Miswar Fattah, M.Si
Makassar, 6 Juni 1978
Education
1997 : SMAK Depkes Makassar
2002 : Chemistry - University of Hasanuddin
2006 : Clinical Chemistry, Biomedic- University of Hasanuddin
Current position
Research & Esoteric laboratory Head, Prodia Clinical Laboratory
Molecular Diagnostic Scientist, R&D Prodia Clinical Laboratory
Scientific division of Molecular Diagnostic , Indonesian Association
for Clinical Chemistry
International Relationship departemen PATELKI
PATELKI
Miswar Fattah, Msi
TOT
Bandung , 27 November 2011
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Term of automation
Concept automation in clinical laboratory medicine : a
history
Current concept in automation of laboratory medicine
Impact automation in medical technologist & Regulation
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Automation is the use of control
systems and information technologies to
reduce the need for human work in the
production of goods and services
Laboratory automation is the use of
instrument and specimen processing
equipment to perform clinical assay with
only minimal involvement the
technologist
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 Reduce human error
 Safety
 decrease laboratory costs
 improve turnaround time
 increase productivity
 Run more tests
 Test in fewer sites
 Operate with fewer instruments.
 Retain lower operating costs.
 Employ relatively less skilled labor.
 Use more automation in a paperless
environment
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
Lab Test
• Faster TOT
• Accuracy,
Precision, Safety

Add information
value
• Autovalidation
• Trending

Effecting change
using lab results
• Lifestyle changes
• Selection of
Lab Test
Autovalidation
Trending
Life Style Adjustments
Appropriate Therapeutics
therapeutics
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7
 In
the early years of clinical laboratory
science--the 1920s, 1930s, and 1940s-tests and assays were performed
manually
 evolution of clinical laboratory
automation began in the late 1950s with
the development of flame photometry
and peripheral blood cell analysis
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Clin Chem 1958;4:127– 41
 the
Coulter Counter in 1957
revolutionized the counting of a
variety of peripheral blood cells,
including red blood cells and
leukocytes
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Wallace H Coulter


Technicon Autoanalyzer II
(AAII) systemPeristaltic Pump Module
AutoAnalyzer is an automated
analyzer using a special flow technique
named "continuous flow analysis (CFA)"
first made by the Technicon Corporation.
The instrument was invented 1957 by
Leonard Skeggs, PhD and
commercialized by Jack Whitehead's
Technicon Corporation. The first
applications were for clinical analysis,
but methods for industrial analysis soon
followed.
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The first multichannel analyzer to perform eight determinations
simultaneously is described. The analyzer records directly on
calibrated paper, providing an “immediately usable form”. One
operator can perform 960 individual tests per day, equal to the
output expected per person in a month with manual techniques
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ClinChem 1964;10:918 –36
Multichannel
analyzers allow 10
simultaneous
determinations
on 1 mL of serum at a
rate of 60 specimens per
hour
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Clin Chem 1966;12:120 –36
 First
fully automated in
clinical laboratory
implement in Kochi
Medical School by
Masahide Sasaki
(Automation Pioneer ).
Modular system
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 Robotik
/ mekanik
 Fluidic
 Metode
 Track
 Sensor
 Komputer
 Software
 Barcode
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gantry robot
The SCARA (Selective Compliance Assembly
Robot Arm)
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 Continuous
Flow Analyzer
• Tubing flow of reagents and patients samples
 Flow
Injection Analyzer
• Centrifuge force to mix sample and reagents
 Dialyzer
module
• Separate testing cuvets for each test and
sample
• Random and/or irregular access
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CONTINUOUS FLOW
 In
continuous flow analyzers,
• samples were aspirated into tubing to
introduce samples into a sample holder,
• bring in reagent,
• create a chemical reaction,
• and then pump the chromagen solution
into a flow-through cuvette for
spectrophotometric analysis.
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• The major drawbacks that contributed to the eventual
demise of traditional continuous-flow analyzers in the
marketplace were significant carry-over problems and
wasteful
use of continuously flowing reagents.
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 Continuous
flow is also used in some
spectrophotometric instruments in which
the chemical reaction occurs in one
reaction channel and then is rinsed out
and reused for the next sample, which may
be an entirely different chemical reaction.
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


Discrete aliquots of specimens and
reagents are pipetted into discrete
chambers in a rotor
The specimens are subsequently
analyzed in parallel by spinning the
rotor and using the resultant
centrifugal force to simultaneously
transfer and mix aliquots of specimens
and reagents into radially located
cuvets.
The rotary motion is then used to
move the cuvets through the optical
path of an optical system
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 Discrete
analysis is the separation of each
sample and accompanying reagents in a
separate container.
 Discrete analyzers have the capability of
running multiple tests on one sample at a
time or multiple samples one test at a time.
 They are the most popular and versatile
analyzers and have almost completely
replaced continuous-flow and centrifugal
analyzers.
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 Sample
reactions are kept discrete through
the use of separate reaction cuvettes, cells,
slides, or wells that are disposed of
following chemical analysis.
 This keeps sample and reaction carryover
to a minimum but increases the cost per
test due to disposable products.
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




