ANAHEIM, CALIFORNIA – As laboratory staffing shortages persist, many laboratories have turned to automation to fill in gaps in the workflow, while instrument manufacturers tout their automated platforms and total automation solutions as tools to alleviate staffing concerns.
But while automation can be a significant help in certain parts of the laboratory process, laboratorians caution that instruments developed to lessen the need for manual labor in the lab must still be utilized correctly to have an impact.
On the sidelines of the Association for Diagnostics and Laboratory Medicine's 2023 AACC Annual Meeting and Clinical Lab Expo last week, laboratorians shared the benefits — and frustrations — of using automation in their labs to help with staffing concerns. Linda Cao, a microbiologist with the Texas Department of State Health Services, said that the agency has had difficulty retaining experienced technicians as some leave for higher-paying private company jobs and others leave the field entirely. That high turnover rate has led to technicians with only a few years of experience training incoming staff, creating a knowledge and experience gap.
Automation has been helpful in filling that gap for tests that the laboratory runs by the hundreds or thousands each year, but the laboratory also performs a variety of low-volume tests that haven't been worth the investment to automate, she said.
In contrast, some professionals, such as Merih Tesfazghi, director of core laboratory services and point-of-care testing at Rush University, are pushing to entirely automate their laboratories and minimize human error. He said he is looking for systems that can aliquot, deliver samples to any analyzer in the laboratory, and prevent sample mislabeling.
Total laboratory automation has been a focus for companies like Beckman Coulter Diagnostics, which offers a full automation solution, the DxA 5000 system, in addition to multiple automated instruments, such as its recently launched DxI 9000 analyzer. Tom Neufelder, the firm's senior VP of software, systems, and automation, said that Beckman Coulter's focus with its automation solutions is on eliminating manual steps wherever possible and reducing errors.
The company has seen the highest penetration of its DxA 5000 Total Laboratory Automation system in core laboratories, and about 33 to 35 percent of its customers use TLA, he said. Demand has also been high in the firm's high-growth markets across the globe, such as Southeast Asia and the Middle East, as well as in China.
But not all laboratories are interested in full automation. Two scientists working in a small federal government lab, who requested anonymity because they did not have permission to speak publicly about their work, said that they are looking for small modules that can automate specific tasks, such as those involved in their mass spectrometry and sample preparation activities, including automated liquid handling and extraction. However, they have seen few options that would provide the flexibility they need, and adding even small automation components would require work to develop standard operating procedures and would raise ongoing concerns about the speed with which vendors could service malfunctioning machines, they said.
Roche Diagnostics, which is developing a fully automated mass spectrometry instrument, has made automation a "strong area of investment," said Brad Moore, president and CEO of Roche Diagnostics North America. Two of the firm's primary automation systems are the Cobas 8100 and the Cobas Connection Modules, and the company has seen widespread adoption of both systems, he said. Many of the company's innovations will be focused on the CCM, he added, and by early next year, Roche is planning to launch a vertical track on the CCM that will allow vertical transport of samples to open up walkways and throughways in the laboratory.
According to Moore, the response to its automated systems has varied across the customer base depending on the degree to which laboratories are looking to automate, but many customers want to automate across different Roche platforms as well as with other third-party systems. Roche has collaborated with other companies, such as Sysmex and Diagnostica Stago, to ensure its platforms can work with those firms' instruments to expand automation options.
Integration across many types of platforms was a necessity for Ronda Greaves, the deputy head of biochemical genetics at Victorian Clinical Genetics Services, a wholly owned subsidiary of Murdoch Children's Research Institute in Australia, when automating her newborn screening laboratory and transitioning to qPCR for part of the laboratory's workflow. Greaves said she went to multiple companies to find an automation solution, before deciding on a Beckman Coulter solution, partially due to its ability to integrate instruments from multiple companies. Beckman Coulter put together a multi-vendor package that incorporated platforms from Beckman, Thermo Fisher Scientific, and Agilent Technologies.
