Background: The main service of medical laboratories is provision of test results. The test results and other patient data are kept in either electronic system or paper-based systems or both. We assessed the current status of the use of information management system by medical laboratories in Mongolia. Methods: Twenty four laboratories of health organizations representing government and private sectors as well as urban and rural locations were included in the survey. The assessment was carried out using a questionnaire based on MNS ISO 15189:2015 requirements. Results: Out of the twenty four participant laboratories 54.2% (12) recorded the test results both in a workbook and in an electronic database, and 12.5% logged the results to the electronic database only. All patient data kept in the electronic system were protected, but the data protection was difficult to implement for paper-based records. Servers of the electronic information management system provided a long-time guaranteed back-up for patient results and enabled data retrieval for the analysis. 68.8% (16) of the laboratories used an information management system called E-health supported by the Ministry of Health. Conclusion Electronic information management system is widely implemented in medical laboratories but it needs further development and broader involvement of laboratories of all levels.

IntroductionWe organized the 4th Mongolian External Quality Assessment Survey (MEQAS) for Clinical Chemistry testing on basis of the Cooperation agreement between the Ministry of Health Mongolia and Sysmex Corporation in the establishment of the clinical chemistry external quality control, and reference laboratory system in 2011-2013.MethodIn 4th survey, the following survey material we used: Mtrol 1 (Level 1), Mtrol 2 (Level 2). To evaluate participant laboratories we divided into peer groups: full automated analyzer, semi automated analyzer and also divided analyzers by manufacturers and calculate standard deviation index (SDI), precision index (PI). We used absolute evaluation and scoring methods.ResultsThe number of participant laboratories increased in number by 133 instruments from 3rd MEQAS and became 139 instruments, but there were no significant improvements in most all items. The comparison transition of CV 4th MEQAS to 3rd MEQAS we found that there were not much differences between before the 3rd and 4th MEQAS, except some items like total protein, Lactate dehydrogenase (P-L), γ-Glutamyl transferase, potassium, bilirubin direct in which CV % have decreased in number by about 3% from 10% in both levels. We found out the difference results between full automated analyzer, semi automated analyzer groups and manufacturer analyzers and methods in both levels. To improve the results in the future to establish national standards for the reporting units and suggested reagents for clinical chemistry tests, which will be the directions for standardization.

Backround: Hematology departments of health laboratories, over capital city and 21 provinces both of governmental and private sectors in this country, have to take responsibilities for providing hematology analysis. A wide range of technology and methods have been implemented among these laboratories. Harmonization of the hematology investigations of different laboratories with standard service all over the country is the major goal to reach. We organized the MEQAS (Mongolian External Quality Assessment Scheme) since 2008 on basis the Cooperation agreement between Ministry of Health and Sysmex Corporation in the establishment of Hematology external quality control and reference laboratory system in Mongolia. This is the report of our 8-year experience of MEQAS as the national project, covering increasing numbers of laboratory members. In 2008-2017 years we set up total 18 MEQAS in Mongolia. Materials and Methods:
Survey Materials
In each survey, the following three different of survey materials were used;
Sample A : Hematology Control Material 1*
Sample B : Hematology Control Material 2*
Sample C : Fresh Whole Blood Sample**
*Hematology Control Material provided by Sysmex Corporation
**Under cooperation of National Center for Transfusiology, a fresh whole blood sample was drawn from a healthy donor and prepared on the same day of sample delivery, according to the procedures reported by Kondo H et. all.
Standard Analyzers
3 units of fully-automated standard analyzers (KX-21, pocH-100i, XS-1000i), installed at the Shastin Central Hospital, were used to assign the target values for the survey materials. These standard analyzers have been calibrated with SCS-1000® before the survey, and monitored with hematology controls, e-CHECK(XS) ® and EIGHTCHECK-3WP® on daily basis.
Instructions & Sample Distribution
On every survey, the workshop was held to give guidance and distribute the survey samples to each participant.
Categorization of Peer Group
Participating data were divided into two peer groups, based on methodology; Group 1: laboratories used automated hematology analyzer (in further Auto’s), Group 2: manually examined group. Each laboratory was given ID number and was asked to analyze these samples 3 times and report the all data and average for CBC 8 parameters.
Statistical Evaluation Method
For individual reports, the results for each participant were evaluated and expressed according to peer group mean and standard deviation index (SDI), Precision index (PI), Absolute evaluation, Scoring system and Target-value evaluation methods (A B C D evaluation). Results:
The Auto’s inter-lab CV% of WBC for fresh whole blood showed decrease from 6.1 to 4.2 comparing with17^th and 18th MEQAS.
The Auto’s Inter-lab CV% of RBC for fresh whole blood showed decrease from 3.7 to 3.4 comparing with 17^th and 18^th MEQAS.
The Auto’s inter-lab CV% of HGB for fresh whole blood were very stable (2.9%, 3.0%), respectively from 17^th to 18^th MEQAS.
The Auto’s inter-lab CV% HCT for the fresh whole blood showed go down from 5.5% to 4.8% comparing with 17^th and 18^th MEQAS.
The Auto’s inter-lab CV% PLT for fresh blood showed go down from 10.2% to 8.2% comparing with 17^th and 18^th MEQAS.
The Auto’s inter-lab CV% of CBC parameter for fresh blood and control Material (Sample A) showed go down from 1^st to 18^th MEQAS.
The Auto’s inter-lab CV% of WBC, RBC, HGB, PLT for Control Material (Sample A) were big difference comparing with Japan’s CV%. Conclusion:
1. The Auto’s inter-lab CV% of WBC, RBC and PLT for fresh whole blood has been decrease respectively 4.2%, 3.4%, 8.2% in the 18^th MEQAS and there was difference in the CV% between manufacturers.
2. The Auto’s inter-lab CV% of WBC, RBC, HGB, PLT for Control Material (Sample A) showed go down from 1^st to 18^th MEQAS but were big difference comparing with Japan’s CV%. Acknowledgements We would like to express our appreciation to the Sysmex Corporation (Japan) for providing financial supports investigate this study.