In this article:
Three key benefits of automation
• How automation has helped decrease HIV transmission
• Questions to ask before buying
The "rise of the machines" may be ominous to some, but in the molecular lab the rise of automation is a welcome innovation. Continuing advancements in automation have led to — in most cases — increased productivity, efficiency, reliability and confidence in molecular testing. What once was done manually can now be performed by automation, producing results in a fraction of the time.
It has become a game changer in the modern day molecular lab for ease-of-use and state-of-the-art functionality. Automation can be a huge advantage for lab directors, but it must be used carefully and monitored appropriately.
What are the Benefits of Automation?
1. Faster, more accurate results“Automation is any laboratory process that is no longer manual, no longer requiring hands-on technical expertise and time. Automation can help us report more accurate results, more quickly. These faster and more accurate results will improve patient care,” said Kathleen G. Beavis, M.D., Chair, Divisions of Microbiology and Virology at Stroger Hospital of Cook County, Chicago.
Rapid automation makes it possible to obtain test results the same day. This is extremely beneficial in many situations, such as HIV, where a molecular test can be performed to measure the HIV viral load in newly diagnosed, hospitalized patients. “At Stroger, if a patient has blood drawn, we automatically test for HIV unless the patient has opted out of this testing. If it comes back positive for HIV, we can quickly perform a viral load test and consider the results in beginning therapy,” said Beavis.
Fast automation results have also played a critical role in helping to stop the transmission of HIV to infants during delivery. “When women come in to deliver a baby, we do a rapid test if the mom's HIV status is unknown. If it’s positive, we like to get a viral load on the mom and the baby. With an automated system, we can get results the same day,” said Beavis. “If we have a positive result on the rapid test, we can administer anti-HIV drugs to prevent transmission to the baby during delivery. We can also counsel the mother whether to breastfeed or not.
“Ten or 15 years ago, pregnant moms would transmit HIV to their babies during delivery 30 percent of the time. This has been cut drastically. Very few babies are born these days with HIV thanks to this rapid testing and the drugs given during delivery. This is truly an HIV success story,” she said.
The use of automation has also made it possible to use a small specimen and still get accurate results. “It can be hard to draw even small amounts of blood from infants. Our automated HIV platform offers different protocols depending on the amount of blood available. We can still get a reliable result with a short specimen. This is a huge advantage.”
According to Beavis, automation can often improve turnaround time, but not always. “Years ago, we had an internal workforce study that showed the technologist was actually faster than the instrumentation when performing serologic testing. But there are other factors — we still wanted to reduce transcription errors and be more precise.”
2. More reliable resultsAutomation lends itself to reliability in a couple of ways. The technology advancements have lead to the improvement of computer systems that provide labs with the ability to interpret, store and manipulate data. System interfaces allow the information from the instrument to go directly to the hospital laboratory information system (LIS). This has eliminated transcription errors and the time involved in writing down, entering and checking results.
Second, with less hands-on time per run, labs are seeing less human error, and as a result, consistent and reproducible results. Rapid, reliable results lead to better patient care.
“In Illinois, if you want to maximize public assistance for HIV drugs, you have to submit HIV viral load levels to a government database. If we don’t get the information in on time, the patient can lose funding,” said Beavis. “The automated HIV assay is so reliable and so fast that we will not miss a deadline because a test was delayed or had to be repeated.”
She stresses that it is important, however, to be diligent in monitoring quality control. Instrumentation can fail, or mechanical issues can cause a failed run. “Many times a manufacturer can replace the kit used, but you lose the time used to put the run together,” said Beavis.
If you are looking to purchase new automation, it’s always advisable to do your homework, get references and consult peer-reviewed literature. “Call a lab director you know and ask, how often is the instrumentation down? Is it mechanically reliable? How is the service from the manufacturer? Ask your manufacturer representative for a clinical evaluation that shows the percentage of failed runs.
“Selecting automation should be done carefully. Search for an automation solution that fits the needs of your lab and your staff,” she said.
3. Workflow efficiency and personnel benefitsWith the high throughput expected from today’s molecular laboratories, automation is an efficient way to streamline your workflow. Molecular analyzers are increasingly becoming easier to learn and easier to use, so training time is reduced. Automation also reduces hands-on tech time and increases your personnel options in the lab by freeing up techs to do something else.
Extracting nucleic acid is very laborious, very manual, and less precise when performed by hand. Now, specimen extraction can be automated. “We used to have two techs, one for manual extraction of nucleic acid and another to run the system. It is very tedious work, and they had to be very good with their hands. With automation, the techs can do more interesting things,” said Beavis.
“Technologists with a lot of expertise and advanced degrees are not common and can have higher salary costs. If done right, the more specialized technologist can help with the verification and training, and you can use a less specialized technologist to do the actual testing. That is a huge advantage to the lab,” she said.
For example, Beavis has a medical laboratory technician on staff who turns out hundreds of molecular results every day for chlamydia and gonorrhea after a technologist or supervisor has reviewed the runs. “That shows the confidence I have in the STD automation. In the past I would have had to assign a much more specialized technologist, which means it’s more expensive to run the test. Automation allows you to use a generalist instead of a specialist. If something can be done with less specialized technicians or technologists, saving my specialized technologists for result review and quality management functions, that’s how I want to get it done. The generalists are exposed to the automated molecular testing and the specialists are constantly learning and implementing new tests.”
In an industry where highly trained techs are hard to find, it’s important to keep your staff happy. With automation, you can have more flexibility with assignments. “I have specialized technologists who always want to keep learning something new. They get bored when they master something. I want to keep them interested,” said Beavis. “I also have specialized technologists who like to drill down and master every detail. These technologists are invaluable when troubleshooting is needed.”
- Murray P, Baron EJ, Jorgensen J, Landry ML, Pfaller M. Manual of Clinical Microbiology, 9th edition. Washington, DC: ASM Press, 2007, p. 192.