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Automation of Labs: a New Beginning

Automation

Digitization is the new norm. It’s 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. Many high-end labs in the country are in an automation mode. Right from analysis of blood samples for glucose level to complicated genetic tests and data capturing of the samples, the robots diagnose and deliver with much more finesse. 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. It is a must for survival, inform experts from the Dx segment.

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Stressing that automation in the diagnostics sector is becoming an essential factor as it brings in efficiency, speed, precision, and cost efficiency experts emphasize that laboratory medicine has seen a paradigm shift from manual processing and handling of reagents and patients’ samples to a so-called “Software-driven, robotic lab” equipped with fully automated analyzers requiring minimal human intervention. The shift is basically driven by a need for accurate, error free, and faster reports, in order to get precise therapy. Gone are the days of traditional trial and error methods of care which are no longer acceptable for obvious reasons. The Indian scenario is also not so different. Today the expectation from a modern medical laboratory is not only limited to accuracy and reliability of test results but a faster turnaround time (TAT), “state of the art” technology with global quality standard, affordable cost and reports carrying simple and useful information preferably with a direction to therapy. 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.

Transcending towards ‘Smart Labs’

As automation reduces efforts invested into inventory management and consolidation of equipment, and also expedite diagnostic processes such as sample bar coding, separation, processing, and archival. In contexts where manpower is expensive, or where trained manpower is hard to find, many labs are transcending towards automation as it works well in terms of economic sustainability.

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Jatin Mahajan Managing Director, J Mitra & Co – Automation is all about speed, accuracy, and cost-effectiveness. Automation complements human efforts – it doesn’t replace them. Robots and automation take care of tedious, dangerous, and repetitive tasks. They can handle a number of extremely complex procedures without any drop in performance levels.

Highlighting that globally, there is a move towards smart labs, Jatin Mahajan, Managing Director, J Mitra & Co, said, “Automation allows laboratories to perform more tests, in a shorter span of time and with more accuracy and reliability. It catalyses efficiency, better time management, andravi

Dr Ravi Gaur Director & Chair Medical Advisory Committee, Oncquest Labs – The pandemic led to a lockdown and temporary closing down of many labs, as the work force and patients’ feared the 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. The COVID -19 pandemic will definitely accelerate investment in lab automation, when the full services are restored.

productivity, it leads to quicker diagnostics results for the patients. It decreases the number of trained personnel required, and thus brings in an overall decrease in the cost of operations and thus cost-per-test. These automated laboratories sync well with Laboratory Information Systems (LIS) and Hospital Information Systems (HIS), leading to quicker reports and overall reportage and management of the patients. Automation also mitigates the scope for human errors. With the stringent quality standards that NABL mandates, it is imperative that all laboratories upgrade themselves to meet the global standards – without these standards, the laboratories will not be able to sustain their businesses. Automation helps the laboratories to upgrade their quality standards and bring them at par with NABL requirements. It also provides a higher level of efficiency and cost effectiveness that was earlier missing. Adopting automation to the level feasible is thus pure simple business sense.”

Further adding to it Dr. Ravi Gaur, Director & Chair Medical Advisory Committee, Oncquest Labs, said, “Increasing patient expectations and shortage of skilled staff to handle these samples, labs are facing several challenges to deliver quality results in a timely manner. The input cost, which includes – reagents and instruments, manpower, infrastructure, accreditation, IT, logistics, administrative expense, etc – has gone up substantially. Growing market competition has led to stagnation or even reduction in MRPs and reimbursement rates. There is a strong pressure on the labs to maintain control over the influx of samples, to improve workflow, and to improve upon profit margins to sustain their operations. So automation is a must.

In our relentless pursuit to empower physicians by giving timely & accurate reports; automation is indeed the need of the hour in IVD laboratories, pointed Dr. Arjun Dang, CEO, Dr Dangs Lab, said, “To maintain error free, high precision reporting protocols especially with COVID19 testing ; automation is indispensable; in all phases of testing. AI and robots wearable will always remain to be a tool to supplement, complement a qualified doctor. With moreArjun Dang

Dr Arjun Dang CEO, Dr Dangs Lab – To maintain errorfree, high precision reporting protocols especially with COVID19 testing; automation is indispensable; in all phases of testing. AI and robots wearable will always remain to be a tool to supplement, complement a qualified doctor.

judicious spending of the doctors time more patients can benefit and technology can certainly help us bridge the gap of patients & doctors ratio in our country.”Dr Shivaji K Jadhav

Dr Shivaji K Jadhav, Head, Molecular Biology (Covid Laboratory) SRL Fortis Hospital – AI is a technology that can imitate human thoughts to perform certain actions. AI can perform simple as well as complex tasks, depending on the level of programming used to create it. In medical lab testing, robots can find effective applications to analyze slides and produce organized results for certain simple tests

Agreeing to it, Dr. Shivaji K Jadhav Head, Molecular Biology (Covid Laboratory) SRL Fortis Hospital elucidated that technological innovations have improved the productivity of clinical labs. With the increasing reliance on technology-based systems and the drastic growth of internet-driven processes, the need for automation is increasing.

