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As a consequence, those who have been successful in creating such platforms have gained enormous power to influence the lives of many people — not to mention enormous wealth. Read the guide to ethical platforms whole trend report below In the early days of the internet, some commentators trying to describe the new invention and the experience of using it reached for a particular metaphor with a physical space.

Within this metaphor, the online platform is the plaza or the pub: a place where people encounter and interact not just with a particular website, but with one another. Alibaba, the most valuable retailer, has no inventory. Something interesting is happening. But as these platform behemoths have emerged, it has become increasingly clear that they are causing real damage to the social fabric through value extraction, exploitation of workers, rampant collection and monetisation of user data and negative effects on whole markets and the environment.

The changes that these technological developments produce, especially how and where testing services are delivered and laboratory-staffing needs, are also discussed. Laboratory automated and manual processes occur in three stages: 1. Preanalytic stage: This includes, choosing the test, placing the order, preparing the patient, collecting the specimen, transporting the specimen, any specimen preparation work, and daily quality controls.

Analytic stage: This involves actual testing of the specimen and all routine procedures up to result reporting. Postanalytic stage: This is concerned primarily with forwarding results to the appropriate hospital department or physician and routine daily maintenance and shutdown Travers and Krochmal, In some settings, such as within the hospital, specimens are transferred efficiently using a pneumatic tubing system. In an independent laboratory setting, specimens are often transported manually by courier to the testing site.

In addition, most decisions about the adequacy of the specimen's volume and whether the specimen is in the correct type of container are made by a laboratory technician, not a machine McPherson, There are many opportunities to automate preanalytic processes. For instance, specimen containers can be prelabeled with bar codes that link specimens to identifying electronic information. The container may also contain substances that automatically prepare the sample for processing Felder et al.

Test tubes may eventually have computer chips embedded in the stopper Felder et al. Technology to automate many of the processes for aliquot 3 or specimen preparation, sample quality testing, specimen transport and handling, and automatic accessioning 4 exist but are not widely used McPherson, Test ordering over the Internet may increase efficiency and reduce administrative errors during specimen collection and processing. Machines eventually may draw blood specimens, and robots may transport specimens from hospitalized patients to the hospital laboratory Felder et al.

Analytic Stage In most laboratory settings, the analytic stage of testing is more automated. Beginning in the s, several rounds of sophisticated automation resulted in multianalyzers, which are multichannel instruments that measure many different analytes. A similar evolution occurred in the hematology laboratory, where the counting of different types of blood cells is consolidated and expanded to include automated differentials on the same instrument McPherson, A chemistry, hematology, coagulation, or urinalysis analyzer can now generate highly precise and accurate results in only a few minutes Cruse, Consolidation of tests and testing equipment is possible in part because operator activities for each type of test are interchangeable.

Emerging in the early s, consolidated workstations contain several instruments in one area. Typically, the area is managed by one technical person supervising several nontechnical staff Cruse, The workstation approach increases the productivity of the laboratory, reduces personnel costs, and dramatically decreases testing turnaround time TAT Cruse, Modular laboratory automation was introduced during the s and represents a more sophisticated design than approaches aimed at automating the entire laboratory all at once.

This technology permits the laboratory to begin with a basic configuration and add automated modules as needed. Thus, a laboratory can buy only the modular pieces that best meet its needs. It also makes integrating the new technology into existing laboratory architecture easier because the modular units are small and mobile Sainato, Only a few vendors of modular automation are in the market at this time Marietti, Robots may be part of a facility's modular laboratory automation system.

Although especially beneficial for tasks such as serology, blood grouping, and tissue typing, Lifshitz and De Cresce, , robots are not used as extensively by the clinical laboratory industry in the United States as they are in Japan. Enhancements in automated processing resulted in improved technical precision and accuracy.

In the s, test results were often transferred by courier or mail. In the s, they were sometimes conveyed over the telephone or via fax. Today, in some laboratories, the completed results are automatically forwarded to the appropriate area of the hospital or physician office electronically through the use of dedicated printers, and billing and utilization report generation is computerized McPherson, Use of the Internet to report results would likely reduce costs by eliminating the need for designated fax and telephone lines.

