Vol. 19 • Issue 20 • Page 45
Laboratories come in all sizes, whether private or commercial. Some small laboratories, for example, have specialized test menus, limited test menus and some are small simply because of the geographical area or segment they serve. There are mid-sized laboratories with large test menus and mid-sized geographic or customer segments, as well as mid-size labs with small test menus and specialized testing. And, of course, there are large private and commercial labs considered large based on the volume of tests or variety in the test menu they offer. Clearly, not all labs are created equal, nor are their processes or bottom lines.
In an increasingly competitive market, how can laboratories distinguish themselves? How can laboratories grow their business and have a positive impact on their bottom line? Why have some labs flourished and grown in spades while others have closed their doors? Two main ingredients contribute to the success of those laboratories that have flourished-automation and process improvement.
Lab Automation
The first step in laboratory automation is the laboratory information system (LIS). The capabilities of the LIS that a laboratory implements are really what determines the parameters for what is possible in all other types of automation and how well you are able to leverage that automation throughout every process within a given laboratory and its associated facilities.
The main areas of automation include:
• Instruments. Automated instruments can communicate with an LIS either uni- or bi-directionally. Some instruments only need to be uni-directional, such as a urine dipstick analyzer, whereas others are far more effective with a bi-directional interface, such as immunoassay or special chemistry analyzers. Taking advantage of the correct interface for the specific instrument with your LIS is what will determine the amount of efficiency from which your lab will benefit.
Interfacing your instruments directly to your LIS is a simple task for an experienced LIS vendor. Some of the benefits include the reduction in time for manual processes (that include not only placing orders to the instrument but also receiving results back directly from the instrument); the ability to see where in the queue the test is or where in the process of testing if there are multiple steps; ability to run and analyze QC; and having a common user interface and robust set of rules-based configuration tools at hand. Autoverification processes are key in instrument automation. To truly leverage automated instruments though, having the ability to configure and manage complex rules and filters is also key.
• Human Transaction Automation (e.g., the automatic accessioning of cases). Using barcode technology for patient accessioning, ordering histology blocks, printing labels or specimen tracking when a specimen is ordered not only cuts down significantly on manual entry errors, but also speeds the entire process through the lab and eases reporting as well as future retrieval and analysis, if necessary. Billing charges can be automatically associated with tests and special stains at the time the test order is placed.
Transcription also can be automated utilizing voice-activated applications to free the hands of your staff. The time spent going back and forth between slides, microscopes, images and a keyboard is costly and can create duplicated work and errors. Transcriptionists can simply dictate what they are seeing directly into the case record, which saves time and reduces error.
As well, digital cameras and high-resolution images are able to be -automatically stored directly with a patient’s case and shared electronically with other facilities and between pathologists for review or referral between colleagues.
Process Improvement
Process improvement can be delved into with great depth; what’s discussed here is a glimpse. Any given laboratory has their processes, from sample receipt, analysis and post-analysis tracking to instrument maintenance and utilization. If you look at the areas that can provide the most room for improving efficiencies and therefore having a more significant impact on the bottom line of the lab itself, then that is where the starting point should be.
I highly recommend a detailed review of your laboratory’s workflow with your LIS vendor. A good LIS vendor has experts on staff that can come to your laboratory and sit with your staff, follow them through their typical day and usage of the LIS for two or three days, depending upon the variety, complexity and volume of testing you do. At the end of the timeframe, your LIS vendor should be able to provide you specific examples and direction on how you can better use the LIS features, short-cuts, preferences and meld your workflow to the system. As well, a great system can be conformed directly to your lab’s workflow with enhanced efficiency.
Organ Mapping
The automation of organ mapping has significantly impacted a lab’s ROI to the physicians it serves with their product being the final report. It is rarely seen as a competitive advantage now to be able to offer organ mapping-at least for prostates-but what other organs does your lab offer the ability of mapping for? Being able to show the location, percentage and diagnosis on a visual diagram as well as in print is now considered a necessity, not just a luxury in this highly competitive market. Physicians want diagrams that depict where there are issues such as malignancy and the percentage of malignancy, for example, in each section of a prostate diagram. They want to define how many sections that diagram has-6, 12, etc.
Automatic Checks, Testing
LISs now have the ability to do automatic intelligence checks directly within the application, such as checking for correctness of sex for the ordered test and automatically building patient histories for display in final reports. HPV and reflex testing also are able to be set up automatically.
Final Report Automation
Final reports can and should be completely customized in look and content. Physicians can request their reports in the manner they like to see them-with complete images, organ diagrams, their logo and masthead all fully incorporated in the report. They can request color-coded sections for easier review to see the diagnosis, demographics and full patient history all in the location or order that they want to see them.
A full-featured, robust LIS will allow you to set up these customized reports in your library and associate them directly with your end customer so the only time you need to make a change to the look of a report is if your customer changes their request.
The delivery method and time also can be automated within your LIS. Reports can be delivered electronically, through a secure, web-based outreach program anytime/anywhere, or printed directly to a printer in a physician’s office from the lab. Reports are able to incorporate detailed, full-color images and can be delivered real-time, upon completion or at pre-determined intervals.
As this industry continues to be more competitive and technology evolves with both hardware and software functionality, the areas for process improvement and automation will continue to flush themselves out. Watch the leaders in this industry to see what new features they introduce to market and stay at the forefront of innovation. This will ensure your laboratory’s competitive position and help you improve your bottom line.
Lisa-Jean Clifford is CEO of Psyche Systems Inc.
Industry Tools Toward Efficiency
Improving overall efficiency, streamlining procedures and maximizing resources allows laboratories to maintain a competitive edge and even thrive during uncertain economic and even political times. A few products are designed with these strategies in mind.
The Thermo Scientific SlideMate Slide printer, for example, is structured to enhance Lean workflow and reduce patient identification errors in the laboratory. It eliminates hand writing slides and the need to sort batch printed slides, ending the potential for costly sample misidentification in the laboratory. The -SlideMate’s small footprint and on-demand printing capabilities are ideal for printing slides next to the microtome or cytology slide processor. As well, its chemical resistant print media is immediately dry and ensures print reliability throughout all laboratory processes.
Nanosphere Inc. uses the unique properties of nanoparticles to enable multiplexed molecular testing on an automated platform, which saves critical time. The technology utilizes gold nanoparticle probes functionalized with oligonucleotides for the detection of target DNA in a microarray format. The new Verigene® Processor SP enables automated processing of microarray test cartridges from sample to result in a CLIA moderate complexity environment. Additionally, a multiplexed respiratory virus nucleic acid test is FDA-cleared for use on this platform, with more applications in the areas of infectious diseases, genetics and pharmacogenetics pending FDA review. The scalability of the modular, random access Processor SP’s affords labs the flexibility to expand their molecular testing volume and footprint at their own pace.