Fluorescence Detection Technologies
•
Fluorescence Intensity (FLINT)
•
Fluorescence Polarization (FP)
•
Fluorescence Correlation Spectroscopy (FCS)
•
Fluorescence Resonance Energy Transfer (FRET)
•
Dissociation-enhanced lanthanide fluoroimmunoassay (DELFIA)
•
Homogenous Time Resolved Fluorescence (HTRF)
•
LANCE Ultra™
•
Fluorescence Lifetime Analysis (FLA)
Luminescence Detection Technologies
•
Glow Luminescence
•
Flash Luminescence
•
AlphaScreen™
•
Electrochemiluminescence (ECL)
•
Bioluminescence Resonance Energy Transfer (BRET)
Radiometric Detection Technologies
•
Filter Binding Assays
•
Scintillation Proximity Assays (SPA)
•
FlashPlates®
•
LEADseeker™
Absorbance Detection Technologies
Other Technologies
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
Laboratory use
• Identification of sample-containing vessels:
• Identification of reagent-containing vessels:
• Identification of equipment:
• Identification of laboratory personnel:
• Entry of instructions or data:

Technology
• bar codes,
• Radio Frequency Identification (RFID),
• biometrics,
• magnetic stripes,
• Optical Character Recognition (OCR),
• smart cards, and voice recognition.
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Reagent lot numbers are
automatically linked to results
Bar codes of randomly
loaded samples are read
Overview
Tubes are sampled through
pierceable
caps
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Pictures and video from Gen-Probe
Paramagnetic microparticle
capture and detection
28
 Sneaker
net
 Mobile robotics
 Conveyor belt
 Accelerated conveyor belt
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Mobile Robot Conveyance
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Ball and Socket Closure Device
The Lasette (Cell Robotics, Albuquerque)
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 Bar
coding at the pointof-phlebotomy
B-D id
 2D vs. 1D bar codes
• Reduce the number of
computer interfaces
• Self directing specimens
 RFID
• Current costs of RFID
around 25 cents
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32
Phlebotomy Tray Preparation
BC-ROBO – mini 20
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Single tray system
BC-ROBO – mini 40
Multi-tray system
33
 Hematologi
 Kimia
klinik
 Immunologi
 Analisa berbasis sel
 Mikrobiologi
 Molekular diagnostik
 dll
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Conveyor Distribution
Technologist Distribution
Picture of the UVA lab
here
Sonic Healthcare
Sydney Australia
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The University of Virginia
Clinical Laboratory
Charlottesville, VA
35
 Automated
work cell
A special case of an integrated
system. Preconfigured,
often available commercially offthe-shelf as a standard system
for a given type of or class of
sample processing
 Automated
workstation
capable of performing a limited set
of Laboratory Unit Operations (LUO's)
(as few as two) in an
automated mode, coordinated by a
workstation controlle
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Leonard T. Skeggs
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IDS, Japan
BIOPHILE,Inc., Charlottesville, VA
38
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bioMerieux’s PREVI Isola is a system for
automating routine agar plate inoculation.
It maximizes colony isolation, eliminates
risks, and standardizes plate inoculation
and results in a fully automated approach
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Genomic Screen for Chronic Disease
Data Interpretation
Smart House Monitoring
Early Warning of Disease Onset
Proteomic Assessment
Personal Health Improvement
Health Intervention
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In vivo Cytometry-A Next Generation
Diagnostic Tool. A Real-time health
monitoring
flow cytometry is a method of counting
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thousands of cells per second
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· AUTO1—Specimen Container/Specimen Carrier contains standards for the design
and manufacture of specimen containers and carriers used for collecting and
processing samples, such as blood and urine, for testing on laboratory automation
systems.
· AUTO2—Bar Codes for Specimen Container Identification provides specifications
for linear barcodes on specimen containers for use on laboratory automation
systems.
· AUTO3—Communications with Automated Systems facilitates accurate and timely
electronic exchange of data and information among automated instruments,
laboratory automation systems, and other information systems.
· AUTO4—Systems Operational Requirements, Characteristics, and Informational
Elements provides standards of interest to operators for display of system status
information such as specimen location, reagent supply, and warnings and alerts to
support laboratory automation operations.
· AUTO5—Electromechanical Interfaces provides guidance for the standardization
of electromechanical interfaces between instruments and/or specimen processing
and handling devices and automation systems in the automated laboratory.
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 Automation
of the main chemistry analyzers,
including immunoassay and linking them
together with preanalytical and postanalytical
automation to give total laboratory automation
has given predictability to result availability
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