In addition, quicker TAT may lead to reduced episode-of-care costs. Many analytic and postanalytic tasks are now automated using process control software Markin and Whalen, For instance, repeat, reflex, 8 and add-on 9 testing are managed through electronic systems. Finally, these systems monitor consistency of results and ensure that panic values are called to medical staffs attention.

Billing and collection processes may become more automated in the future. Laboratories may automatically obtain and transmit all required documentation necessary for payers to process the claim through electronic systems e.

Additional information required includes referring provider information, the patient's copay responsibilities, diagnosis codes, and other data that might be necessary to demonstrate medical necessity. Typically this information is transmitted manually each time a test is ordered. Integrating electronic systems that automatically send updated information electronically every time a test is ordered would increase efficiency. There are steps that take place after the laboratory submits its results to the physician including physician interpretation and physician and patient action.

After physicians receive the results, they must interpret what those results mean for the patient. Sometimes the physician is assisted in interpreting results by normal ranges included in the laboratory report or a written explanation of the testing results. In some cases, the physician may consult with a laboratorian to better understand the meaning of the test results.

The next step is the physician's course of action. The laboratory tests may indicate that all test results are normal and that no action needs to be taken other than informing the patient of the results. Other courses of action might include additional laboratory testing, hospitalization, changing a medication or the dose of a medication, initiating a new course of treatment, monitoring the patient more closely, or counseling a patient to change certain health-related behaviors.

The ultimate outcome for the patient is not simply dependent on obtaining an accurate test value. It also depends on the physician's interpretation and the action taken by both the physician and patient. Laboratory experts that keep pace with emerging IT have found new, more efficient ways to communicate and provide services; educate themselves, their staff, and their clients; market their products; and manage data and information.

Because Internet-based communications are inexpensive and not hampered by time differences and geographic distance, experts predict that the Internet will become the primary means of communication in the future Burtis, ; Klatt, Requests for testing and test results will be communicated electronically.

Electronic image transmission will mean that hard-to-diagnose images can be sent quickly and efficiently to national specialty centers Wilkinson, Test result reports will be linked to journal articles and other sophisticated multimedia information sources Friedman, This capability may become more important with the increased use of genetic testing by general practitioners since physicians often do not understand the meaning of genetic test results Holtzman, Streamlining the cost of providing this additional information will also be important since individual consults with a laboratory expert are often not paid for separately and must be worked into the cost of the test.

The use of electronic systems creates the opportunity to improve laboratory services. For instance, laboratory results for certain tests can be influenced by drug use. Patient records could include all pharmaceuticals the patient is taking. The computer could then be programmed to identify cases in which the results are likely to be affected, and it may even be able to assist in the interpretation of test results and suggest appropriate actions to be taken.

Internet-based reporting creates opportunities to communicate test results directly to patients. In the spring of , Quest Diagnostics, a large national independent laboratory, began offering consumers direct access to test results via an Internet healthcare Web site owned by Caresoft, Inc.

Their physicians will have the opportunity to review the results before information is put on-line. Only routine test results are offered, and Caresoft sends personal identification numbers to users via the U. They also have access to technical libraries in electronic format Burtis, Experts predict that IT will radically alter the format and role of medical journals. They will be more electronically based with links to multimedia sources of information Berger and Smith, Information technology has created new marketing and advertising opportunities for laboratories Klatt, Increased consumer empowerment, new testing techniques that are simple enough for home use or home sample collection, and IT have combined to create new direct-to-consumer marketing opportunities for laboratory tests.

Laboratories may follow the pharmaceutical industry's lead by marketing directly to consumers and by making products directly available to consumers over the Internet. Consumers may prefer to bypass their personal physician for convenience and to keep test results out of their medical records. Most of these types of tests are paid for by consumers, so they do not have the incentive of insurance coverage to obtain these tests through their health care provider.