About 90 percent of her newborn screening laboratory is automated, and while staffing shortages weren't a main factor in the lab's transition to automation, she noted that automation has helped with certain staffing concerns. One benefit of automation is the ability to avoid repetitive strain injuries that can occur with some manual operations, ensuring that technicians aren't taken out of the laboratory when they're most needed, she said, adding automation has also allowed technicians to learn different skill sets to keep their jobs interesting.
Laboratory injuries were also a point of concern for Leonard Holtegaard, a senior systems engineer for the department of laboratory medicine and pathology at Mayo Clinic. During a talk sponsored by Abbott at the AACC meeting, he noted that injuries that take technicians out of the workforce for long periods of time place a burden on the other staff who are already struggling to keep up with increasing test volume growth. Laboratories will need additional staff to handle that growth, as well as to fill gaps created by laboratorians retiring, and automation can help address some of those pain points.
In addition to decreasing the amount of repetitive and tedious tasks and lowering the risk of musculoskeletal injuries to technicians, automation can empower them to work on more interesting and challenging tasks, improving staff engagement and retention, he said. Automation can also minimize human interaction and errors, but "automating just to automate is never a good idea," Holtegaard noted.
Total laboratory automation is often not a solution for lower-volume or lower-complexity laboratories, he added. Modular automation is usually the preferred method, and in his experience, extraction is the task that most laboratories want to automate.
But Holtegaard said that total laboratory automation should be a consideration for all laboratories in the future as testing volumes rise and the staffing shortage continues. Laboratorians shouldn't expect the shortage to improve, he said, and as they plan for the future, they shouldn't count on staff who aren't already in the lab.
Sharon Bracken, president of diagnostics for Siemens Healthineers, also forecast a near-term rise in laboratory testing volumes that, combined with the labor shortage fueled by practitioner fatigue, retirements, and high turnover rates, has forced laboratories to rely on inexperienced technicians to manage testing demand. As a result, improving the ease of use for automated systems is a priority for Siemens.
In a Siemens press conference at the AACC meeting, Susan Dawson, laboratory director at the NorthShore University HealthSystem Swedish Hospital in Chicago and Skokie Hospital, said that her laboratory uses Siemens analyzers and software to optimize workflows and perform maintenance, quality control, and calibration tasks. Reducing manual labor frees up time for technicians to look at abnormal test results and perform the remaining manual tests, which ultimately benefits patients, she said.
Difficulties filling open laboratory technician positions are also contributing to the need for automation, said Nichole Howard, marketing director for Diagnostica Stago. Allowing technicians to focus on tasks that require expertise and automating those tasks that do not is essential, she said. "Everywhere that we can possibly automate a process that does not require their technical expertise and training — as manufacturers, we have to do that," she said.
For Diagnostica Stago, that has included incorporating end-to-end automation, algorithm-driven reflex testing, and scheduled quality control tasks, she said. In June, the French firm launched the newest version of its Max Generation analyzers, the STA R Max 3 and STA Compact Max 3, which automate pre-analytical sample management and check sample fill volumes, hemolysis, icterus, and lipemia. The instruments work with total laboratory automation lines on the market and Stago's STA WorkCell Max coagulation automation line.
Not everyone is sold on automation as a solution for the staffing shortage, however. Frederick Strathmann, senior VP of the US business at Mobilion Systems, said that automation can be a great way to increase throughput but that it does not alleviate the number of people needed in a laboratory.
While automation can be a solution in some ways, "it's been applied at parts of the workflow that maybe were not the bottleneck that everybody … thought they were," specifically within the analytical side of laboratory operations, he said. Instead, many of the places that cause bottlenecks and could benefit from automation are pre-analytical, such as sorting samples, and post-analytical, such as data processing and analysis.
In his view, modular automation "has a lot of power" because it can be used in places where specific laboratories need help but allows for "flexibility in the overall framework."
Automation can also free up laboratorians' time to engage in other activities that they've been unable to manage, such as professional development, but the staffing gap will still be there. Automation "can narrow the gap between how much staff you need and how much staff you have," but it won't eliminate that gap entirely.
"As an industry, the assumption was that if you put in automation, you'd be able to operate with less staff," and that hasn't been the case, he said.