Work in the clinical laboratory has been transformed in recent years through advances in digital pathology, artificial intelligence, automation and digital information flow. The profound changes brought about by these technologies are only the beginning, and for the hospital laboratory, the future is now.
Digital pathology is poised to transform diagnosis
Expert analysis of a pathology slide is a critical step in many diagnoses, but it is often a significant bottleneck. In the standard pathology workflow, the same slide may need to be read by multiple pathologists at different institutions, delaying diagnosis. The entire tissue sample on the slide must be examined one field at a time, and multiple slides may need to be compared.
Digitization of an entire slide to create a high-resolution image file offers the opportunity to help solve each of these problems and more. Converted to an electronic file, the same image can be read by different experts with no delay, enhancing collaboration and second opinions. The whole sample can be seen at once, and multiple slides can be compared side by side on the screen.
Digitized images also provide the platform for use of image analysis tools, from simple software for quantification and annotation to advanced artificial intelligence algorithms that can identify and classify tumors for review by a human pathologist. Recent advances in digital cytogenetics and chromosome analysis are also poised to improve the accuracy and repeatability of analysis.
Digital pathology platforms in the hospital lab are likely to ease the burden on pathologists, reducing their workload of routine analysis while at the same time increasing the speed and accuracy with which they can provide diagnoses.
The development of digital pathology can also accelerate the use of remote pathology diagnosis, easing the staffing crunch many labs have experienced in recent years. Clinical Laboratory Improvement Amendments regulations for remote locations must be adhered to when setting up remote pathology. The ability of AI-based systems to analyze results reliably and reproducibly, partnered with trained personnel, can also increase productivity and quality in the clinical pathology laboratory. Allowing for automated validation of results based on algorithms has been an important cornerstone for laboratories, while leveraging AI to enable healthcare providers to avoid unnecessary tests is propelling the laboratory to the forefront of modern medicine.
The power of automation
Digital pathology is just a part of the lab of the future. Most aspects of lab operations can now be aided by, driven by, or entirely performed by robotics and other forms of automation. From barcoding to robotic sample pipetting to automated delivery, advances in automation have helped labs become more efficient and provide better results.
As clinical labs have confronted the challenge of staffing that is affecting the U.S., automation has helped pick up the slack. Automation of routine tasks can allow highly skilled, licensed staff to focus on higher-level procedures. Automated blood analysis systems can also cut down on the volume of samples required for analysis, an especially welcome change for very young and elderly patients, who may be limited in the volume of blood they can give.
Not every clinical lab will find the cost savings they seek in increased automation, and it is important to perform an in-depth analysis of current and future needs, as well as opportunities, before committing to any automated system. Economies of scale definitely come into play, and smaller facilities may instead find it economical to turn to an outside provider instead of investing in a major upgrade to an automated system.
Staffing is the past, present and future of the clinical lab
Investments in technology can offer major rewards for the right institution but cannot replace investing in personnel. As the clinical lab becomes a more complex, efficient and high-throughput system, top-quality staff become even more essential to reap the benefits of technology investments. The best-run labs may have the most advanced technology throughout their operations, but they achieve their potential only by having top-quality staff in all the key positions. Investments in staff and technology cannot be an either/or proposition—you need both to have a great lab.
The laboratory of the future will require technology resources that are complex and require significant investments. Partnering with a reference lab may be the most cost-effective way to obtain the benefits, both in better patient care and cost efficiencies, that new technologies can offer.
Tammy Germini, MBA, MT(ASCP), is the executive director, Operations – Health Systems, Quest Diagnostics. She can be reached at tammy.y.germini@questdiagnostics.com.