Size up this critical medical laboratory automation component.

Automation is a critical component in the progress and evolution of any medical laboratory. But automating a laboratory and all of its processes is not simply a matter of plugging in a few machines and watching samples line up for testing. Managers need to know what automation entails and how it fits in with their own circumstances. Because of the complexities inherent in the automation process, an explanation of those and a "how-to list" for the preparation of, transition to, and implementation of an automation line follows.

Why automate?

Most lab managers understand why automation is vital for confronting the challenges that lie ahead and recognize the importance of leveraging the opportunities it creates:

Automation can help alleviate the pending labor shortage due to fewer students. The shortage of medical technologists (MTs) is becoming more significant every year as fewer students enter the field. Annually, only 4,000 people nationwide are graduating in the field. Schools are graduating 30% fewer MT students than 10 years ago and 56% fewer MT students than 20 years ago. The shortage is so severe that it has caught the attention of the U.S. Congress: Rep. John Shimkus recently re-introduced the Medical Laboratory Personnel Shortage Act--a bill intended to encourage more students to pursue medical laboratory careers by providing financial assistance.

Automation can help alleviate the pending labor shortage due to retirement. Current professionals are reaching retirement age in disproportionate numbers. Forty percent of medical laboratory employees are between the ages of 46 and 66 according to the American Society for Clinical Pathology, and nearly half of the current workforce will be ready for retirement by 2010. The U.S. Department of Labor's Bureau of Labor Statistics estimates that 13,800 medical laboratory professionals will be needed each year through 2012 to fill vacant positions.

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Automation can help respond to the increased demands that will accompany an aging population. The aging baby boomer population will soon create increased demand for medical testing. By 2040, 26% of the U.S. population will be at least 60 years old, up from 16.3% in 2000, according to the Center for Strategic and International Studies.

Automation optimizes the functioning, effectiveness, and accuracy of a laboratory. Laboratory automation allows for more testing in a shorter amount of time. It optimizes workflow processes to provide rapid, accurate, and cost-effective test results. Workstation consolidation, which reduces the amount of manual testing that is necessary, typically results from automation.

Automation can produce a more dynamic and robust laboratory. Automation typically frees up medical technologists to spend more time on the difficult cases that require careful analysis and assessment. Automation can also help a laboratory move from being viewed as an expense into being viewed as a revenue-generating resource. With an increased capacity for testing, a laboratory can expand its client base by serving outside healthcare facilities in addition to accommodating in-house needs.

Considering the possibilities

The need for automation is growing, and the benefits are compelling. Still, automating a laboratory is a significant undertaking and one that requires dedication and preparation. Labmanagers should fully understand what they need as they begin the process.

The first step is to make sure that the staff will energetically champion the effort, because the desire for automation must be strong. As with any significant change, the decision to automate may be met with reluctance and hesitation--whether from management wavering over costs or from veteran technologists wary of change.

Even the most enthusiastic advocates for automation should ensure that taking such a momentous step is justifiable. Consequently, the lab manager must assess future needs as well as current requirements. The medical laboratory should already be conducting a sufficient number of tests to justify the initial expense, although future demand may be near enough and strong enough to offset current shortfalls. Today's medical laboratory that performs 400 hematology tests a day may soon be called to perform 1,000 a day. Will the new automation system be able to handle the increased workload? Also, if a laboratory is located in a geographic area with seasonal demands, these requirements should be built into the initial assessment. For example, laboratories in Florida and Arizona experience enormous surges in capacity demands during the winter months.

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The impact of transitioning

Experience has shown that the transition to automation impacts the laboratory in profound ways. Perhaps most importantly, an automated system reduces the amount of manual testing required and produces a corresponding improvement in test-result accuracy. If stringent rules and algorithms are put in place, fewer slide reviews or manual differentials may be necessary, and there will be less need for further manipulation of samples. Less sample manipulation means fewer opportunities for error.

Many laboratories use the transition to automation as an opportunity to reevaluate their own workflow rules and processes. They often review their autoverification rules or implement new tests that were previously unavailable, whether such tests offer improved precision or provide entirely new testing capabilities. Additionally, as the amount of throughput increases, more data is generated. The laboratory has to analyze more samples in less time, so decision rules, protocols, and priorities surrounding the data, as well as filtering of the data, need to be taken into consideration.

While the transition to automation causes operational and management changes in the laboratory, there are ways in which the conversion requires surprisingly little change. If the changeover is successful, laboratory customers will not see any disruption in services, since the outgoing system can typically be run in parallel with the automated system during the final transition stages. The switch to automation can be surprisingly quick, and preparation usually takes no more time than it does to bring standalone units online. Other laboratory staff members continue to perform the same functions as before--providing samples ready for testing and receiving results, although the new speed with which results are returned may be surprising.

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Communication counts

A critical step during the transition to automation is to initiate an effective communication program. As the decision to automate is being made, communication with decision-makers outside the laboratory must emphasize the current and future needs of the laboratory. Executive decision-makers may be inclined to consider the merits of competing bids solely on price. While the cost factor is certainly a significant one, lab managers know that issues such as reliability, flexibility, and expandability are also important, so they must effectively communicate the relative strengths of different systems and equipment.

When the decision to automate has been made and the process is in the preparatory stages, the lab manager should communicate with other key departments in the healthcare facility. In addition to showcasing the upgrades taking place in the laboratory, the lab manager can also solicit feedback on additional, and perhaps unexpected, capabilities that other departments would like to see put into place. Similarly, the manager should also ensure that the lab staff is trained appropriately and should make other efforts to optimize the transition. It is extremely important to reassure laboratory staff that their positions are not at risk and that they will probably be moved to other areas of the lab where their high-level skills, training, and expertise will be better utilized.

Communication and cooperation with the laboratory information system team is critical. New systems must be properly integrated with existing ones, and rules and algorithms that preserve the lab's ability to properly process abnormal samples and reduce the number of unnecessary manual reviews must be written. A good vendor will provide assistance with all of these tasks.

Implementation of automation is truly an exciting process. A medical laboratory will never be the same, and a well-managed, properly automated lab will be able to meet future demands in a more effective and dynamic fashion. With the right preparation and planning, transition to automation can be conducted in a strategic manner.

Brian Verne is the senior marketing manager at Sysmex America Inc. in Mundelein, IL.