Automation in Lab Diagnostics: Enable growth with cost benefits and operational efficiencies

By
Dr Ravi Gaur , MD Pathology
Founder & Director DRG Path Labs, New Delhi
Chairman Medical Advisory Committee, Unipath Specialty laboratories ltd

Today it is totally a New World of Pandemics. A “normal” no one could have predicted this time last year. Year 2021 is the “new normal”. From almost death of labs at the start of Pandemic, all diagnostic providers jumped back to normal and are now at the forefront of fight against Covid Pandemic. The role of diagnostics over past one year, and in the months and years going forward, cannot be underscored enough. There is a need to create newer models for providing service to our patients and to prepare ourselves for future & ensuring business continuity, at the time of such eventualities. The diagnostic is definitely going to take a center stage. Faster, easier, more accurate diagnostics will give us an edge and is the new normal as we move ahead.

Diagnostic Laboratories are essential in medicine, research, and development. They are the place where ideas are produced, implemented, and optimized. Innovative technologies are very important in such processes, especially in healthcare. Reliable results and a high degree of quality has to be ensured at all times.

The world of the laboratory is changing at a rapid pace. As we move forward ‘Digitalization and Automation’ will mark a new era. Digitization is the new norm. It is a clear lesson the ongoing pandemic has taught, and the medical diagnostics field is one that is adopting it at in much faster pace due to the shrinking of qualified lab personnel and more and more precision expected in clinical results. In this context, automation is playing a larger and larger role. There are numerous advantages in automated systems and soon it will find a way into more and more clinical laboratories.

Today the expectation from a modern medical laboratory have gone up. To meet such ever increasing demands, modern medical laboratories in India have adopted several ways and no doubt automation, robotics, and the use of artificial intelligence (AI) are cornerstones of this attempt.

Moreover, the fallout from COVID-19 has led the labs to focus on the need to automate faster. Moving forward to bridge the revenue gaps, streamline operations, and prepare them for better future crisis laboratory automation is no longer optional. Technology through automation and artificial intelligence is definitely one of the most disruptive sources.  We are now heading for ‘Smart Labs’ and It works well in terms of economic sustainability. Adopting automation to the level feasible is thus pure simple business sense and is a must for survival.

Automation will help in delivering faster results —even with a high volume of specimens, optimization of resources and process efficiencies. It will reduce errors and the results will have also better reproducibility and comparability. It makes processes transparent and traceable. The specimens can be tracked throughout the entire process. Automated processes save material and require less personnel. Inventory management is another area which will lead to timely stock alerts and reduce inventory holding and keep a check on expiry of kits. This allows for further cost savings. Automation will help in improving margins for sure. Automation is basically cost cutting by tightening the corners and not cutting the corners.

Clinical laboratories will also benefit from automation, in matters of safety for the laboratory personnel. Automation will help the laboratories to upgrade their quality standards and bring them at par with NABL and other global quality requirements

The pandemic led to lockdown and temporary closing down of many labs, as the work force and patients feared risk of infection and were not turning up at the laboratory. This exposed the fact that, despite a lot of hype over the years, advanced automation has not been substituted for human workers at scale. Had the automation moved with more alacrity and determination in the past, labs would have been in a better position to face the pandemic. 

As full services of labs are restored, we move forward we will see an accelerated investment in the lab automation, when the full services are restored. This might take a while, but major providers have already started exploring the possibility for adoption of complete automation in all processes, from pre-analytical, analytical to post -analytical. Many high end labs in the country are now in an automation mode

Many have raised the question that how and  why robots and artificial intelligence are considered to be a smart and better option than qualified pathologists? Aren’t there any possibilities of malfunctioning? If yes, how to resolve it?  I think it will not be fair to compare Human Pathologist with automated artificial intelligence (AI) & robots. An AI driven system for pathology, that achieves a performance of almost 90-95% or even more, may sound to outperform pathologists, but this is not going to be the case. Human body is too complex and dynamic. No two diseases are same, and this is more so in cases of cancer. Pathologist provide the final diagnosis based on the morphology and staining characters of the tumor cells. Human pathologists is aware that, one cell type can have different characteristics in different patients and even a patient’s healthy cells can appear similar to another person’s tumor cells. With AI, it would be difficult. Computers will need much more aggressive training and exponential data to become aware of all likely disease presentations. At times human pathologist correlate many diverse factors and use commons sense to arrive at correct diagnosis. However, AI driven augmented intelligence, will be of much greater benefit. AI can be of great help to pathologist for improving upon their performance and tissue analysis, specially in highly complex cases. There is a need for pathologist and computer to work together for better delivery. We should think in terms of collaboration instead of talking about competition.

When we think of automation we need to talk about robots and cobots and their utility in the diagnostics industry? In my view, Collaborative robots (Cobots) will definitely be more useful than Robots. As I understand, the cobots are designed to work along with and hand in-hand with human employees, while robots work in place of employees. Cobots are more capable of “learning” on the job. These machines focus on reducing human errors, doing repetitive tasks, such as picking up sample to deliver to a designated space, thus the staff can focus more on other important skill requiring work which need more focus ,like clinical correlation, result interpretation and skill.

‘Automation’ is a bit scary for workers, as efficient automation, robots or cobots can work faster, cheaper, and nonstop. However, the automated processes can vastly improve productivity and efficiency. It is already happening in pathology labs and with rapid pace. The hematology, biochemistry immunoassays microbiology, molecular testing etc is getting fully automated. Robotic arms are taking care of pre-analytical space. Digital technology has changed the healthcare delivery. Test ordering is getting fully automated. In hospitals samples are being transported by pneumatic tubes. These changes are improving efficiency of testing process. As we go ahead, we will see more advances, but I do not think we can replace laboratory technicians. On the contrary, technicians will be doing more meaningful job and will feel more satisfied with their work.  Any automation in healthcare leads to more human empowerment. Automation may eliminate the need for manual labour but can never eliminate the need for knowledge. However unskilled workers will need to update themselves and get more skilled as we move forward. 

The new technologies and the process of automation is going to cost. Labs have to invest capital, for gains. As the capital expenditure is going to be on higher side, there is some reluctance in Indian Diagnostic labs to adopt these measures. Skilled manpower is still available at lower cost as compared to developed world. But with increasing fixed costs, labs are facing challenges to scale up and even sustain their operations, despite 18-20% growth year on year. Thus, labs are left with no option but to adopt maximum possible automation for survival.