On Autopilot

Automation in the clinical laboratory ranges from single-task devices smaller than a breadbox to total laboratory systems that ingest samples at one end and eject results at the other, with human attention required only for exceptional situations. Today, most laboratories are working with a level of automation somewhere between those two poles, with larger facilities tending toward higher levels of automation. Nearly all laboratory processes that do not require human judgment or expertise can be automated to some degree. Hundreds of manufacturers are active in this field, and most of them produce a long list of automation devices and systems. While the array of choices can be confusing, it also ensures that most automation needs can be met.

The individual combinations of circumstances that prompt a laboratory to increase its automation level can be as numerous as the technologies available, but they tend to fall into a few broad categories. Testing volumes are increasing for many facilities, and automation has allowed some laboratories to handle volume increases of as much as 80% without adding staff hours. In most cases, turnaround times for test results are reduced when automated systems are implemented. Error rates nearly always appear to decrease under automation, and misidentification of specimens typically drops as well. The primary motive for moving humans away from many tasks that can be automated, however, is to make sure that those humans will be available where they are needed most.

Staff shortages are affecting clinical laboratories across the United States, and projections based on training-program enrollment predict that the problem will grow worse. Every laboratory job category is affected; meanwhile, declining reimbursements and increasing test volumes force laboratories to squeeze the highest possible productivity out of every employee. Job satisfaction falls as a result, and some laboratorians decide to work in other fields. More, however, simply change employers, and laboratory automation can help a facility recruit these workers while it retains staff.

An automated laboratory can balance workloads so that high efficiency does not require a punishing pace. By eliminating routine tasks, automation can make work more interesting and professionally rewarding; many laboratorians may also enjoy working with sophisticated equipment in a state-of-the-art facility. Employee safety is enhanced by automation because exposure to harsh reagents and infectious pathogens is minimized. The chance that an employee will stay until retirement age can also be improved if automation improves working comfort and reduces the daily pedometer reading associated with the job. By combining these factors that promote employee recruitment and retention, a laboratory increases its chances of becoming and remaining adequately staffed.

Automation Today

While the permutations and combinations of automation found in any single laboratory may seem endless, the technology involved falls into two basic categories: total laboratory automation and task automation. A task-automation device may perform many individual tasks and handle many types of testing, but it still functions as a separate unit. Because newer equipment usually complies with industry communications standards, task automation can become part of a larger scheme, either when it is installed or later.

That larger scheme is total laboratory automation, which can involve:

• Task automation for individual activities
• Tracks and robots to move samples to the correct devices at the right times
• Enclosures to prevent hazards to staff (such as being exposed to pathogens or getting too close to high-speed equipment)
• Middleware to allow communication among all the system’s new and old components
• Software to balance staff and device workloads and to flag tests needing human interpretation or attention
• More software to run the laboratory automation system as a whole
• The laboratory information system that unifies the entire process

Naturally, the complexity of a total laboratory automation system is reflected in its cost. In all but its simplest forms, this is not an off-the-shelf purchase; the system is usually customized for each purchaser’s space, operating methods, workflow, testing volume, existing equipment, and budget. Most automation vendors (including Beckman Coulter, Brea, Calif) can help with system design and specifications. The facility may issue a request for proposals from multiple vendors, but service is an important component of a satisfactory installation, so it can be wise to favor vendors whose service departments are already known to provide good local response. Site visits to complete installations that have been running for at least several months can also help with vendor evaluation.

In an attempt to make total automation affordable for smaller laboratories and/or budgets, vendors have created modular systems that require less customization. One example is the Efficiency Series™ from Integrated Laboratory Automation Solutions, Inc, Troy, Mich. This series interfaces with track-ready instruments and uses a wide variety of tube sizes, providing sorting and delivery that increase productivity, the company says.

Whether a laboratory is ready to pursue total automation or decides to automate individual tasks, walk-away devices devoted to particular steps, tests, or combined functions will probably form the core of the system. Those chosen first should be problem solvers: If the staff time needed for a test is excessive, if the growing volumes for a test delay turnaround, or if the cost of sending out a test is too high, that test should be automated first. Many laboratories choose to automate the most frequently requested tests first; typically, these are hematology, chemistry, urinalysis, and coagulation, all of which are available in comprehensive, automated devices.

Dynex Technologies, Chantilly, Va, provides an example of a walk-away workstation with its DSX™ four-plate automated ELISA processing system. It handles adding samples and reagents, washing, incubation, and absorbance detection, and it can be used in immunology, infectious-disease, hormone, allergy, blood-chemistry, and drug testing.

The Sysmex CA-1500 (Sysmex America Inc, Mundelein, Ill) is a benchtop walk-away system that uses clotting, chromogenic, and immunological detection and user-programmable test protocols. This flexibility is complemented by a cap piercer that minimizes biohazards.

The OLA2500 Lab Automation System (LAS) and High Speed Sorter (HSS), both from Olympus America Inc/Diagnostic Systems Group, Center Valley, Pa, are intended for facilities with medium to high testing volumes. The LAS performs high-throughput aliquotting, decapping, and sorting, and has preanalytical and postanalytical sample-processing functions. The HSS is a front-end sample processor that decaps tubes and sorts them into their destination racks, in addition to performing postanalytical archiving.