Collecting and analyzing patient outcome data may become more essential in the marketing of laboratory services as third-party payers increasingly demand evidence that new health care services are cost-effective and positively affect patient outcomes. New hardware and software have increased the laboratory's ability to store and process data.

Currently, Quest Diagnostics maintains the world's largest private database of clinical laboratory test results. It intends to use these resources to add value to its laboratory services Where is the lab industry headed, For example, data may be used to track a patient's progress, minimize redundant testing, evaluate phlebotomists' collection technique, and track patient outcomes McDonald, ; Plebani, Large databases can also be used to track disease outbreaks and conduct other types of public health research McPherson, While research opportunities abound, laboratories will be challenged to identify ways to protect confidential patient information and obtain patients' informed consent to participate in research Chou, Incremental changes often make testing processes simpler, more efficient and often less expensive , and of higher quality.

Less frequently, technology makes major advances that result in totally new tests or testing techniques. Esoteric Tests Esoteric tests are relatively uncommon tests that are dependent on physician interpretation skill. Because PCR has become so common, it has lost its esoteric label. The total U. With 1. As esoteric tests become more commonly performed, competition and economies of scale may increase, driving prices down further, even in the esoteric market.

Genetic Testing With the mapping of the human genome, the field of molecular diagnostics, which includes genetic testing, is expected to grow rapidly during the next five years. Early detection may allow clinicians to predict predisposition to disease. This is important because genetics are possibly a significant factor in seven of the top ten causes of death in the United States Klipp, In addition to addressing the factors associated with these causes of death, genetic testing is also used for determining HIV and hepatitis viral loads, making prenatal diagnoses, identifying chromosome abnormalities, determining the paternity of a child, ascertaining cancer cytogenetics, and identifying inherited or predisposition to diseases.

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Government funding to various schools and universities for providing laboratory set up to provide and improve the quality of education is a growth factor for the laboratory equipment market. Laboratory equipment setups are always associated with high costs, and hence there are affordability issues. Also, the proctoring and checking of this equipment should be done carefully as the breakage chances are very high. All the laboratory equipment is fragile and is easily breakable.

Hence for handling this equipment, skilled professionals are needed. Equipment such as chromatographers, reagent-based equipment needs proctoring to be done daily. We all learned that social distancing and lockdown are the only keys to preventing and controlling the infection. Hence due to which there are many businesses and governmental markets faced losses due to this. Also, the stringent rules and regulations for preventing infection spread restricted the population to their homes.

The medical tourism market is shut down, and hence there is a lack of awareness, and the knowledge transfer is also limited. Hence the funds were not appropriately released in recent times to this market. The high cost of technologically advanced laboratory equipment is also a market hampering factor for this market and needed funds to maintain it.

All four leaders expect the increase in outsourcing to continue even after the pandemic. Chapman echoes that thought, adding, however, that labs will be less likely to do full lab outsourcing contracts, instead opting to outsource on an as-needed basis—a trend he noticed even prior to the pandemic.

Meeting pandemic challenges Other recent changes in outsourcing have increased the importance of clear, concise communication between labs and outsource service providers. As with almost every industry, travel and in-person meetings between outsource providers and their clients has largely been replaced by virtual options. McEvoy says Intertek had already been doing virtual meetings and calls with clients for a while, but they have simply improved at them during the pandemic.

With people less willing to travel, he says these virtual meetings will likely continue to be common practice post-pandemic. So, we insist on having that regular communication with our clients just to keep things on track [and] to make sure things aren't being missed. The limited numbers of volunteers and staff willing and able to travel to a site for clinical trials due to COVID safety concerns and protocols has affected the ability of both pharmaceutical labs and their contract partners to meet deadlines.

In terms of outsourcing challenges in general, Bowden says selecting the right outsource provider and product can be difficult. Carefully examining all the options and networking with other laboratory managers to get their feedback on outsourcing is essential to making the best choice, she adds. When it comes to analytical labs in general, any time scientists are working in the lab performing analyses is higher value, Bowden explains.

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