“Owing to the ongoing advances in connected technologies and cloud-based laboratory information management systems (LIMS) platforms, these tools are helping businesses to access the benefits of the digital transformation and provide laboratories a secure way to organize data, making accessing insights quick and easy, while allowing businesses to control which data is sent to third-party instrument vendors. Automation reduces efforts invested into inventory management and consolidation of equipment and also expedites diagnostic processes such as sample barcoding, separation, processing, and archival. The use of automation will definitely help in streamlining the process with error free and achieve the highest quality,” Jadhav said.

The experts in the Dx segment also cite that as far total automation is concerned balancing cost is crucial. Like many big labs, it can be cost effective but they are far and few. India has a large number of small labs and they need to afford both in terms of money and space.

Balancing cost while opting automation

Touching upon the cost of manpower, which is increasing in India, experts informed that the laboratories will have to spend more to attract and retain efficient manpower.

Giving her detailed perspective on the cost Dr. Abhik Banerjee MBBS (CU), MD Pathology (MUHS) Chief of Quality, Senior Consultant Pathology Nodal Officer, COVID 19 Cell Suraksha Diagnostic Pvt. Ltd said, “With the slow but steady increase in the number of diagnostic chains in India, even smaller laboratories need to spend more on automation and cutting edge technology to stay competitive. Peer pressure on laboratories to consistently deliver accurate and timely reports will go on increasing and judicious use of automation, robotics, and AI under supervision of trained, competent manpower can be the laboratory’s response to all these challenges. However, weDr Abhik Banerjee

Dr Abhik Banerjee, MBBS (CU), MD Pathology (MUHS) Chief of Quality, Senior ConsultantPathology Nodal Officer, COVID 19 Cell Suraksha Diagnostic Pvt. Ltd – With the slow but steady increase in the number of diagnostic chains in India, even smaller laboratories need to spend more on automation and cutting-edge technology to stay competitive. Peer pressure on laboratories to consistently deliver accurate and timely reports will go on increasing and judicious use of automation, robotics, and AI under supervision of trained, competent manpower can be the laboratory’s response to all these challenges. However, we need to remember that, automation comes with a price.

need to remember that, automation comes with a price. The balance between the revenue generated from the workload of a laboratory and the cost of automation must be carefully balanced. The cost-saving, in terms of reagent cost as well as reduction of man hours, works only when the laboratory caters to a substantial sample volume. As mentioned earlier, Government also has a big role to play here. Reducing the cost of automation, some sort of regulation on analyzer and reagent cost will thereby help laboratories irrespective of their size and location to adopt at least the base level automation and ensure faster, cost-effective and reliable service to their customers,” Banerjee said.

Labs

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

Opining that developing countries are faced with unprecedented challenges of rising costs, increased workload demands while managing a limited workforce, Dr. Geetanjali Gupta, Lab Director & Quality Manager, Saral Diagnostics said, “In view of the rising growth rate and population needs, the diagnostic sector in India needs harmonization of best practices in lean work processes and IT support using skilled manpower or robotics which can perform more value-added-work such as quality monitoring, evaluation, and setting up of new tests with reduced turnaround-time.”

Experts believe that laboratory automation was already happening at a fair pace before COVID-19 struck and it has speeded up during the pandemic.

“The pandemic led to a lockdown and temporary closing down of many labs, as the work force and patients feared the 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 humanDr Geetanjali Gupta

Dr Geetanjali Gupta, Lab Director & Quality Manager, Saral Diagnostics – In view of the rising growth rate and population needs, the diagnostic sector in India needs harmonization of best practices in lean work processes and IT support using skilled manpower or robotics which can perform more value-added-work such as quality monitoring, evaluation, and set up of new tests with reduced turn-around-time.

workers at scale. The COVID -19 pandemic will definitely accelerate investment in lab automation when the full services are restored. This might take a while, but major providers have already started exploring the possibility for the adoption of complete automation in all processes, from pre-analytical, analytical to post-analytical,” Gaur said.

