In years past, automation typically referred to large automation lines that were only economically feasible for large laboratories. Advances in technology have introduced many more options for automation that provide benefits for different types and sizes of laboratories. These advances are timely because laboratories face an ongoing labor shortage and must leverage tools that can boost efficiency and productivity.
Executive Summary
- Staffing shortages and demand for rapid turnaround time (TAT) are among the factors pressuring laboratories to seek tools that boost efficiency.
- Automation is a broad term that refers to equipment or software performing repetitive tasks with minimal human intervention.
- Laboratories are adopting automation solutions because they bring significant benefits.
- Automation equipment helps streamline and error-proof complex workflows and boosts lab efficiency.
- Robotic systems, laboratory information system (LIS) software, and workflow automation tools are effectively used within labs to manage data and standardize processes.
- Automation in microbiology is especially beneficial due to microbiology’s need for highly skilled laboratory professionals and longer TAT associated with microbial growth.
- To achieve the efficiency from automation, implementation should include a review and revamping of processes to ensure optimization.
- With a shrinking workforce, efficiencies gained from automation technology allow labs to continue to contribute to the best patient care.
Efficiency Is No Longer Optional for Laboratories
Laboratories of all types face challenges related to a dynamic healthcare environment, an aging population with greater testing needs, and a continued staffing shortage. Labs face expanding testing menus, a constant push for faster TAT, and longer operating hours. These challenges must be met while simultaneously maintaining quality of care and cost-effectiveness.
Automation Aids Efficiency
This environment means that to continue to provide accurate, timely results, labs must be incredibly efficient. That level of efficiency cannot be achieved with manual processes. Labs need support from information technology (IT) and automation equipment to streamline and error-proof complex workflows. Automation and integration are widely recognized as essential for laboratories as part of their overall strategy to improve productivity and efficiency. Automation can boost operational efficiency, improve test accuracy, reduce errors, standardize processes, and speed TAT.
Lab Automation Defined
Automation is a broad term that refers to equipment or software performing repetitive tasks with minimal need for human intervention. Laboratory automation can refer to software that incorporates rules that automate workflow, an integrated automation line, or a tube sorter that manages specimen routing. Laboratory automation allows labs to handle a larger test volume and reduce errors that are inevitable when humans perform repetitive tasks.
Many high-volume labs use large-scale automation. However, with today’s technology and advancements in lab automation equipment, labs do not need to commit to total laboratory automation (TLA) but can use modules designed to automate only a portion of a laboratory’s operations—whatever fits into the budget and lab strategy.
Automation Types & Technologies
Laboratory workflows can be categorized as manual, standalone, or modular automation. The most valuable level of automation depends on laboratory complexity, size, and test menu. Robotic systems, LIS software, data management solutions, and workflow automation tools are effectively used within labs to automate and standardize processes. Robotic systems automate liquid handling, sample preparation, and parts of the testing process.
LIS Automation
One of the simplest forms of automation is automating data flow within the LIS. The LIS or data management system manages and processes substantial amounts of data. A strong LIS includes tools that automate and standardize processes with rules-based decision support and report configurability. Workflow automation tools within these solutions integrate laboratory processes and instruments to optimize efficiency
Standalone (Modular) Lab Automation
Modular automation equipment allows smaller labs to experience the benefits of lab automation without a large capital outlay. Modular lab automation refers to equipment that helps with pre-analytic specimen sorting, sample extraction, and post-analytic specimen sorting for storage. These modular systems require staff to manually transport specimens to testing instruments, rather than using a track. These systems tend to be selected for safety and quality improvements, rather than workload reduction. The smaller footprint and pricing make modular automation options a good fit for small to medium sized laboratories.
Total Lab Automation (TLA)
TLA, the most common form of lab automation, includes pre-analytic and post-analytic functions and additional analytic components via interfacing. A conveyor or track system and robots enable walk-away workflow without the need to manually move specimens to the analyzers. TLA is more expensive but can result in lower costs long-term when calculated several years out. TLA can reduce staff requirements, which subsequently reduces overall space needs. This option, typically in place within large laboratories, improves traceability and sample management (e.g., reruns, reflexes, add-on testing). (1)
Key Benefits of Lab Automation
Laboratory automation solutions are finding their place in the current healthcare landscape because they bring significant benefits. In a short-staffed environment, automation frees up staff for less repetitive tasks, increases overall efficiency and productivity, and allows for more accurate tracking of lab activities. Automating laboratory workflows improves the overall efficiency of testing by speeding up tasks, minimizing waste, reducing reagent usage, and facilitating higher throughput. Optimizing operational efficiency through automation leads to lower costs, error elimination, reduction in repetitive motion injuries, and improved results accuracy and reliability.
