Evolving Trends of Automation in the Medical Laboratory

CHAPTER TWO
LITERATURE REVIEW
2.0 INTRODUCTION TO MEDICAL LABORATORY AUTOMATION:
Medical laboratory automation technology encompasses a wide range of instruments, equipment, and software designed to automate and streamline various laboratory procedures and processes. The field of laboratory automation has been transformed by advancements in robotics, artificial intelligence, machine learning, and microfluidics. These advancements have empowered researchers to conduct tests with enhanced accuracy, efficiency, and consistency (Yu et al., 2019).
Modern laboratory medicine is characterized by an era of automation. The concept of laboratory automation was initially introduced by innovations like the AutoAnalyzer, which facilitated continuous flow analysis, and the Robot Chemist, which automated traditional manual analytical steps. Subsequent generations of stand-alone analyzers have significantly transformed laboratory medicine by enhancing efficiency, increasing throughput, expanding assay menus, and reducing errors (Genzen et al., 2018).
2.1 HISTORICAL EVOLUTION OF AUTOMATION IN MEDICAL LABORATORIES
From as early as 1887 history of predictions for the future of medical laboratory science was collated to demonstrate the merits, and demerits of the predictive process. The review examined laboratory organization and staffing, automation and robotics, computing and information technology, analytical techniques and technologies, point-of-care testing, telemedicine, micro-technology, nanotechnology, proteomics, evidencebased medicine, and microscopy and histology. Since this extensive historical review, others have also examined “the future of laboratory medicine” (Hallworth et al., 2015)..
The birth of laboratory automation is dated in the 1950s, when application of flame photometry for clinical measurements and peripheral blood cell analysis using impedance techniques were first introduced. Since then, the shortage of laboratory professionals emerged as an important problem in Japanese hospitals during the mid-1970s. Masahide Sasaki, supported by a team of 19 medical technologists, first developed conveyor systems, robots that loaded and unloaded analyzers and supporting process control software systems in the clinical laboratory at the Kochi Medical School. The first phase of the clinical laboratory automation has occurred in analytical instrumentation. Clinical chemisatry laboratory gained the first automated analyzer, AutoAnalyzer, in 1956, which could analyze only limitednumber of analytes: urea, glucose, and calcium. AutoAnalyzer evolved into Tecnicon single and multichannel continuous flow autoanalyzers in very short time (Kochi, Japan), thus leading the way to the first automated laboratory, originally defined as a “fully automated laboratory system”. (Armbruster et al.,., 2014)
Automation is one of the greatest breakthrough in the recent history of the diagnostics laboratory sciences. Laboratory automation began in the 1950s and has progressed throughout the decades to reduce the turnaround times in laboratory testing and eliminate the human errors. By replacing the repetitive and laborious manual processes involved in laboratory testing, automation has reduced the overall errors and allowed laboratory technicians to focus more time and energy on quality assurance.(Yeo et al., 2018). Five or more decades earlier, the term automation was used to describe the test processes in clinical chemistry analyzers. However, during the past two decades, the automation has also covered extra-analytical processes, which have become substantial for the efficiency of clinical laboratories (Bakan et al., 2017). A high-quality test result means it must be correct and be reported as soon as possible, i.e., short turnaround time (TAT). The automation in the clinical laboratory has evolved together with evolution in the automation-manufacturing industry. During this progression, laboratory testing has grown from a manual process with very narrow, simple test menu to an automatically-processing instrument with very large test menu and high throughput. Similarly, the automated analyzers have evolved from fixed, simple automation to a programmable, versatile, more complex automation. Because of this progression, one can change the old statement “laboratory automation is nice to have’’ into the new one “the automation must be present in every modern laboratory”. (CLSI 2009)
In terms of accuracy, laboratory automation stands out as a defense against the risks associated with errors in the diagnostic process. Manual handling of samples and analysis execution are prone to variability and mistakes, which can have implications ranging from misdiagnoses to inappropriate treatments. By adhering to predefined protocols and executing tasks meticulously laboratory automation greatly reduces the chances of error. The research provides an example by demonstrating a decrease in error rates associated with automated testing. This error reduction is highly relevant from a perspective that underscores the importance of accurate test results for making appropriate clinical decisions. Automations impact is particularly evident when it comes to routine tasks within the laboratory. These tasks are inherently susceptible to error, making automation incredibly transformative in this aspect. Automated systems excel at executing these tasks without succumbing to fatigueinduced lapses in attention. This reliability is crucial, for ensuring results, which form the foundation of clinical decision making. This clinical manifestation provides insights that show how automation can effectively decrease errors, in clinical testing.(Sutton et al., 2020)
2.2. EMERGING TECHNOLOGIES IN LABORATORY AUTOMATION