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The diagnostic segment experts also voice that the Indian diagnostics industry will be machine-dependent that lead to human improvement.

Man Vs Machine

‘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. Experts inform that the technicians can’t be replaced by machines.

“Automation is all about speed, accuracy, and cost effectiveness. Automation complements human efforts – it doesn’t replace them. Robots and automation take care of tedious, dangerous, and repetitive tasks. They can handle a number of extremely complex procedures without any drop in performance levels. Humans bring a level of creativity to tasks that system-driven automation cannot. But humans also get tired, and lack of focus could lead to less-than-optimal performance. Thus automation brings about a re-alignment of the work profile from repetitive and low-skilled, to complex and skilled for humans, enabling them to engage in higher quality initiatives. Collaborative robots are designed to work with and alongside technicians, rather than replace them — making it possible to build workflows that incorporate the strengths of both humans and robots,” Mahajan added.

Also read: Robotic Process Automation in healthcare: The need of the hour

Talking in detail, Gaur said that the hematology, biochemistry immuno as says microbiology, molecular testing, etc is getting fully automated.

“Robotic arms are taking care of preanalytical space. Digital technology has changed healthcare delivery. Test ordering is getting fully automated. In hospitals, samples are being transported by pneumatic tubes. These changes are improving the efficiency of the testing process. As we go ahead, we will see more advances, but I don’t think we can replace laboratory technicians. On the contrary, technicians will be doing more meaningful jobs and will feel more satisfied with their work. I feel with cobots in our labs, will result in better quality job creation. Workers will not be doing repetitive tasks that may hurt them or expose them risks that cobots can perform efficiently at a reasonable cost, accurately, and with no issues of bio safety hazards. Any automation will lead 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,” Gaur added.

Referring on the use of AI, robots in labs specifically, Jadhav said, “AI is a technology that can imitate human thoughts to perform certain actions. AI can perform simple as well as complex tasks, depending on the level of programming used to create it. In medical lab testing, robots can find effective applications to analyze slides and produce organized results for certain simple tests. One concern that is often raised pertains to whether these robots will replace pathologists in the near future. Well, the answer is no. While technology is accurate, it does require human interpretation. The results produced by AI need to be analysed by a pathologist with hands-on experience in order to be sure. Of course, any robot can malfunction and that is why quality control in this field is absolutely essential. When it comes to errors, the technology always needs to be calibrated to keep it up to the mark. This helps to reduce the incidence of malfunctions and can also alert professionals to stop processing samples in case of such issues.. A robot can’t serve this function, and hence, will never be able to fully replace a pathologist. Automation can improve safety records by implementing automatic fail safe mechanisms and reduce the risk of human error. IoT also provides IVD with the capability to directly interact with the support layer, which allows event capture in an electronic way. Diagnostic devices play an essential role in improvising the healthcare industry. It is estimated that 60 percent of the medical decisions in the world are made with the support of IVD solutions.”

He also added that Collaborative robots (aka cobots) are designed to work safely alongside humans in shared work spaces. Informed that the increased flexibility and dexterity can complete more delicate tasks conventional robots cannot, such as polishing fragile materials in production processes.Dr Anjali Tiwari

Dr Anjali Tiwari, Lab Director and Technical Manager, Regency Hospital Ltd – AI at best can be an assistive tool to make clinical decisions so that a single mind does not miss out. But the output of AI has to be integrated with other information sets visible only to a human clinician. Though the labs will be receptive in the idea the practical consideration in terms of employment, workload and affordability may be restrictive.”

Cobots are smaller, lighter, and safer than conventional industrial robots. With their flexibility and relative ease-of-use compared to fully automatic robots, cobots are considered to be an affordable and attractive choice for small and medium sized businesses. These businesses can benefit from robot’s traditional value proposition they do repetitive or unsafe tasks, freeing up human workers to do more complex work, and without taking compensation.

Cobots will remain to be instrumental in increasing efficiency and TAT within the lab in analytical procedures. Robots have a huge role in the pre and post analytical space, but require further validation before implementation. Certainly, the precision will be greatly enhanced, but monitoring by a trained doctor for significant value addition will be required,” Dang said.

