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Skilled manpower will be required in order to validate automated process

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Dr Ajay Phadke, Centre Head, Dr Avinash Phadke Pathology Labs, shares with Prathiba Raju on how automation in diagnostics sector is becoming an essential factor as it brings in efficiency, speed, precision and cost efficiency

Why is it necessary for the Indian medical diagnostics industry to be automated?

Adding technology to pathology testing to automate processes can be precise, accurate and a quicker option. It not only allows a larger throughput, but also reduces the chances for errors.

In addition to this, there are many changes that constantly occur in testing methodologies, which automation can easily adapt to.

Automation reduces efforts invested into inventory management and consolidation of equipment, and also expedites diagnostic processes such as sample barcoding, separation, processing and archival. In contexts where manpower is expensive, or where trained manpower is hard to find, automation works well in terms of economic sustainability. Artificial Intelligence (AI) has proven to be helpful in analysing slides and to understand complex specimens in segments like molecular diagnostics and histopathology. When we look at the speed and efficiency of technology, one must also think about access. Functional medical practice is something that must have wide geographical accessibility for it to be most effective. Technology, verticals such as molecular diagnostics have become more accessible to rural areas with the use of portable products and point of care devices.

How and why robots and AI are considered to be smart and a better option than qualified pathologists? Aren’t there any possibilities of malfunctioning? If yes, how do you resolve it? Any instances?

AI is a technology that can imitate human thoughts to perform certain actions. AI can perform simple as well as complex tasks, depending on the level of programming used to create it. In medical lab testing, robots can find effective application to analyse slides and produce organised results for certain simple tests. One concern that is often raised pertains to whether these robots will replace pathologists in the near future. Well, the answer is no. While, technology is accurate, it does require human interpretation. The results produced by AI need to be analysed by a pathologist with hands-on experience in order to be sure. Of course any robot can malfunction and that is why quality control in this field is absolutely essential. When it comes to errors, technology always needs to be calibrated to keep it up to mark. This helps to reduce the incidence of malfunctions and can also alert professionals to stop processing samples in case of such issues. Moreover, healthcare is not limited to addressing the functional needs of patients; it also needs to provide psychological assurance to them. A robot can’t serve this function, and hence, will never be able to fully replace a pathologist.

Which is more in use — robots or cobots?

Currently, the diagnostics segment has a mix of both. What sets a robot and a cobot apart is the level of autonomy that they have in the tasks they perform. A robot is something that has the ability to completely replace a person. In simple manual tasks like barcoding of samples, this is definitely possible. For such tasks, the programming of the robot can help it reach higher accuracy and efficiency than a human. However, with more complex tasks, a cobot would be a better option. A cobot is a collaborative robot that assists humans in their activities. In histopathology report, for example, a cobot would look at the regions of a slide that seem important for the pathologist to examine. This makes it easier for experts to focus on potential areas of concern with greater efficiency. Such processes can aid quicker diagnosis. Similar collaboration can be applied for c tests and Pap smears. In future, cobots seem to be the technology of choice, as they allow a balance between automation and the human intervention rather than completely replacing human professionals.

With increasing automation and robots in labs, what will happen to the skilled and unskilled workforce in medical diagnostics centre?

The possibility for complete automation of laboratory testing depends on context, as well as the number of samples being dealt with. Let’s take a simple example. In countries such as New Zealand and Sweden some labs run up to 10,000 samples daily, with only 7-30 human staff. But in India, the same volume, if not more, are handled by around 50-100 individuals. Total lab automation means that barcoding, aliquoting, processing, reporting of data, filtering abnormal data and archiving data are carried out by automations. However, the need for qualified and experienced professionals, who can provide their expertise at important junctions involving deeper investigations, is undeniable. Skilled manpower will always be required in order to validate automated process. Moreover, increasing use of automation in the West is also associated with higher cost of manpower. In many cases, automated equipment is sourced by laboratories from a host of different vendors. However, the functionality and cost is improves immensely when one vendor provides uniform, seamless automation. This potential is hard to achieve. Total automation is something that is hard to do, as pathologists, who sometimes focus on niche problem areas, need to be present in order to utilise their skillsets and add quality and surety to the automated diagnostic process.

How do robots help in the precision of clinical decision?

When we look at the precision that robots bring to diagnostic processes, the advantages are considerable. In the context of pathology, diagnoses and barcoding are based on fixed processes that are performed with greater accuracy by automated technology. Thus, the variability introduced by human action can be reduced. Higher accuracy and precision in diagnosis can be achieved, when clinicians and robots are able to collaborate effectively.

How does the Indian diagnostics industry respond to the utilisation of automation?

With both sustainability and technology at the forefront of Indian society, the changes are more than welcome. India’s deep affinity for technology reflects in the rampant use of screens and mobile devices across the country. It is no wonder that there is a positive connotation associated with technology in medicine as well.

Moreover, as the years pass, the cost of manpower will increase, leading to higher company expenditure to attract and retain employees. With time, there will be more pressure on smaller laboratory ventures to increase productivity by acquiring technology to stay competitive. That is one side of automation. The other and probably the most important side of technology adoption is to deliver faster and advanced diagnosis. With around 70 per cent of medical treatment being dependent on diagnostics, it becomes imperative for the industry to consistently provide accuracy in a timely manner. And technology will serve as a critical enabler to deliver quality healthcare support to patients as well as clinicians.

Consolidation of healthcare in larger metro cities and tier 1 cities is inevitable. This will be fuelled by more automation, point of care devices and higher accessibility by providing services in the patient’s home environment.

How cost effective is automation?

The crux behind using technology in medical laboratory testing lies in efficiency and cost-effectiveness. As mentioned before, a high load of sample on a daily basis is made easier to handle by technology. However, if a laboratory receives five samples daily, and the machine requires a 100 minimum, it does not make sense to automate the process, as the revenue being made by such a small turnover will take a long time to meet the down payments for such equipment. Another case is moving from ELISA to CLIA, which provides better signal detection, but requires more expenditure. In case where manpower is expensive, as in most western countries, automation can be effective towards reducing expense of larger workloads. The cost savings in terms of reagent pricing as well as manpower hour reduction only works when the workload is substantial.

Earlier, smaller labs would outsource a lot of tests such as vitamin D, thyroid etc. to central chains since they didn’t have a cost-effective option to start these parameters in-house. Now the advent of smaller, fully automated systems with a wide test menu, it is possible for them to process a lot of these samples in-house at a very cost-effective rate.

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