Greg Ahlberg, Vice President, Diagnostics, U.S. Commercial Operations, Abbott Diagnostics, Manufacturer of the ACCELERATOR family of automation products
Total Lab Automation
The clinical laboratory’s focus on operational efficiency has driven major improvements the past decade, particularly since the advent of the Affordable Care Act. Improving the speed and accuracy of diagnostic test results has an impact on patient outcomes, which is why this area is a keen focus for both in-lab and out-of-lab stakeholders. Over the last 20 years the use of automation in clinical labs has progressed significantly, from the first random access analyzer to total lab automation (TLA). When considering automation, labs must first determine the objective, overall goals and the area to be automated (i.e., samples, data or materials).
Core lab automation has seen a shift towards TLA tracks being open to third-party vendors, aggregating close to 100 percent of testing to a single track. European labs have welcomed this strategy as it enables the best use of capital assets and increases efficiency and effectiveness. Another area being automated is the tracking and managing of reagents through RFID-tag technology. By automating this very manual process, labs experience financial savings and improved staff efficiency.
Given the trends being observed among clinical labs today, automation will play an even larger role in the future, going beyond operational effectiveness to also positively impact clinical effectiveness and ultimately help improve patient outcomes.
Jorge Lana Linatl, Senior Manager, Workflow and IT Solutions, Beckman Coulter Diagnostics, Manufacturer of the Power Express Automation System
Automation and patient care
Providing quality patient care will continue to be the driving force behind the future of clinical automation. A well-implemented automation system helps achieve better turnaround times, resulting in faster diagnosis. Patients can be treated more quickly and hospital stays are shortened. There is still a lot of untraveled territory in automation, as many labs still have yet to implement it. Automation is not only for high-volume customers; all labs, no matter the size, can benefit from automation features, as automation systems are scalable. Systems will begin to have more multidisciplinary features and incorporate deeper connectivity among the analyzers. We will likely see further reductions in turnaround time, the ability to capture more errors earlier, and advanced flexibility for all types of labs. The future of automation is driven by the need to do more with less, as lab budgets are reduced and staffing shortages increase. In order to better allocate skilled resources in the lab, automation systems will be able to more efficiently handle the tedious, and sometimes hazardous, tasks while skilled laboratory professionals are able to focus on important matters that require human interaction. The knowledge that they are performing more important tasks will increase these professionals’ job satisfaction and quality of work, and help labs to retain them. The ultimate goal will be achieved and performance in the lab will increase.
Candace K. Williams, MT (ASCP) SBB, Sr. Product Manager, Immunohematology, Bio-Rad Laboratories, Manufacturer of TANGO and IH-1000 Automated Blood Bank Systems
Connectivity and control
Blood bank labs were among the last healthcare testing environments to embrace automation, but they are rapidly catching up with chemistry and hematology labs as hospitals and blood collection centers face greater regulatory scrutiny and staff cuts. Over the years, automation has enjoyed several technological advancements that enhance patient safety, standardize test protocols, and decrease turnaround times. Automated and semi-automated analyzers now can handle greater volumes and more diverse menus of diagnostic and blood screening tests with more accurate results interpretations and less hands-on manipulation than manual test kits. What’s next? From here, it looks like future advancements may not necessarily be “in the box” but outside the box, though the main drivers will still be greater safety and economy. The next wave likely will be about web-based connectivity and remote control and assessment. Products under development or regulatory review in the United States would allow a blood bank lab to serve as the electronic testing hub for a hospital chain, with a main data management system supporting instruments in the same facility and other facilities. Because these systems use common Internet web browsers, satellite facilities can be spread across the globe. Functions will include results review and validation, editing or adding comments to a result, ordering additional assays for a sample, and reviewing historical results. Web-based systems will make better use of blood bank specialists’ expertise, improve productivity, and reduce the time required to provide transfusion products to patients.
Nilam Patel, MT (ASCP)SH, Sr. Product Manager, Automation Solutions, Sysmex America, Inc, Manufacturer of Sysmex XN-9000 track and testing modules XN-10, SP-10, DI-60, TS-10 and Bio-Rad A1c
Scalability and vendor collaboration
Today’s changing healthcare environment is requiring clinical laboratories to seek flexible and scalable automated solutions that can be customized to their specific needs. As laboratories begin their search to find their right automation solutions, they need to be aware that efficiencies and outcomes are available through different types of automation and through a variety of vendors. Two commonly seen automation types in mid- to high-volume settings include Island of Automation and Total Laboratory Automation (TLA). Island of Automation includes consolidated track islands of EDTA sample testing, whereas TLA includes testing and management of non-EDTA sample tubes onto a single, multi-faceted track system. Laboratories have a choice to select among these options for the best, most efficient and reliable technology to meet their workflow needs. If laboratories choose a TLA approach, vendor collaboration is critical if laboratories are to choose the best configurations and automated solutions for their evolving needs. Collaboration within the laboratory among key laboratory departmental stakeholders (Chemistry, Hematology, Coag, IT and LIS, etc.) also is important during both the configuration decision and implementation phases of a project.
John David Nolen, MD, PhD, MSPH and Peter Manes, Director of Laboratory Automation, Cerner Corporation, Manufacturer of Cerner Labotix
The modular approach to automation
Laboratory automation has changed dramatically over the years, moving from a monolithic, hardware-based approach to a flexible, modular approach that is highly software-reliant. Today’s laboratory managers have been trained with the idea that automation is a “must have,” not a “nice to have“; they are highly informed and educated about what they want and need for their lab. They appreciate the long-term effects of laboratory automation, and that it is much more than a marketing or “lock-in” tool for IVD manufacturers. They understand the interdependence of the laboratory automation system (LAS) with the laboratory information system (LIS) and other instruments in the lab. The root of laboratory automation is understanding the process of the laboratory and utilizing automation to adjust for optimal outcomes and not simply to mimic human actions. Today’s laboratory staff are demanding more flexibility in laboratory automation systems, primarily in being more “open” to mix and match analyzers from a variety of vendors and having all departments on a single platform or line. This is the clear trend moving forward, and it is exciting as labs focus on process control and more and more vendors cooperate with each other to make it happen.
Susan Hammond, Global Reagents Manager, Randox Laboratories-UK, Manufacturer of an automated biochemistry assay for the detection of adiponectin
Automation in biochemistry
The use of ELISAs for clinical testing within a laboratory is notably time- and personnel-consuming, with heavy resources used on manual interaction. Moving from ELISA technique to an automated biochemistry method for detection of the same analyte increases time- and personnel-efficiency considerably, and time and management efficiencies equal cost-effectiveness. The significance of ensuring quality in testing practices and thus confidence in clinical results is also a key consideration for running automated biochemistry tests over manual ELISA testing techniques. The risk of error and contamination and therefore compromised clinical results, which is higher when running ELISA methods, will be greatly reduced through the alternative of biochemistry automation. By transitioning analytes historically only available on ELISA to automated biochemistry methods, laboratories are able to expand their test offerings to patients and clinicians. As an example, within key cardiovascular testing, analysis such as H-FABP, 11dhTxB2, adiponectin and sPLA2 being available in an automated biochemistry format allows laboratories to expand their testing and test menu with ease. Automated biochemistry analytes increase testing range, with little adjustment within the laboratory, allowing for detailed patient testing profiles, without the manual restrictions placed by running ELISA techniques.
