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Provincial Plan for Integrated Laboratory Services in Alberta

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Provincial Plan for Integrated Laboratory Services in Alberta Provincial Plan for Integrated Laboratory Services in Alberta February 2017 Table of Contents FOREWORD ........................................................................................................................................................... 1 EXECUTIVE SUMMARY ........................................................................................................................................... 2 INTRODUCTION ................................................................................................................................................... 14 METHODS ............................................................................................................................................................ 16 STAKEHOLDER ENGAGEMENT .......................................................................................................................................... 16 BEST PRACTICE ENVIRONMENTAL SCAN ............................................................................................................................. 19 FINDINGS ............................................................................................................................................................. 21 CURRENT LABORATORY SYSTEM OVERVIEW ........................................................................................................................ 21 MANAGING THE BUSINESS OF THE LABORATORY ................................................................................................................. 38 BEST PRACTICE ENVIRONMENTAL SCAN ............................................................................................................................. 52 OTHER FEEDBACK ......................................................................................................................................................... 61 ANALYSIS, RECOMMENDATION AND REQUIRED ACTIONS ................................................................................... 70 ANALYSIS .................................................................................................................................................................... 70 RECOMMENDATION: SERVICE DELIVERY MODEL .................................................................................................................. 82 REQUIRED ACTIONS ...................................................................................................................................................... 82 LABORATORY INFORMATION SYSTEM ................................................................................................................................ 82 INVESTMENT IN INNOVATION AND TECHNOLOGY ................................................................................................................. 83 ORGANIZATION OF LABORATORY SERVICE DELIVERY ............................................................................................................. 83 DIAGNOSTIC TEST MENU ................................................................................................................................................ 84 STANDARDIZATION ....................................................................................................................................................... 87 OPTIMIZING LOGISTICS .................................................................................................................................................. 88 OPTIMIZING FACILITY INFRASTRUCTURE ............................................................................................................................. 89 ENSURING ACCESS TO SKILLED LABORATORY PROFESSIONALS ................................................................................................. 89 ACCREDITATION ........................................................................................................................................................... 90 TRANSLATIONAL RESEARCH, INNOVATION AND ECONOMIC DEVELOPMENT................................................................................ 90 APPENDIX A – STAKEHOLDERS ............................................................................................................................. 92 APPENDIX B – PROVINCIAL RESOURCE GROUP - MEMBERSHIP LIST .................................................................... 94 APPENDIX C – BIBLIOGRAPHY .............................................................................................................................. 96 APPENDIX D – CPSA LABORATORY ACCREDITATION .......................................................................................... 102 APPENDIX E – LABORATORY ORGANIZATIONS CONSULTED IN BEST PRACTICE REVIEW .................................... 112 APPENDIX F - TRANSLATIONAL RESEARCH WORKSHOP ..................................................................................... 122 APPENDIX G – CALGARY LABORATORY SERVICES - SERVICE DELIVERY MODEL .................................................. 133 APPENDIX H – COST / TEST COMPARISON ......................................................................................................... 139 LIST OF FIGURES ................................................................................................................................................. 142 LIST OF TABLES .................................................................................................................................................. 142 TABLE OF CONTENTS i GLOSSARY OF ACRONYMS ................................................................................................................................. 143 REFERENCE LIST ................................................................................................................................................. 146 ii TABLE OF CONTENTS Foreword Lab services are one of the most critical and sometimes underappreciated areas of our healthcare system. Every day patients and providers across Alberta make important decisions about care based on the results of laboratory diagnostics. Thousands of laboratory physicians, scientists, technologists and other staff work to serve the needs of Albertans in a timely way. Hundreds of these individuals took the time to talk to us as we developed a Provincial Plan for Integrated Laboratory Services in Alberta. Their dedication and commitment to both patients and high-quality laboratory services was obvious in all of their engagement with the project team. Staff, medical and scientific professionals, and senior managers from Alberta Health Services, Calgary Laboratory Services, DynaLIFE, Covenant Health, Lamont Health Care, and Medicine Hat Diagnostic Laboratory generously gave their time, energy and forthright input to a multitude of discussions about how we could better meet the needs of Albertans in this important area of healthcare. Others outside the service delivery sphere also shared their thoughts and suggestions with us including non-laboratory clinical groups, regulatory colleges, training and research institutions, patient advisory councils, professional associations and unions in the laboratory sector, and staff from Alberta Health and other ministries and agencies across the Government of Alberta. Over the last eight months we also talked with senior leaders of leading laboratory service organizations across the world, learning about their challenges and experiences – we are very appreciative of the time and effort they contributed to this project. We would like to thank the Provincial Steering Committee, chaired by the Deputy Minister of Health, who provided us guidance and clear direction during this work and the Alberta Health Services executive sponsors of the Provincial Laboratory Services Project, who enabled our work. We also want to extend a sincere thank you to Penny Ballem, MD, FRCP, FCAHS, who served as the project lead and principle author of this report. The unique business of laboratory services is the fastest changing area of healthcare. Our review of the current status and suggestions for moving ahead are grounded in the need to adapt quickly to the many challenges and to ensure laboratory services in Alberta are a sustainable, integrated, and high quality sector in our public healthcare system. FOREWORD 1 Executive Summary The laboratory diagnostic sector is unique in the health system. Accounting for just 3.5 per cent of the total health budget, the results of laboratory diagnostics inform and impact over 70 per cent of healthcare decisions. The timely delivery of laboratory services is vital in sustaining patient care on a daily basis and in enabling the health system to function efficiently. Whether it is testing prior to initiating weekly chemotherapy, before a patient can be discharged from hospital, or adjusting anticoagulants for a patient in the community, an effective and efficient laboratory diagnostic sector is essential to optimal patient outcomes and a high functioning and high quality healthcare system. The laboratory sector is changing rapidly and the last 15 years have been particularly remarkable with molecular diagnostics transforming many of the sub-disciplines of laboratory medicine. However, the cost of meeting volume pressures, an aging population, new testing demands, and needed investment in rapidly evolving diagnostic and information technology is a significant challenge for diagnostic laboratories everywhere. Given these challenges, many
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