A collaborative lab will prove to be the best for India, indicates Dr. Anjali Tiwari, Lab Director and Technical Manager, Regency Hospital Ltd, said,”As totally automated robotic lab will require the least number of people and in turn displacing the skilled personnel. We as a country cannot afford unemployment and also the cost of total automation will not work for small to medium sized labs that are spread all over the country. AI and robots work on algorithms that have been trained on big data and they work on a similar process that humans use. The ability to handle the complexity of decision-making and the speed of the machine is supposed to be more precise and error free. The human mind on the other hand does not work on algorithms but uses heuristic and probability based decisions. AI at best can beDr. Varsha Vadera

Dr. Varsha Vadera, Consultant & Head Laboratory Medicine & Advanced Diagnostics, Kokilaben Dhirubhai Ambani Hospital – Currently cobots would be better suited for a number of jobs in lab automation. As they perform the repetitive jobs with the same efficiency day and night 24×7 and get better output

an assistive tool to make clinical decisions so that a single mind does not miss out. But the output of AI has to be integrated with other information sets visible only to a human clinician. Though the labs will be receptive to the idea the practical consideration in terms of employment, workload and affordability may be restrictive.”

Keeping her points, Dr. Varsha Vadera, Consultant & Head Laboratory Medicine & Advanced Diagnostics, Kokilaben Dhirubhai Ambani Hospital informs that currently cobots would be better suited for a number of jobs in lab automation. As they perform the repetitive jobs with the same efficiency day and night 24×7 and get better output. Centrifugation of samples, sorting of vacutainers, decapping, recapping, sample management as per program, making blood smears and staining them, aliquoting, are some of the tasks which can be efficiently performed by Cobots. Cloud-based Robotics – Automation Intelligence and Automated Data capture are very useful tools.

As far as the man vs machine debate Vadera said, “As automation takes on some of the jobs of both non-skilled and skilled workers, new avenues and jobs are created, time is available to learn and perform the other routine tasks efficiently. There may be some staff reduction, but over-all there is the better staff deployment and lab efficiency improves. The skilled workers need to undergo regular and periodic training, attend workshops, conferences, and conclaves. Today it stops there, as the day they come back the piled-up work needs to be attended to. However, it would be more prudent if the same staff were to make a presentation which can be given to the rest of the staff on salient features learned at these events, enumerate points which the lab can consider adopting, and also speak about how their lab ranks with the other labs.”

Sighting on Genomics in automation, Dr. Sunil Tadepalli, Founder & CEO, Labnetworx said, “Genomics is ideally suited to include AI in the clinical workflow. The reason is that large Next Generation Sequencing (NGS) panels like Whole Exome (WES) and Whole Genome Sequencing (WGS) will result in discovering thousands to millions of variants in an individual patient. To evaluate these variants and to identify one or very few relevant variants to the patient’s disorder is challenging. AI is already being used in this context to help in the diagnosis of single gene disorders. For AI to be a useful tool, the platform needs to be trained using data collected from thousands of patients. We also need to use standardized vocabulary like Human Phenotype Ontology (HPO) terms to describe the clinical features in the patient. With the increasing use of NGS technologies in India, we can foresee the increasing use of AI in genomics in the future. A useful primer about how this can be used is available from Centogene and can be accessed here.

The experts talking about the pros and cons of automation emphasized that automation will help in improving margins for sure.

Automation – Cost-effective

A good automation process can reduce human errors. Such errors cost whether pre or post-analytical or analytical are a part of the expense of any lab. So automation is definitely cost-effective to inform industry experts.

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“Reduction in human errors will lead to reduced repeat sampling, reduced repeat tests, and rechecks, timely delivery of results which can lead to more reflux testing spl in emergency patients. Inventory management is another area that will lead to timely stock alerts and reduce inventory holding and keep a check on the expiry of kits. All this will definitely help to improve lab margins and improve service delivery,” Gaur said.

Adding to it, Mahajan informed that automation has driven the growth of the Indian diagnostics industry in the last couple of years, and made it the cornerstone of the healthcare industry. Emphasized that the sector will continue to rise exponentially, driven by automation-infused speed, reliability, and cost effectiveness.

“All tedious, repetitive and dangerous tasks will continue to shift towards automated processes, bringing about a higher level of safety standard within the industry. The increased efficiency will lead to higher revenues, resulting in greater profits for each and every organization and individual within the laboratory ecosystem,” he added.

With both sustainability and technology at the forefront, the industry believes that the next wave of diagnostics will be a combination of automation and manpower, concentration will be on increase quality; high volumes to drive the industry to provide high quality and seamless services to patients.

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