Automation has become an essential part of today’s lab as it allows for high volumes of testing at a much faster rate. As a result, pathologists are able to make steady progress by using new tools, instruments and systems that can prepare samples as well as run experiments, and analyse results. Automation offers streamlined solutions for lab procedures and has a number of benefits such as increased productivity, reduced errors, improved workflow coverage and enhanced data quality. Further, automation solutions have now started to extend their footprints into other areas of the lab such as microbiology and molecular diagnostics.
Dr. Basel Altrabulsi, Medical Director, National Reference Laboratory (NRL), Abu Dhabi, says that even though in the past, local, academic, and specialised testing laboratories processed most tests, nowadays centralised testing uses advanced technology as well as global operations to concentrate clinical tests in a single, central laboratory. He adds, “the central lab core is consistency.”
The role of central labs has become quite critical to efficiently managing patients and labs are able to deliver quality data, speed and flexibility to complete projects on time and on budget. Central lab testing offers ‘combinable data’, generated from the same analytic method platform to correlate and standardise results. The end product will therefore be similar regardless of the facility it came from.
Dr. Basel stresses that even though there is resistance to the central model, centralized laboratories improve the speed of reporting results, something that enhances patient safety, while keeping consistency in analysis around the world. As a result of this, laboratory automation systems have gained prominence in developing markets as it enables them to maximise laboratory operations and reduce expenses. Centralised laboratories ensure that hospitals and clinics are able to operate more efficiently as they no longer need to ensure they have a fully equipped and staffed laboratory on site.
An initiative of Mubadala Healthcare, NRL was founded in partnership with and operated by the Laboratory Corporation of America (LabCorp). Its aim is to increase the coverage and overall efficiency of laboratory testing, and implement international best practice testing processes. NRL has deployed lab automation systems to achieve these goals. Its partner, LabCorp, is one of the largest clinical laboratories in the world and is also a pioneer of genomic testing using polymerase chain reaction (PCR) technology. This partnership allows NRL access to LabCorp’s extensive test menu including all esoteric testing and allows NRL to “tap into their knowledge and experience in the field of clinical pathology” which Dr Altrabulsi explains, allows them to deliver the best care to their patients. The lab has also partnered with Integrated Genetics, a LabCorp Speciality Testing Group, which is a leading provider of reproductive genetic testing services.
The automation movement
“Laboratory testing” says Dr Altrabulsi, “has grown from a manual, ‘hands-on’ process providing a simple test menu to an instrument-centric, high-volume clinical engine inside the modern healthcare enterprise.” Lab automation plays an essential part in performing those actions that require high precision and levels of accuracy and has proved extremely useful in helping eliminate human error. Most of the tasks executed in a clinical lab today, from micro plate handling to liquid handling, are achieved through lab automation and these processes handle routine tasks that were once performed by pathologists and lab technicians, and help in achieving a fully traceable and standardized sample processing. Further, the convergence of the different disciplines of laboratory medicine is driving the movement forward and will allow lab automation to expand as well as connect to all the parts of the lab.
While the fields of clinical chemistry and haematology were the first to be automated, areas such as molecular diagnostics and anatomic pathology are most likely to follow soon. Microbiology recently joined the movement with the arrival of fully automated microbiology platforms that automate the entire work flow with one system.
Eliminating human error
Lab automation is increasingly playing an integral role in making sure patients receive the right treatment and eliminates the risk of human errors. Its major advantage is the fact that it has helped scientists and technicians achieve complex processes in comparatively little time with lower operating costs. Automated systems also have the added advantage of a low error rate, which is important for ensuring that the right diagnosis is made in a timely manner. Some of the factors that have contributed to the steady growth of lab automation include shortage of skilled lab personnel and cost effectiveness, among others.
As technology changes, some see more advanced bedside testing devices as a challenge to the primacy of the lab in the diagnostic process. Dr Altrabulsi however, sees a role for the lab in supporting all improvements in patient care, including point of care (POC) testing and bedside tests. POC tests are designed to be used at the site of patient care and can be performed outside the physical facilities of a lab. Although a potential threat to the future of labs, POC testing increases the likelihood that the patient, physician, and care team will receive the results immediately, which allows for quicker decisions to be made.
Genetics and future trends
Another advancement is that of genomic technologies that are reaching the point of being able to detect genetic variation in patients with high accuracy and reduced cost, “offering the promise of fundamentally altering the way medicine is practiced”. This has caused the emergence of major analytical and interpretative challenges, ranging from the validation of large numbers of genomic changes in a patient, to the economic feasibility of this approach and its deployment in standard care, to managing the terabytes of data that accompany a single sequenced genome.
“Until recently, genetic data did not drive diagnosis but had a primarily confirmatory role” explains Dr Altrabulsi, citing genomics as a driving force in the future of diagnostic medicine. One of the major challenges facing pathology today is the conversion of pathogenic genetic data into a primary diagnostic tool. This is where lab automation comes into play along with a combination of clinical observation and biometric data, and can assist in shaping clinical decisions and long-term management in a more proactive way.
Sharing his vision for the future, Dr. Altrabulsi explains that there are many factors that will have an impact on laboratory medicine in the near future and these have the potential to make patient care "more efficient and less expensive". Some of the factors include globalisation of laboratory medicine, technological advances such as POC, automation robotics and integrated diagnostics. Advancements could also include integration of molecular diagnostics into daily testing as well as the integration of pharmacogenomics into the field of cancer management and making non-invasive testing more prevalent.