Laboratory diagnostics

Reaping the benefits of digitalization in the lab

To meet increasing test volumes, Dr. Lal Pathlabs typically added more instruments. Today, this high-volume reference network in India has a different solution.
Doris Pischitz
Published on July 24, 2023

Dr. Lal Pathlabs, one of India’s most prolific diagnostic laboratories, wanted to consolidate its test menu, improve turnaround times (TAT), and reduce manual work. The team used process automation and integrated information technology (IT) to scale operations while maintaining high standards of accuracy.

The success and growth of Dr. Lal Pathlabs was previously based on the early adoption of many diagnostic and IT technologies, task-targeted automation, and pre-analytical processing solutions. Together, these enabled the team to reduce downtime, increase scalability, and optimize efficiency. However, when testing volumes doubled over seven years in its National Reference Lab (NRL) facility in Delhi, India, Dr. Lal Pathlabs needed a new approach to their laboratory workflows. Its chosen levers were consolidation of the test menu and automation of the laboratory workflow to reduce manual touchpoints and minimize non-value-adding activities.
The lab partnered with Healthcare Consulting Solution (HCS) from Siemens Healthineers to evaluate and recommend enhancements for all incoming samples and off-track testing. The collaborative process started with a five-day onsite study to observe and measure workflows throughout the laboratory process, together with the laboratory’s staff. They then used actual laboratory data to uncover inefficiencies and quantify the impact of non-value-adding activities. Simulating various total lab automation (TLA) configurations that would a) streamline sample loading, b) connect dedicated chemistry, immunoassay, and third-party special testing, and c) enhance sample processing to automate cap removal, split samples, and sort and/or seal tubes all helped reinforce how a rules-based workflow could improve turnaround times by reducing touchpoints and non-value-adding activities. The results encouraged Dr. Lal Pathlabs to re-evaluate the separate workflows in its existing discipline-specific automation and to locate the sample receiving area (SRA) with integrated chemistry and immunoassay testing – and including TLA – on the same floor.

Thanks to these recommendations, the NRL facility now features one-touch, integrated chemistry and immunoassay testing with 15 Atellica Solution1 modules and two analyzers (non-Siemens Healthineers) connected to Aptio Automation1 in the core lab. In addition to monitoring day-to-day operations and maintaining uptime, Dr. Lal Pathlabs is using the business analytics reports in Atellica Process Manager1 to optimize the ongoing performance of people, processes, and instruments across the lab.
Dr. Lal Pathlabs network also installed eight Atellica Solution instruments across its larger satellite labs. A suite of deeply integrated Atellica Diagnostics IT1 software has expedited operational performance, quality control (QC), and result management at the NRL and two satellite laboratories. Implementing the IT solutions eliminated cumbersome and time-consuming manual tasks such as reporting for accreditation, compliance paperwork, etc., which took staff hours to do. The lab’s operations have improved significantly because technicians can now turn their attention to important tasks such as validating patient test results before they are sent to a physician.

Due to the COVID-19 lockdown, the Atellica Process Manager had to be remotely deployed from the support center that Siemens Healthineers runs in Mumbai. Its Throughput Analysis and Reagent Utilization reports were then instrumental during a subsequent COVID-19 surge in April and May 2021. At the time, sample and testing volumes quadrupled, while staff numbers fell by half due to illness or quarantine. To maintain peak throughput, Dr. Lal Pathlabs implemented onboard inventory monitoring alerts for key assays associated with the care of COVID-19 patients, including CRP, IL6, D-dimer, ferritin, and LDH. In addition, assay menus across the 15 Atellica Solution instruments connected to the TLA solution were rebalanced to speed up TAT for what had become a much-used new test pattern.

The new floor plan, SRA with automated bulk sorting, and TLA have reduced the number of manual steps for the lab technician from 34 to 14. This reduction is most obvious in SRA sorting: The process previously required five people and would take up to two hours a day. Today, a single employee can complete it in less than an hour. Fewer manual steps have also led to overall time savings and faster TAT.
Reduced and more consistent TAT were among the main goals for Dr. Lal Pathlabs. TAT measurement begins when a sample is loaded into a rack input module on the TLA system and ends when the result is released to the laboratory information management system (LIMS). Today, over 92 percent of samples are loaded, tested, and released from the TLA system in less than 120 minutes. Prior to TLA, only 80 to 88 percent of samples achieved this goal, and they exhibited greater variability. The solution has also enabled Dr. Lal Pathlabs to meet its target of three hours for overall time to report (OTR). This key performance indicator measures the time between the tube being scanned on arrival at the main lab’s SRA and the result being released to the healthcare provider or patient via the LIMS.
Primary tube aspiration and integrated testing on the track reduced the need for sample splitting and aliquots, saving costs and reducing waste. Sample splitting initially fell by 62 percent with automated bulk sorting in the SRA followed by chemistry and immunoassay testing on analyzers connected to the TLA solution. Much to the surprise of Dr. Lal Pathlabs, an additional 83 percent of savings was achieved in the final phase of the project, when Atellica Data Manager applied increasingly complex rule sets to drive advanced workflows.
Dr. Lal Pathlabs also saw a significant reduction in insufficient specimen quantity after the successful deployment of TLA and IT integration. These “quantity not sufficient” (QNS) errors are a result of not having enough volume of specimen to test for the parameters or panels ordered. Savings in aliquoting, a dedicated rack for error samples, and chemistry and immunoassay analyzers that can perform testing with less specimen volume helped reduce this type of costly and time-consuming error.

Automatic startup, calibration, and quality control (QC) routines without staff intervention further increased labor savings. For example, the instruments perform QC automatically using onboard refrigerated materials each morning, and results are available when the staff arrives. Removing human error and variations related to test and thaw time increases the effectiveness and consistency of QC. In addition to alerting staff if no QC material is available on the instrument, Atellica Process Manager software allows remote control of analyzers across the network, enabling staff to resolve these and other issues from a central location. Dr. Lal Pathlabs also configured Atellica Data Manager to evaluate patient results based on a robust set of autoverification criteria, including instrument flags, reference ranges, and QC performance with patient moving averages (PMA) tracking. In case of QC issues, the software suspends testing and redirects samples to an alternate instrument for the test
Additionally, Dr. Lal Pathlabs has been using Six Sigma as a quality management strategy that helped achieve levels of process consistency by identifying and remediating issues related to variation. Thanks to the new process, more assays meet the lab’s Six Sigma requirements.

Six Sigma measures process quality by evaluating how many standard deviations can fit within the tolerance limits of the process. The more standard deviations – or sigmas – fit between the mean of the process and the tolerance limits, the more robust the process.
These revolutionary changes and achievements represent a starting point rather than an end state for Dr. Lal Pathlabs. Based on time and cost savings, the focus has shifted to automating smaller sites in the entire hub-and-spoke network and improving workflows at blood collection sites to reduce patient turnaround time.
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By Doris Pischitz
Doris Pischitz is an editor in corporate communications at Siemens Healthineers. The team specializes in topics related to healthcare, medical technology, disease areas, and digitalization.