (D of Health), with the support of the Secretary for Health and Welfare, proposes to set up a Laboratory Automation System in its Clinical Pathology Laboratory Centre for preparing specimens for routine biochemistry and haematology tests.
JUSTIFICATION
3.The practice of laboratory medicine has changed in recent years due to advances in science and technology in both the instrumentations used and the methodology employed. The use of a Laboratory Automation System is becoming a norm in handling large volumes of specimens in laboratories in developadvanced countries such as Canada, USA, Japan and some European countries.
4.The Pathology Service in the Department of Health (DH) is lagging behind other developadvanced countries in the application of advanced technology. At present, the pre-analytical specimen handling process for routine biochemistry and haematology tests is done manually. The steps include sorting and labelling of specimens, centrifugation, specimen loading and unloading on instruments, decapping and recapping of blood containers, pipetting serum for different tests, specimen storage and retrieval of specimens for re-analysis. This process has the following deficiencies -
- despite vigilant infection control procedures, the manual handling of infectious clinical specimens exposes staff to biohazards and risks of infection;
- errors may occur in any one of the steps of the manual process which would lead to inaccurate test results for diagnosis and affect patient care as well as epidemiological studies; and
- the manual process is inefficient and time-consuming.
5. Routine biochemistry tests involve the quantification of various analytes in human sera and other body fluids. Examples of the analytes include sodium, potassium, calcium, chloride, urea, total protein, albumin, glucose and cholesterol. Routine haematology tests involve mainly the measurement of haemoglobin and complete blood count which includes red cell count, reticulocyte count, platelet count and white cell differential count. These measurements are essential for physicians to effectively diagnose and monitor the therapy for a wide range of diseases including renal diseases, liver diseases, diabetes and cardiovascular diseases. Also, specimens of these two types of test will deteriorate easily if the sera are not separated and stored under very low temperature. The Pathology Service is therefore taking every measure to ensure early availability of test results.
6. The current annual demand for routine biochemistry and haematology tests from the various services units of DH is about 500 000 specimens. This volume of throughput already reaches the maximum capacity of the existing manual system. With a projected minimum annual growth in demand of 6%, there is an urgent need to enhance the capacity of the laboratory service.
7. We propose towill install the proposed Laboratory Automation System in the Clinical Pathology Laboratory Centre at the Lek Yuen Health Centre. The system comprises a fully automatic specimen preparation system and a fully automatic specimen transport and loading system. The former system will provide automated bar code labelling, sorting, centrifugation, uncapping, separation and pipetting of specimens. The latter system will provide automated transportation, loading, unloading, capping and storage of specimens. The system, employing up-to-date technology and methodology, has the following benefits -
- minimising staff exposure to biohazards and risks of infection by automating the specimen handling process;
- improving accuracy and reliability of test results by reducing errors in the pre-analytical specimen handling process from an average of 1% to 0.1%. The automated system will generate an alarm to alert staff should any error occur during the handling process. It also incorporates an intensive sample identification and verification protocol which will reduce sample identity errors. Its automatic specimen tracking feature will reduce the misplacement or loss of specimen;
- shortening the specimen handling process and reducing the time needed for preparing specimens for tests by two hours (from the present three hours to one hour). As a result, this will ensure that all the specimens for haematology and biochemistry tests can be tested on the same day of receipt, thereby avoiding deterioration of the specimens;
- improving laboratory productivity. The design annual throughput of the system is about 1 200 000 specimens. We estimate that the number of specimens to be handled by the system within its ten years of serviceable period will increase from 596 000 in 1999-2000 to 1 010 000 in 2008-09;
- improving the quality of service as the technical staff will have more time to review abnormal samples, evaluate tests results, implement quality assurance programmes, liaise with clients and solve problems; and
- saving ten experienced laboratory staff who may then be deployed to undertake other tasks. We plan to deploy three of them to speed up cytology screening for carcinoma of cervix of women with a view to improving the reporting time from six weeks at present to about , say, three weeks. We will deploy the other seven staff to the microbiology service to enable more laboratory tests to be performed for the detection and identification of bacteria and virus. This will improve our investigation and surveillance of food poisoning and infectious diseases including cholera, typhoid, measles and influenza.
FINANCIAL IMPLICATIONS
8.The cost of a Laboratory Automation System varies according to the throughput, the degree of automation, the number of analysers linked to the system and the number and types of individual units incorporated. These units include sorter, inlet unit, centrifuge, serum level detector, cap removal unit, tube labeller, pipetting station, cap replacement unit, storage locker, transport tracking, outlet unit, etc. The system we now propose to install is intended to cater for an annual throughput of 1 200 000 specimens and to allow total laboratory automation. It will be linked to five chemistry analysers, five haematology analysers and two slide makers.
9. D of Health estimates that the proposed Laboratory Automation System will cost $33 million, made up as follows -
| $ million
|
|---|
| Automatic Specimen Preparation System | 18
|
| Automatic Specimen Transport and Loading System | 14
|
| Spare parts | 1
____
|
| Total | 33
____
|
10.The proposed timetable for the procurement of the system is as follows -
| Invitation of tender | May 1998
|
| Award of tender | August 1998
|
| Delivery and installation of the system | November 1998
|
| Test run and acceptance | February 1999
|
Accordingly, we expect to incur the total expenditure for the system in 1998-99.
11. The estimated additional annually recurrent expenditure is as follows -
| Year 1
$ million | Year 2
onwards
$ million
|
|---|
| (a) Maintenance cost | 0 | 3.2
|
| (b) Consumables | 0.4 | 1.0
|
| _____ | _____
|
| Total | 0.4 | 4.2
|
| _____ | _____
|
(The maintenance cost and expenditure on spare parts will not be required in the first year of operation under the one-year warranty period of the proposed system.)
12.If Members approve the proposal, we shall include the necessary provision in the 1998-99 draft Estimates.
BACKGROUND INFORMATION
13.The Pathology Service of DH provides medical laboratory support to public clinics and health institutions for both patient care and public health functions. It has to respond to changes arising from advances in technology and increased demand for laboratory support from the Department's new initiatives for health promotion, early disease detection and surveillance and control of infectious diseases.
14.With the installation of the proposed system, DH will re-organise its resources for haemotology and biochemistry services currently distributed in five regional laboratories and have these centralised in the Clinical Pathology Laboratory Centre at the Lek Yuen Health Centre. DH will make the necessary logistics arrangement for site preparation, relocation of related equipment and resources and other supporting service to support the new system.
Health and Welfare Bureau
September 1997
