The laboratory environment has been characterized by ongoing rapid and dramatic innovation since the 1980s. There has been remarkable growth in the range and complexity of available tests and services, which is expected to continue. Laboratory technology is often at the forefront of medical advances. In some cases, testing techniques to diagnose or screen for a particular condition are available before effective treatment. Innovation in laboratory technology, which includes both new tests and advances in equipment and testing techniques, has made testing more efficient and automated. Information technology (IT) has revolutionized the transfer of data by decreasing the time it takes to order and receive test results and by creating opportunities for research on large datasets. Many predict that clinical laboratory technology will play an even more important role in the future delivery of health care (Felder et al., 1999; Wilkinson, 1997). Innovation in health care, particularly when it is more efficient than existing methods, is welcomed by payers, providers, and patients; however, the efficient integration of innovation into medical care may be affected by policies related to coverage, coding, and payment.

There are wide variations in the types of technology employed by different types of laboratories. The discussion of technology trends below does not mean that these trends are occurring in all settings. For example, certain small laboratories do not have the volume of testing to justify automated or elaborate IT systems.

This chapter reviews the three major technological innovations that have radically altered the way samples are collected and analyzed and the way results are reported. These innovations include automation, IT, and laboratory measurement or testing technology. The changes that these technological developments produce, especially how and where testing services are delivered and laboratory-staffing needs, are also discussed.

Automation has been, and promises to continue to be, an important force in the changing laboratory marketplace. 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.

2. Analytic stage: This involves actual testing of the specimen and all routine procedures up to result reporting.

3. 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, 1988).

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Journal of Clinical chemistry and Laboratory Medicine
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