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Dr. Sushrut Pownikar
Head, Quality Assurance Department & Deputy Director, Oncquest Laboratories Ltd
As a child, I used to be amazed at Star Trek’s Dr. McCoy, when he could diagnose rare and exotic diseases with a tiny handheld device. The ease with which all the bodily functions could be monitored was not only futuristic but looked honestly; unbelievable. But today; Medical science is bridging that gap, in leaps and bounds. We now are literally splicing protein and finding out genetic defects at molecular level. We have better techniques, faster turn around times and intelligent networks that are changing the landscape of clinical diagnostic field.
Laboratory science is often at the forefront of innovation in medical technologies. So, what would the laboratory environment of the future look like? I believe there are three core elements that will decide this for us.
- Laboratory Automation
- Information Technology (IT)
- Testing or analytical technology
Automation has helped lab in all the three phases of patient testing: Pre analytical, analytical and post analytical.
Though preanalytical phase is still largely bereft of automation per say; prelabelled barcoding systems, automated centrifuging and aliquoting, sample rejections, sample distribution tracks and pneumatic chutes have changed the workflow from predominantly manual to automated mode. Some first world countries have labs that have robots delivering samples to the instrument inlet zone, taking over the role of ubiquitous “lab attendant”. In future, RFID labelled test tubes, app-based sample tracking systems, chip-based specimen tubes and automated accessioning on the spot will decide the fate of sample even before it reaches the lab. Another interesting development that happened during Covid times, is the advent of mobile labs performing highly skilled tests like real time PCR right next door. Technology has increased the accessibility and ease of getting tested. All that is left now is for robots to start collecting blood samples and recommending tests to the patients!
Automation has put its best foot forward when it comes to analytics. Labs of the future will work on artificial neural networks that will centrifuge, aliquot, share and distribute sample. Reflex testing, repeat analysis, critical alerts, delta check, and trend analysis is now in-built in many instruments’ software/ middleware. The bi-directional handshake between the Library Information system (LIS) and the instrument is a living breathing organism that communicates and decides which test is asked for, which to prioritize and what message to send forward to other instrument waiting for their turn to run the sample.
There is a multi-pronged focus on faster turnaround times, least amount of sample volume per test and new techniques for more specific and sensitive results. This not only increases the patient’s compliance but also reduces the cost of testing in the longer run.
A small footnote for Point of Care Testing or POCT; There was time when we had glucometers for sugar estimation, we now today in a position to do much more. A single drop of blood not only can test many more parameters like Hemoglobin, urea, HBa1C, cholesterol etc. but also can use your smart phone to analyze and generate instant reports for consultations. Post analytical phase has seen report deliveries, updates and critical alerts being automatically generated based on cut off criteria that are fed into the system. Technology also allows for reflex additional testing based on the interim results without manual intervention.
IT we all know, is revolutionizing the world and laboratory sector too is reaping benefits. With the help of a robust LIS and various algorithms at work, we can create rules that can define and monitor any lab process. The versatility of IT allows us to manage instruments and manpower from a remote location. Hi-resolution digital images and live imaging in future will make it easier to see slides and diagnose without then need of a microscope. Tele Pathology is increasingly being used for diagnosis and second opinion. IT is also helping in integrating all the spokes of the lab into a composite entity. Data analysis, quality and confidentiality protocols have become more robust and proactive, now that intranet and internet has increased accessibility. The humungous data is now being analyzed and acted upon with the help IT services. Information tech has enabled effective communication with all concerned be it, Patients, Clients, Doctors on the outside or lab on the other side.
There are no two ways about it, testing techniques in laboratory medicine have grown in an exponential way. Molecular techniques like RT PCR and CB NAAT were esoteric test then and are now common, not just because of Covid but also because of ease of availability and reduced costs. Cytogenetics is again a prime example, why cancer detection rates have gone up in general. In fact, physicians are playing catch up as newer tests are being launched in the market, even as they are getting introduced into the textbooks!
There is one more upcoming technology that hold immense potential and needs a mention over here. Nanotechnology is a science wherein miniaturized components are introduced inside the body with measuring sensors for biochemical analysis. This technology might also have a potential use in developing small, point-of-care tests.
With the mapping of human genome, genetics testing has come of age. Future technologies have the potential to detect not only susceptible cancer related genes but also help in the field of pharmacogenomics. Genes with adverse effects to drugs can be identified and help in patient treatment.
As we move ahead; science and technology are the key words that will drive us the laboratory people into the second half of the 21st century. In the words of Mr. Spock “ It will be fascinating to see how go ahead from here.”
