CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Dr. Katz
“The labs immediately recognized that consolidating and streamlining testing into a central facility could save the system millions and millions of dollars.” The construction of the new core laboratory, which cost $30 million for the building and instrumentation, was a milestone of the integration process.
That the instruments were all replaced at once five years ago and are nearing the end of their normal life may seem to call for replacements on a large scale. But Dr. Katz doesn’t go along with that notion. She and other clinical chemists in the region believe “you have to have a good plan for when they break, but there is no requirement to change instruments if they are working.” At this point, she says, “we may want to stretch things out so we could potentially get to a line that has chemistry, immunology, coagulation, and hematology on it.”
The proposed line would be similar to the automation system operated by PCL Alverno in Hammond, Ind., she says, which allows multiple different instruments. The line Allina Health has now, an automation solution by Impeco, needs updating. “We don’t have that many lanes, different size test tubes are a huge problem, and how the lanes work in terms of computer programming is just old technology, not as sophisticated as the new versions are.”
Over the next six months, Dr. Katz says, the laboratory is bringing each of the major companies in to give a vision of where they think automation will be. “We don’t just want to see what their lines can do for us right now. We also want to see what they’re having in 2020 or 2022. We’re asking them to give us a visionary statement.”
She hopes Allina Health can follow the Alverno model and integrate its testing. “But that would mean we’d be tearing down a fairly large portion of the lab and replacing the line we have. In terms of the health system’s point of view, they just gave us $30 million, and I don’t know if that would be able to happen again in 2020. So we may be forced to do something in the interim”—at least to get a better-functioning line.
The laboratory will certainly need to change out its chemistry and immunology, Dr. Katz says. “That would come with any new instrumentation we bought, no matter what company we had. And we’d be able to get some other more specialty immunology testing instrumentation that would be compatible with an updated automation line, maybe with hematology too.” But it’s possible that the next remaking of the lab may have to be staged out over five years or possibly 10.
Dr. Anthony
This year Allina Health is implementing a whole platform shift on blood gas analyzers by purchasing 23 Gem Premier instruments made by Instrumentation Laboratory. “We don’t have them yet and we’re trying to figure out how they will work with our LIS, but it’s happening.”
The most time-consuming “pain point” is specimen processing, and that opens up multiple issues when considering an automated line. “The personnel are not MLTs, so their sophistication in terms of weeding stuff out and making decisions is not the same. We haven’t been good in how we centrifuge to get specimens online. Throughout the core lab, there was this idea that everything would be automated and super fast, but we gradually figured out that with things like vitamin B12, which was a high-volume test but the reagent itself is fussy, the techs were spending hours and hours doing lot changes.” Then the troponin turnaround time suffered, Dr. Katz says, because the vitamin B12 was blocking up the Architect immunology instrumentation. She sees fixing the specimen processing problem as a work in progress, largely guided by technologist observations of workflow.
Trying to push the technology a little further is Allina Health’s challenge. “We’re okay now. The scary thing is, how do we get from this stage of segmented departments to the next stage? How do we negotiate that transition without having a major shutdown that would affect our ability to test?”
To dodge that risk, she says, it’s understandable that some labs want to take everything, even instruments that are working, and change them every five years. “The question is, can we negotiate our way through a longer period of time, not be as wasteful, and also get to another further technological leap?” For Dr. Katz, that’s the balancing act that laboratories must continue to perform as they make tricky decisions about new instrumentation.n
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Anne Paxton is a writer and attorney in Seattle.