How many of you work in a microbiology laboratory that is completely, and I mean completely, paper-free?
It is a nice goal to aspire to but it is also very difficult.
I think most of us are now past the days when the sample work-up was hand-written on the back of the request form (I certainly remember those days…) but this aside there are many other ways that paper can pervade our workplace.
Think about the following other potential sources of paper:
- Method Manuals
- Internal QC
- External QC
- Meeting Minutes
- Training Records
- Results coming back from Reference Labs
- Educational Material including journals and textbooks
- Order forms for consumables
How many of the above list is your lab ‘paperless’ in?
For a lab to be completely paperless it needs to be disciplined.
Not only does it need to not produce its own paper (I would recommend a printer ban..), but it also has to have systems for digitalising (by scanning) any paper that comes into the laboratory from external sources.
More hastle than it’s worth?
Maybe, but once the systems are in place, such a vision has the potential to produce a very clean and clutter-free laboratory. It will also be cost effective in terms of saving money on printers and paper.
I think truly progressive laboratories should aspire to these kinds of goals…
I think In-House audit-trails are pretty sophisticated now. We can more or less tell who did what, how and when for samples that remain within our laboratory. This is particularly true for laboratories that have paperless systems and electronic audit trails.
Where laboratories in general are not so good is when samples get sent away to other laboratories outwith the local network, i.e. reference labs.
The computer systems may be different, interfacing may not be easy, the sample may go to the wrong department, it can be difficult getting the result back etc etc. The reference laboratory may not appreciate the importance or urgency of a particular sample.
Good transit auditing using professional tracking systems, good relationships and sound electronic communication between the referring and reference lab all help to reduce these problems. However at the end of the day, sending samples outwith your own laboratory network is always a leap of faith. You lose an element of control over the sample and establishing audit trails for a particular sample outwith your own laboratory can be frustrating work. In addition these are often some of the most important samples received into the laboratory.
However what you can be sure of is that the referring laboratory will generally get the blame from the requestor if something goes wrong!
What will you be doing in 2050?
I will be 77. Fingers crossed I will still be alive. If so, I will probably still be working, as by then the retirement age will likely have gone up to 80!
Have you thought about how clinical microbiology laboratories in general might look in 2050?
Here are my thoughts:
- They will be highly automated. Much more like the biochemistry and haematology departments of today.
- They will generally be big. Because of the above, laboratory “capacity” will often be far in excess of (local) demand.
- They will be virtually paperless. Accreditation agencies will insist on electronic audit trails and fully interfaced hardware, and rightly so.
- Electronic ordering will be the norm. …and with it the ability to reject tests due to insufficient details or because a similar test was done a couple of days ago.
- For bacteria, culture will still be around, but in a hands off mode. I suspect genital and enteric bacteriology will have gone completely molecular. Testing of general wound swabs, respiratory samples, urines and sterile site samples will probably still be culture based in part, but culture inspection will almost certainly be of a digital image, as part of an automated processing system.
- Antimicrobial Resistance Testing will remain controversial. Likely to remain a combination of phenotype, genotype, and increasingly proteotype.
- Maldi-TOF will have evolved. ID of filamentous fungi and mycobacteria will be routine on Malditof. Several different resistance determinants will be identifiable by mass spectrometry. The hardware will be more sophisticated than currently.
- Sequencing will be common. More common than nowadays, but I suspect their main role will still be in roles outwith routine diagnostic microbiology, eg genetic tumour markers, HLA typing, outbreak typing etc.
- Microscopes will be very different. Will be completely digital, with viewing and manipulation done on a large screen. Looking “down” a microscope will be a thing of the past.
- Training will be very different. Training will be more focused on troubleshooting automated systems and quality control processes as opposed to learning about the individual micro-organisms.
- There will be a lot less microbiologists about. Microbiology scientists and technical staff, as well as Clinical Microbiologists will all be reduced in number due to both the automation and also the cost.
I look forward to checking back on this post in 33 years time to see how accurate these predictions turned out to be…..!