THIS SUMMER, the global clinical laboratory industry lost a true innovator in medical laboratory management, operations, and informatics. On August 8, 2012, Dr. Alan Lloyd died peacefully at home from pancreatic cancer.
Lloyd was widely-respected for his unique approaches to laboratory operations, lab workflow, and use of informatics to support clinical assessment of laboratory test results.
Much of his work was done at Sonic Healthcare, Ltd., of Sydney, Australia, where Lloyd served for more than two decades. As Chief Information Officer (CIO), he was an early member of the executive team that grew the company from its roots as Sonic Technology Australia Limited into the multi-billion-dollar global enterprise that it is today.
Born in South Africa, Lloyd earned his MB.ChB at Godfrey Huggins Medical School, University College of Rhodesia in 1974. He next earned an M.MED (Chemical Pathology) from the University of Cape Town in 1982.
Practical Problem Solver
Lloyd’s innovative nature did not take long to surface. In 1984, he was one of the pathologists who founded City Park Private Laboratory. He described this lab facility as “highly automated and with a sophisticated laboratory computer.” Lloyd played a key role in developing what he described as “discriminant analysis programmes for the following test panels: lipid studies, glucose tolerance tests, thyroid functions, liver functions, and full blood counts.” In 1986, his work was demonstrated using a live computer at the South African Pathology Congress.
In I987, Lloyd emigrated to Australia and began working at a hospital laboratory. Within a few years, he was back in private practice at Macquarie Pathology. He then joined Douglass Hanly Moir (DHM) as a chemical pathologist.
Almost immediately, DHM became part of Sonic Healthcare and the company began to grow by acquiring other pathology laboratories. Lloyd’s keen interest in software system design and laboratory automation was quickly recognized and he was rewarded with the promotion to the position of Chief Information Officer for Sonic Healthcare, where he remained until he retired in 2010 after a diagnosis of pancreatic cancer.
Lloyd had a practical approach to problem solving. His most fertile work was in two areas: streamlining laboratory workflow and using information technology (IT) to unlock more useful clinical knowledge from laboratory test data. He was also ahead of his time in using software and the laboratory information system (LIS) to support workflow in pre-analytical, analytical, and post-analytical phases of lab testing.
It was during the 1990s, when the first laboratories in the United States were spending millions of dollars to install the first generation of total laboratory automation (TLA). At the same time, Lloyd was moving toward the same automation goals in Sonic’s highest-volume lab facilities, but spending only tens of thousands of dollars.
THE DARK REPORT viewed Lloyd’s innovations during site visits to Sonic Healthcare’s labs in Melbourne, Sydney, and Brisbane. Lloyd was using inexpensive, off-the-shelf industrial conveyor belts, modified with six to eight “channels,” to move specimens from reception to processing.
Industrial Conveyor Belts
As the accessioner logged in the specimens, he/she would lay the specimen on its side in the channel which would transport it directly to the correct test station—whether hematology, automated chemistry, or other. The conveyor belt would then move that specimen directly to the proper location.
When asked why his automated solution didn’t use individual transport pucks and hold specimens upright, as was typical of the first generation TLA sold by the in vitro diagnostics (IVD) manufacturers, Lloyd had a common sense answer: “Specimens travel on their sides in courier cars. So why not travel on their sides within the lab until they get to the pre-analytical staff for centerfuging, aliquotting, and the like?”
Meanwhile, under this conveyor belt was a second off-the-shelf conveyor belt. When the accessioner completed data entry, he/she would put the paper requisition on this conveyor belt. That requisition was transported to the end of the line where another staff member gathered it and immediately scanned the requisition, so it could be viewed digitally within the LIS.
It was a similar story with how Lloyd used information technology. He was equally ahead of his time in deriving the “values” of clinical lab and pathology informatics and putting them in practice in real life patient care. Within Sonic Healthcare, he developed a dynamic expert pattern recognition software called Morpheus.
Morpheus automatically analyzes complex current and previous patient test results, demographics, clinical attributes, and other “discrete” data such as medication use. The agile, powerful, and yet simple design of the software meant that it was easily adopted by Sonic’s pathologists to analyze complex patient lab and clinical information. Lloyd, as a trained pathologist, wanted laboratory informatics to be a tool that helps clinicians solve real life issues.
Lloyd’s approach to pattern recognition illustrates why his ideas were so productive. In pattern recognition, investigators typically take patient data and compare it to pre-established known “patterns” derived from scientific knowledge. Lloyd turned this approach upside down.
He did the “reverse” analysis. Lloyd took large volumes of population data and ran it through the Morpheus pattern recognition engine, asking the computer to find common patterns within the population. By doing so, he mitigated the limitations and reliance on personal scientific knowledge by supplementing it with “artificial intelligence” of the computing power and increased real life applications.
Finding Patterns with IT
Lloyd took such analysis one step further by expanding the data source to include healthcare financial claims. He could then identify patterns of costly clinical attributes, along with specific clinical variables associated with significant healthcare cost. These analyses have identified opportunities for population management targets and provided predictive modeling for health insurance benefit design.
In the approaching world of accountable and coordinated healthcare, Lloyd’s legacy is the expertise, approaches, and informatics tools that pathologists can use to assume a leadership role within these emerging healthcare delivery systems. In that regard, Lloyd’s lifetime of innovations in automation and informatics positions pathology to deliver that value.