A study at Tel Aviv Sourasky Medical Center showed that remote digital morphology could be used to provide services remotely without disrupting laboratory workflow.

 By Lianne Trantz

Across industries, the COVID-19 pandemic transformed how people view their workplaces. Among the lasting outcomes is a new cultural expectation that employees will stay home when sick to avoid transmitting illnesses to colleagues. Coming in sick is no longer a badge of dedication; it’s a threat to your team. What’s more, there’s greater acceptance of and hunger for the flexibility of remote work. These changes, however, create challenges for work environments that have traditionally relied on employees being physically present, including clinical laboratories that conduct diagnostic tests. Staffing shortages exacerbate this challenge; even a single employee’s absence can hinder the lab’s ability to serve care teams.

The longstanding barrier to remote work in the clinical laboratory is the need for highly trained experts to be physically present for preparing and reviewing blood samples using manual microscopes. While digitalization can benefit these workflows in terms of efficiency, the semi-digital systems currently employed to transmit images for remote review cannot fully replicate manual microscopy, which remains the fallback for analysis in many cases.

But what if fully digital workflows could be put in place in the laboratory setting? If the need for manual microscopy vanished from the workflow equation, could remote staff remain productive from any location? What would be the consequences on laboratory throughput, subsequent diagnoses, treatment of patients, and staff retention?

This idea was put to the test at Tel Aviv Sourasky Medical Center (TASMC), and the results were reported in a study published in November 2022 in Applied Clinical Informatics. The study’s lead author, deputy director of Hematology Laboratories at TASMC Ben-Zion Katz, PhD, wrote that the use of fully remote digital morphology “enabled personnel to continue providing their services from home, without disrupting laboratory workflow.”

The study was designed to assess the impact of remote peripheral blood smear (PBS) review on laboratory turnaround time (TAT) per PBS, workflow efficiency, and cost savings. It was especially focused on reviews required after hours and over the weekend. The hope was that remote review would make the overall morphology workflow more efficient.

Working Weekends: How Digital Morphology Affects Throughput

To conduct the study, TASMC’s hematology laboratory implemented and evaluated a novel, 100% digital imaging system with full remote capability.

TASMC regularly conducts about 38,000 complete blood counts (CBCs) every month and 970 subsequent PBSs when results are abnormal—a review rate of about 2.5%. The lab defines TAT per PBS as the time (in hours) between a flagged sample’s arrival at the lab and a corresponding final report’s release to the laboratory information system (LIS).

Four morphological experts are certified to sign LIS reports in the hematology laboratory at TASMC. Prior to the study, one expert would perform PBS analyses during the weekday morning shift, and none worked on weekends. Due to the resulting backlog of samples accrued over the weekend, two experts would be on-site during the first weekday morning shift.

The technology: Crucially, the system under evaluation provided a full-field view of PBSs throughout the process. The full-field PBS approach enables secure, browser-based viewing of all clinically relevant areas of interest on the scanned image at 100X, including the monolayer and feathered edge. Remote personnel who are authorized via TASMC’s secure network can zoom out to see the full context of the sample and zoom in on individual cells in much the same way as when using a manual microscope.

The results: Implementation of remote analysis on weekends resulted in a significantly lower TAT per PBS and decreased operational costs by reducing overtime weekday shifts. Notably, morphology experts were also able to deliver critical information to care teams outside of working hours.

  • Remote weekend viewing resulted in a 15.8% reduction in the overall morphology TAT per PBS at the laboratory over a five-month period, despite a similar overall workload.
  • TAT per PBS was reduced on the first day of the weekend by 41.4% and on the first weekday by 59.1%.
  • The additional hours incurred over the weekend were more than offset by a reduced need for double weekday shifts, resulting in approximately 12.76 work hours saved per month.

Full-Field Digital Morphology Imaging Makes Remote Analysis Possible 

In theory, conventional semi-digital systems enable remote analysis, but in practice, they provide only static snapshots of the scanned image. These snapshots often fail to provide experts with the full information required to make confident decisions.

Specifically, common conditions such as pseudothrombocytopenia and the presence of malignant cells may not be properly assessed due to the scanned field of view being too narrow, prompting the reviewer to conduct a manual microscopic review.

Full-field digital morphology imaging solves this problem by enabling confident, comprehensive, and consistent remote analysis through the secure hospital network. As a result, there is no need for trips to the lab for manual confirmation.

Remote Capacity On Demand

The timing of this evaluation during the pandemic created an opportunity to examine how digital workflows can alleviate on-site staff shortages.

On several occasions, one or more of the center’s cell morphology experts tested positive for COVID-19 and could not be present in the lab for extended periods during quarantine. Under normal circumstances, this would have caused a staffing crisis at the lab, potentially resulting in severe backlogs that would impact clinical decision making and treatment for patients. But in this case, things turned out differently: Digital morphology workflow was seamless, as staff quarantined at home were able to remain productive.

During the study period, the remote system’s full-field imaging capabilities gave quarantined reviewers access to all areas of interest on the scanned image, including the monolayer and feathered edge.

The study’s results and its concurrence with pandemic-driven staffing shortages create a strong case for digital transformation in hematology.

Digital Morphology: Essential for Efficient Operations 

By opening up weekend shifts to remote work, this lab was able to better distribute workloads throughout the week, reducing TAT per PBS by nearly 16% and saving nearly 13 work hours per month.

This study demonstrates that fully digital morphology can drastically improve clinical lab workflows by eliminating geographical constraints, making labs more efficient, flexible, and adaptable. These characteristics are vital in terms of both lab productivity and staff recruiting and retention.

Fully digital workflows can dissolve the physical boundaries of the clinical laboratory, paving the way for a new kind of remote workplace that benefits patient outcomes through optimized lab operations.

Featured Image: A study at Israel’s TASMC demonstrated that fully digital morphology can drastically improve clinical lab workflows by eliminating geographical constraints, making labs more efficient, flexible, and adaptable. Photo: Scopio


Lianne Trantz, VP of Marketing at Scopio Labs, where she communicates how the company’s digital cell morphology solutions impact clinical laboratories.