Boost Staff Efficiency & Reduce Human Error
Without automation, the existing laboratory workforce could not maintain the steadily increasing workload and
service volume. Adopting automation reduces repetitive manual labor and allows labs to upgrade their professional job roles. By automating repetitive and time-consuming tasks, laboratory professionals can focus on more complex and critical activities, leading to higher productivity. By improving lab productivity, automation has the potential to lessen the laboratory workforce need, which helps manage staffing shortages. Automation is a boon for laboratories that are dealing with workforce shortages or managing high-volume testing with less staff. (2)
Improve Productivity, Efficiency, & TAT
Laboratory automation can streamline workflow and increase sample throughput, thereby decreasing TAT. Interfacing EHRs and analyzers with an LIS automates the total testing process in the laboratory and facilitates automated, rapid delivery of patient reports.
Improve Lab Safety
Automation can improve laboratory safety from both patient care and lab staff perspectives. Eliminating the errors associated with humans performing repetitive tasks improves TAT and test accuracy. That same elimination can reduce the incidence of injury (e.g., carpal tunnel, wrist pain). With automation equipment, staff touch a specimen only once and the system manages the rest of the process. An automated specimen transport system across all phases of testing can significantly improve efficiency and reduce manual steps by up to 80%. (3)
Optimize Test Quality & Accuracy
With humans performing tasks there will always be a certain amount of variability, exacerbated by the level of task complexity. Because of this, the laboratory has long realized the benefits of standardization. Automation equipment allows for the tracking of all steps of a process, minimizes manual errors, and improves the precision and accuracy of testing. This standardization in turn improves the quality and accuracy of test results.
Enable Efficient Specimen Tracking
Automation can minimize manual steps for specimen storage and retrieval. It can also provide quick access to samples that need further testing. Some automated systems can archive samples in trays that are then manually taken to storage, and some automated systems can automate the delivery and retrieval of specimens to and from storage.
Provide Quick Data Access & Audit Trail
A robust LIS can provide automation that tracks every activity performed in the lab and automatically generate a detailed audit trail. With easily accessible audit-tracking reports, laboratories can analyze and draw insights from their data to make informed decisions.
Microbiology Automation
Microbiology is historically a labor-intensive specialty with slower TATs, so any advantage that can speed and automate those processes can make significant efficiency improvements. The benefits of automation are likely to make a bigger impact because of microbiology’s historical dependency on highly technical and skilled laboratory professionals and because of the added time involved awaiting microbial growth that slows TAT. These two factors, alongside increasing testing volumes and staffing shortages, have led to the greater adoption of automation in microbiology laboratories.
Modern technologies (e.g., mass spectrometry, liquid transport media, molecular techniques, automated identification and susceptibility systems) have allowed for greater microbiology standardization. Other technology advances (e.g., culture plate imaging digitization, electronic reading of incubation plates) have also helped introduce automation to microbiology, and all of these automation options offer significant advantages.
Currently, two microbiology automation systems within laboratories include:
- BD Kiestra™: This laboratory automation offers standardized and scalable solutions for inoculation, incubation, plate imaging and reading, and follow-up testing.
- Copan Diagnostics WASPLab®: WASPLab is a modular, scalable, and customizable specimen processing, culture incubation, and workup system for microbiology. Specimens move from front-end processing to smart incubation. Digital microbiology with artificial intelligence and interpretive algorithms are used for automatic plate reading.
More Automation Benefits for Microbiology
Because of its high incidence of manual processes and slower TAT, microbiology labs can experience additional benefits from automation.
Improve Antimicrobial Stewardship
Hospitals have for some time focused on improving antimicrobial stewardship to reduce ineffective empirical treatments that leads to increased antibiotic resistance. Automation’s ability to speed TAT can have a positive impact on antimicrobial stewardship, including reducing patients’ length of stay and healthcare costs.
Reduce Errors via Traceability & Standardization
Automated specimen processors and TLA solutions provide greater traceability than manual processes. For example, during specimen processing (e.g., plate labeling, specimen transfer to plates), automation equipment can verify patient identifiers at all steps of the pre-analytical process, eliminating patient identification errors. Laboratory errors such as using the incorrect plates, mislabeling, and cross-contaminating specimens are reduced by standardizing processes and decreasing repetitive human tasks.