Roche Diagnostics, Indianapolis, offers the RSD 800 task-targeted automation system to handle preanalytical and postanalytical steps for up to 800 samples per hour. It is designed to make staff safer by eliminating repetitive stress injuries and reducing exposure to biohazards.

Beckman Coulter offers the Power Processor to automate preanalytical processes: logging in, sorting, centrifugation, and cap removal, with a throughput of 300 tubes per hour. The companion Hematology Outlet automatically sorts hematology and other noncentrifuged samples.

The Nemesis 7200 automated slide stainer (Biocare Medical, Concord, Calif) allows individual slide or identical programming to optimize staining. The company says that it also improves speed, flexibility, and costs for staining, while providing detailed reports and tracking of reagents and slides.

Automation can also be applied to reagents themselves to improve efficiency. Bar-coded chemistry reagents in cartridges to fit Beckman analyzers are available from Carolina Liquid Chemistries, Brea, Calif.

The Biomic V3 automated antibiotic susceptibility and identification system (Giles Scientific Inc, Santa Barbara, Calif) reads and interprets antibiotic disk susceptibility tests for bacteria and yeast, along with reading commercial pathogen-identification panels. An incorporated expert system based on published recommendations from the United States, United Kingdom, France, and Germany improves the quality and standardization of test results.

Gen-Probe Inc, San Diego, makes the Direct Tube Sampling (DTS) family of automation systems in three capacities: 400, 800, or 1,600 results per hour. All reactions take place in a single tube with a penetrable cap, and the DTS system’s design minimizes cross-contamination.

Immunicon Corp, Huntingdon Valley, Pa, offers the EasyCount System. This fluorescent microscopy-based imaging system uses a single test lasting less than a minute to calculate cell viability by counting dead and living nucleated cells. Four wash cycles, spin time, decant speed, number of agitations, and rpm are programmed by the user of the UltraCW automatic cell washing system (Helmer, Noblesville, Ind), with five programs stored for regular repetition.

Recent Innovations

At the LabAutomation2007 conference in January, the Association for Laboratory Automation gave its New Product Award to the Benchtop System (Symyx Technologies, Inc, Santa Clara, Calif). This self-contained unit is capable of handling powders and liquids, and conducts sample heating, cooling, mixing, filtration and analysis.

The Capillarysys 2 (Sebia Electrophoresis, Norcross, Ga) automates electrophoresis testing, providing 90 serum protein results per hour. It also performs walk-away immunotyping (a newly patented process), carbohydrate-deficient transferrin testing for chronic alcohol abuse, and high-resolution and hemoglobin capillary electrophoresis.

Milestone Medical, Shelton, Conn, manufactures Pathos, an automated microwave high-throughput histoprocessor that the company describes as a leap forward based on a decade’s experience with microwave histoprocessing. Same-day diagnosis is made possible through same-day Pathos processing.

The Cell Growth and Discovery WorkCell™ (Thermo Fisher Scientific, Waltham, Mass) features the Cellomics ArrayScan imager, making it the first preconfigured system with image analysis; it is used for in-line image analysis and high-capacity cell growth.

Computype Inc, Minneapolis, has introduced Label Morphor II, a network print server that lets multiple locations automate sample intake by standardizing the bar codes, wording, and design of labels for microwell plates, test tubes, and vials.

Coming Soon

Automation will undoubtedly evolve as new forms of testing become more common. As each new development becomes too widely ordered to be sent out economically, an automated instrument will become available to handle it. Testing for cardiovascular events such as myocardial infarction and stroke is likely to be an area of rapid growth, as is molecular fingerprinting in general. Computer-assisted image diagnostics and molecular diagnostics are expected to become laboratory focal points. Genetic factors are increasingly associated with the likelihood of various cancers and inflammatory states; as this area expands, automated forms of screening and diagnosis can be expected.

Anatomic pathology is an area in which automation growth is predicted. Tissue processing and image viewing is likely to become more streamlined as robotic systems are widely employed. Specimen preparation is labor intensive and may provide great staff time savings as it becomes automated.

Choosing an Automation Level

Because of the broad array of automation equipment on the market, this is one area where the clinical laboratory will have no trouble finding a vendor to provide as much or as little technology as it wants. The difficulty lies in deciding exactly how much automation will produce the best results. A balance must be reached among the costs of equipment acquisition, operation, and service; the improvements that can be achieved in turnaround times, error rates, staffing needs, and testing volumes; and the positive effects of automation on staff recruitment, safety, satisfaction, and retention.

Want to read more? Search for “automation” in our online archives.

The volume of tests handled by the laboratory may be the deciding factor. The higher the testing volume, the greater the return on investment for laboratory automation appears to be, since equipment that is busy all the time is paying for itself. An exception to volume-based automation levels can be made, however, for the laboratory that performs a particular type of testing at an unusually low volume. Unless this work can be sent out without excessive costs or waiting times, it may make sense to buy benchtop automation. Many vendors supplying total automation base it on the laboratory’s existing processes in order to minimize disruption and lessen training time, but it makes no sense to automate a mess.

Kris Kyes is technical editor of  CLP. For more information, contact .