The Automation Question

Automation

If you’re a laboratory administrator considering implementing automation into your lab, you may think “should I purchase a total laboratory automation (TLA) system or modular automation?” is the ultimate question. But in reality, that one query is just the tip of the iceberg. It opens the door to a laundry list of considerations, and paying attention to all of these subsequent questions can help you decide what’s best for your laboratory.

“I’ve had the opportunity to work in automation since 1989. Automation is like anything else we deal with in healthcare,” explained Rodney S. Markin, MD, PhD, professor in the Department of Pathology and Microbiology and chief technology officer at the College of Medicine, University of Nebraska Medical Center (UNMC), Omaha. “There’s no one answer, and no one size fits all. It’s fascinating to me that in the rest of healthcare, we understand there’s no one size fits all answer. But with lab automation, we either go left or go right.”

Instead of feeling the need to find the ultimate “right” answer, focus on finding the right solution for your laboratory. When considering going with a TLA system or modular automation, there’s a lot to think about. What’s the layout of your laboratory, or what physical space do you have? What kind of laboratory are you operating – a large academic hospital laboratory? A small, rural lab? What kinds of tests are your staff most often performing? The answers to these questions, among others, can help you make an informed decision.

A Large Scale Approach

Talking about a TLA solution may actually be a misnomer, Markin noted. “TLA was a trade name,” he said. “And there is no way you can actually automate every process in the lab.” The parts of the laboratory that can be automated with the current offerings, Markin said, are the ones that uses classic tubes – hematology, chemistry, immunology, urinalysis and coagulation.

The number one consideration that comes into play when looking at a TLA solution is cost.

“There’s a high upfront expense, if you’re willing to make the financial commitment,” said Robin Felder, PhD, professor and associate director of Clinical Chemistry, University of Virginia School of Medicine, Charlottesville. “But I have yet to see a lab that regrets making the decision to go with a TLA-type approach.”

If you have the budget for a TLA solution, there are a variety of advantages. “You need fewer people to oversee an automated lab as opposed to a manual lab,” said Markin, who is also the medical director of Laboratory Informatics and associate vice chancellor for Business Development at UNMC. But he stressed this doesn’t mean that fewer laboratory professionals are needed with a TLA system.

“At the end of the day, we don’t have enough laboratorians,” he noted. “Having an automation system in the lab frees these professionals up to do more of the things they are trained to do and to use their intellectual skill set – not just feeding specimens onto instruments and taking them off.”

A TLA system can also help create a uniform turnaround time for your laboratory, a nice advantage for laboratory staff and for the clinicians who need test results, Markin added.

Seeing a TLA system in action before purchasing one can be a little difficult, however. You can’t have a vendor representative bring a TLA system to your lab to show the staff how it works, Felder explained. “It creates a lot of shopping challenges because you have to visit other labs that have them installed. But usually there is one relatively close by,” he said. “You used to have to fly around the country to see them.”

The Modular Way

For laboratory administrators who can’t shell out the big bucks for a TLA solution, a modular approach may be the way to go. Richard Hammer, MD, director of Hematopathology and Coagulation at the University of Missouri School of Medicine, Columbia, said his laboratory has some modular automation. “Many people go the modular route, and the reason being is the cost,” he said. “The way things are now, you can add on enough modular systems over time that they can turn into a TLA system. But most labs can’t afford to automate the whole lab at one time. So what we try to do is automate the areas that have the highest testing volume first.”

“Modular automation is a nice way to creep up to TLA,” Felder agreed. “The lab can see benefits almost immediately. It’s baby steps instead of big steps.”

Hammer noted his laboratory is currently looking to buy a hematology analyzer, and they are continuing to go the modular route. “This way, we can decide the amount of money we need to spend to manage the volume we’ve got,” he explained. “We get to choose vendors based on their technology, and down the road, we have the option of plugging in another lab module into that same system to expand instead of starting from scratch.”

For smaller labs, in volume and in space, modular may be the way to get the most of your money. “A TLA system can be pretty big and take up a fair amount of space. A modular system allows more flexibility,” said Hammer, who is also an associate clinical professor of Pathology and Anatomical Sciences. “Everybody’s always fighting for space, and modular automation allows you to put many of these systems on the floor space or the desktop, depending on what it is.”

“With the consulting I’ve done, I’ve only picked labs that have a bowling alley shaped space for TLA, because I don’t want to design a system they won’t be happy with,” Felder added. “You need the right infrastructure first, and to get the right geography, before being able to upgrade to a TLA system.”

A drawback to modular automation is that the lab professionals still need to be responsible for getting specimens from Point A to Point B, Felder said. “This can lead to accumulation of specimens at various workstations and really slow the whole process down,” he added.

Purchasing pieces of modular automation means they may not all come from the same vendor. This could be a problem if you want the pieces of automation to integrate, Hammer noted, though there is software available to make this possible.

A Final Decision

The thought of picking between these two types of automation can seem overwhelming, but after thinking about your laboratory’s size, its volume, turnaround time, staff needs and service lines, along with how much of a budget you have, the answer is probably clearer.

“It’s like having a patient visit a doctor and say, ‘I have a headache,'” Markin compared. “You need to ask all the questions to find out what you need to make the correct diagnosis.”