Improve Microbiology TAT
Significant delays occur in microbiology when colonies must be subcultured due to poor technique or insufficient isolation of colonies. When subculture is required, delays of up to 24 hours are common. With automation, variation in mixing and specimen selection is minimized, and a standardized, accurate volume is transferred. This level of accuracy reduces the need for subculturing, which shortens TAT. (4)
Microbiology Automation Benefits in Action
As reported in The Dark Report, a large acute-care hospital lab saw significant benefits when it implemented TLA and Lean techniques in its microbiology lab. Benefits included improvements in TAT, staff productivity, and testing quality, as well as reduced errors. Adding automation allowed the microbiology lab to handle a 15% increase in specimen volume while simultaneously reducing staff by six full-time equivalent MLTs. (5)
Other Factors to Consider for Automation
As with any technology, there are limitations to consider, such as high implementation costs and complexity and other factors that will influence the effectiveness of the automation solution. Laboratories must carefully evaluate the return on investment and assess their workflows to determine if automation makes sense and if so, what systems will work best for them.
Requires Process Optimization
To achieve the efficiency gains that come from automation, implementation should include a review and revamping of processes to ensure optimization. Process optimization requires an understanding of the laboratory’s objectives and how the automation technologies fit in with existing processes. This involves analyzing and reengineering workflows to eliminate bottlenecks and streamline operations, taking a Lean approach. By eliminating inefficient steps, redundancies, and delays, laboratories can optimize resource utilization and gain the most benefit from automation technology.
Importance of Integration
Laboratories that decide to leverage automation equipment also need to work with an LIS vendor to integrate those systems within the laboratory workflow so that data is aggregated, and sample processing and test reporting are part of the automated process. Integrated automation solutions support the concept of laboratories as part of an interoperable healthcare solution.
Orchard Software Integration Expertise
Orchard Software has more than 30 years of expertise in integration. With the understanding that automation equipment is essential for many labs to achieve efficiency, we have steadily worked to integrate those solutions as part of an interoperable, enterprise solution. We currently offer interfaces to Roche cobas® and Beckman Coulter automation solutions to help labs with those systems reach peak productivity.
Orchard Software Integration to WASPLab
Orchard® Enterprise Lab™ integrates with the Walk Away Specimen Processor (WASPLab) workflow for microbiology laboratories. The WASPLab is an automated specimen processing and media plate reading solution. Orchard Enterprise Lab works with WASPLab to place orders, complete setup tasks, receive observations, and send preliminary or final reports. Orchard Enterprise Lab automatically updates the Microbiology Work Card in tandem with workup tasks. If WASPLab detects a positive culture, the technologist is alerted, and the culture can be worked up directly in Orchard Enterprise Lab.
Automation Will Continue to Expand
Automation can help manage increasing workload, reduce errors, and improve laboratory efficiency, helping labs deal with an industry staffing shortage. Improving laboratory efficiency requires a thorough analysis of what IT infrastructure, automation systems, and integration solutions are needed. Alongside these solutions, laboratories must incorporate Lean processes that support their goals. In the current healthcare landscape, with a shrinking workforce, adoption of automation technology that improves lab efficiency will allow labs to continue to mitigate challenges and contribute to the best patient care.
References
- Holtegaard T. The past, present, and future of laboratory automation. [Webinar]. September 14, 2022. Accessed at: https://news.mayocliniclabs.com/2022/07/20/the-past-present-and-future-of-laboratory-automation/.
- Al Naam YA, et al. The impact of total automaton on the clinical laboratory workforce: A case study. J Healthc Leadersh. 2022 May 9;14:55-62. doi: 10.2147/JHL.S362614. PMID: 35586661; PMCID: PMC9109973. Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9109973/.
- Tyagi M, Rothenburg I. Improving laboratory productivity through automation. AACC. August 2022. Accessed at: https://www.aacc.org/science-and-research/scientific-shorts/2022/improving-laboratory-productivity-through-automation.
- Ledeboer N, et al. The automated clinical microbiology laboratory: Fact or fantasy? J Clin Microbiol. 2014;52(9):3140-3146. Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313129/.
- Burns J. Combining lean with lab automation to get impressive results. Dark Rep. 2015;22(10):10-15. Accessed at: https://www.darkintelligencegroup.com/the-dark-report/laboratory-automation/combining-lean-with-lab-automation-to-get-impressive-results/.