The evolution and future of external quality assessment in Korea

External quality assessment (EQA) plays a central role in ensuring reliable and standardized laboratory testing worldwide. In South Korea, the Korean Association of External Quality Assessment Service (KAEQAS) has been the driving force behind EQA since 1976, evolving from a small clinical chemistry program to a comprehensive system spanning more than 90 schemes across nearly all laboratory disciplines. Over five decades, KAEQAS has grown to serve over 2,000 institutions, contributing significantly to national quality assurance and alignment with international standards such as ISO 15189.

The article traces the historical development of KAEQAS, including milestones such as accreditation to ISO 17043 and the launch of next-generation computerized testing systems. Its scope now includes clinical chemistry, hematology, microbiology, molecular diagnostics, accuracy-based proficiency testing, and collaborative public health projects. Through peer-group analysis and the use of commutable reference materials, the programs provide both benchmarking and educational resources to foster continuous improvement.

Despite its successes, the Korean system faces key challenges. Participation remains voluntary for many institutions, leaving smaller clinics and long-term care facilities underrepresented. Persistent gaps in test standardization—especially for specialized analytes—further highlight the need for expanded category 1 accuracy-based programs. Additionally, while computerization has advanced, limitations remain in real-time analytics, automated reporting, and the establishment of a comprehensive specimen bank.

Looking ahead, the article emphasizes the importance of regulatory reforms, international harmonization, and technological innovation. By mandating broader participation, expanding high-quality accuracy-based programs, and modernizing infrastructure, KAEQAS can strengthen its role as a global leader in laboratory quality assurance and contribute to safer, more reliable patient care.