The need for efficient systems to deliver quality healthcare is much more intensified today and healthcare providers face the challenging mandate of doing more with less, says Dr Suvarna Ravindranathan, General Manager, SRL Diagnostics, Karnataka

Dr Suvarna Ravindranathan,
General Manager,
SRL Diagnostics, Karnataka

Indian in vitro diagnostics market

The market in India is highly fragmented. It is not surprising given its healthcare delivery structure, but of the estimated one lakh laboratories in India many have just basic facilities and only three to four laboratories are state-of-the-art multidisciplinary core labs. The hierarchy has specialized laboratories on the top, followed by laboratories in hospitals and nursing homes, and finally by small testing centers. All specialized laboratories operate in the private sector. The government at the best has semi-automated laboratories.

Test volumes range from 50 to 100 samples per day for one laboratory located in a small town to several t h o u s a n d samples per day for a major laboratory.

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One of the major challenges faced by the new Indian government is to provide affordable healthcare to all. Healthcare in India, as elsewhere in the world, is facing unprecedented challenges, including the economic burdens associated with rising costs, chronic diseases, and caring for ageing populations. The need for efficient systems to deliver quality healthcare is much more intensified today and healthcare providers face the challenging mandate of doing more with less.

Medical diagnostics is at the center of healthcare delivery and is facing its own challenges. With increasing demand for tests, focus on quality, and accuracy by physicians as well as changing economic paradigm, laboratories are forced to think out-of-thebox to keep functioning.

An estimated 70 percent of medical decisions are based on laboratory test results. However, diagnostic laboratories in India are limited by means and resources. The thought of investing in an automation system feels like a daunting task, let alone expanding a laboratory or replacing existing systems. But the need for quality and reproducibility as well as the increasing demand for tests with less turnaround- time has only fuelled the need for adoption and use of laboratory automation.

The key challenge for the diagnostic industry is to find innovative and cost-effective ways to improve testing efficiency and eliminate errors. Given the variation of power supply in India, equipment manufacturers must have a clear vision of how to best enhance a laboratorys capability with their automated equipment.

Automation gains

Since automation for clinical laboratories came into existence equipment manufacturers have been promoting the benefits of stand-alone and total laboratory automation systems. The crux of their marketing lies in the fact that these equipment save time, reduce manual steps and above all, remove the human element from testing to lower the risk of errors.

Automation makes the process very easy, makes the process and manpower requirement less. Even with less manpower more tasks can be accomplished more efficiently. Even the turnaround time will scale up to significant improvements and the chances of error are minimized to a large extent.

Automation and quality

Leveraging the full capability of automation to drive quality and productivity improvement is the aim of all laboratories. While many believe that automation provides consistent quality, there are many who dont buy this theory. Lab automation alone will not ensure quality. It will provide reproducibility only to a certain extent. There is a difference between quality and reproducibility. Reproducibility is something like precision but accuracy will come only if you practice quality. Quality procedures and standards need to be in place.

Prohibitive cost of automation

Manual labor is readily available and less expensive in India; however in a clinical laboratory automation supersedes manual labor. It requires a huge initial investment compared to the unit cost of the product. In India, automated laboratory equipment are expensive. The best innovation that has come up is the development of customizable automation configurations that allow the flexibility of phased implementation. The cost of automation varies. If an analysis is needed to be interfaced with computers, this will not cost much. However if robotics is taken into consideration then along with automation it will definitely cost quite a lot.

Major challenges and opportunities

A strong requirement for quality managers who are properly trained and have proper standard operating procedures in place is challenging. In fact, it is necessary to train and retain competent staff, which is equally challenging. Precision and accuracy are the mark of a good laboratory. Medical laboratories, through their systems, have to generate results that can be replicated or reproduced in different diagnostic centers.

Automation will extend beyond traditional robotics to include more mobile systems. Pre-analytical process will get more customized and efficient

Outlook

Automation in clinical laboratory is gaining pace in India. In future, smaller laboratories will consolidate and feed samples to larger automated laboratories. In the future, this market is expected to become more organized and consolidated as small and independent laboratories become franchisees in the hub-and-spoke model of the larger players. By 2015, 30 percent of the market is predicted to be organized, which will lead to more automated labs in India.

Automation will extend beyond traditional robotics to include more mobile systems. Pre-analytical process will get more customized and efficient.

Clinical laboratory automation involves the integration or interfacing of automated or robotic transport systems, analytical instruments, and pre- or post-analytical process equipment such as automated centrifuges and aliquoters, decappers, recappers, sorters, and specimen storage and retri systems. In addition to the electrical and mechanical interfaces of these various components, the computers that control these devices or instruments must also be interfaced to each other and/or the laboratory information system.

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