Dr. Ravi Gaur, MD Pathology, Director & Chair of Medical Advisory Committee at Oncquest laboratories Ltd elucidates to Prathiba Raju, Elets News Network on how laboratory automation is no longer optional. It is a must for survival.
Why is it necessary for the Indian medical diagnostics industry to look upon the total automation of labs?
With the rapidly growing demand for pathology testing 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 & 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. Laboratory automation is no longer optional. It is a must for survival.
What are the lessons taught by COVID-19 on the total automation of labs?
Laboratory automation was already happening at a fair pace before COVID-19 struck. The pandemic led to a lockdown and temporary closing down of many labs, as the workforce 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. 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.
The fallout from COVID-19 has led the labs to focus on the need to automate faster as we move forward, bridge the revenue gaps, streamline operations, and prepare themselves better for future crisis. Had the automation moved with more alacrity and determination in the past, labs would have been in a better position to face the pandemic.
How and why robots and artificial intelligence are considered to be smart and better options than qualified pathologists? Aren’t there any possibilities of malfunctioning? If yes, how do you resolve it? Any instances?
I think it will not be fair to compare human pathologists 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. The human body is too complex and dynamic. No two diseases are the same, and this is more so in cases of cancer. Pathologists provide the final diagnosis based on the morphology and staining characters of the tumor cells. Human pathologists are 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 pathologists correlate many diverse factors and use commons sense to arrive at the correct diagnosis. However, AI-driven augmented intelligence, will be of much greater benefit. AI can be of great help to pathologists for improving upon their performance and tissue analysis, especially in highly complex cases.
There is a need for pathologists and computers to work together for better delivery. We should think in terms of collaboration instead of talking about competition.
Which is more in use – robots or cobots? What is the difference which is more useful when it comes to the diagnostics industry?
I think 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 samples to deliver to a designated space, thus the staff can focus more on other important skills requiring work that needs more focus, like clinical correlation, result in interpretation, and skill.
In pathology labs, precision and safety are two very critical elements. The rising administrative cost is leading to a reduction in the available workspace. The time too is limited as patients want better turnaround time for reports. The input cost and budget are equally essential. Specifically, to address all these issues and challenges, the use of Cobots and Robots is getting must, as we move ahead to next-generation diagnostic solutions.
With increasing automation and robots in labs, what will happen to the skilled and unskilled workforce in the medical diagnostics centre?
‘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 at a 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 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.
“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.”
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.
How receptive is the Indian diagnostics industry to being machine-dependent, what does the future look like?
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, in spite of 18-20% growth year on year. Thus labs are left with no option but to adopt maximum possible automation for survival.
How cost-effective is automation? Give examples.
Automation will help in improving margins for sure. 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. Reduction in 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.