Case study: Inside Laboratorio Referencia’s journey integrating digital lab solutions

• Integrating digital tools and autovalidation rules can optimize turnaround times and standardize high-volume laboratory networks
• Rather than replacing human workers, laboratory automation can elevate staff into specialized roles focused on quality assurance
• A successful transition to digital solutions begins by prioritizing "low-hanging fruit", while actively involving the laboratory team in the process

In the Dominican Republic, Laboratorio Referencia, the leading private clinical laboratory network, provides lab services across 95 branches and 23 processing centers, while offering a comprehensive menu of 1,500 tests under strict quality control. Operating a clinical laboratory network of this scale, managing logistics and providing consistently accurate test results, requires high-tech solutions that can deal with multiple levels of complexity. 

In this interview, Mauro Barrantes, Director of Laboratorio Referencia, discusses how integrating digital tools has resolved operational bottlenecks within his lab network’s high-volume workflow. He outlines how real-time monitoring and autovalidation rules have optimized turnaround times, standardized clinical decisions across multiple sites, and streamlined the evidence needed for rigorous international accreditations. Barrantes also offers practical insights on how to take on lab digitalization, and how it can ultimately empower laboratory staff to take on strategic roles.

Q: Perhaps you can start by introducing yourself and the laboratory you work at—and telling us a little about how this digital story began for you.

Barrantes: Thank you. I'm very happy to be here with you. I'm Mauro Barrantes, director of Referencia, a private clinical laboratory in the Dominican Republic. It's a laboratory with 95 branches across the country, within reach nationwide—the most important laboratory in the Dominican Republic, and one of the most automated and, digitally speaking, most modern in the region. We have 95 branches and 23 processing centers. We have laboratories inside clinics and hospitals, in outpatient settings, as well as patients who come directly to us. We are 3,500 employees, with a menu of roughly 1,500 tests. We're also a specialized laboratory—highly specialized in high-complexity testing as well as routine work: Genetics, molecular biology, forensics, mass spectrometry. In fact, we're the first laboratory in the Americas to have an automated mass spectrometry system, and we're very proud of that. We're always innovating—innovation is one of the pillars of the laboratory, along with service excellence, accreditations, and providing a service to the whole community. It's a high-volume laboratory that handles significant volumes of samples and patients, and we're in constant growth. The digital side has been a real challenge, because as the laboratory grew, digitalization is what allowed us to maintain that quality, honor our commitments to our clients, and deliver better and better service.

Q: I want to start at the very beginning. There was a moment when you said, "We have to make the leap to digital"—surely motivated by challenges or bottlenecks in your day-to-day operations. Can you mention some of them, and how adopting digital tools helped you overcome them?

Barrantes: Thanks to the laboratory's success, it has grown a great deal—and big challenges go hand in hand with growth. When you have a laboratory that grows substantially and has deep penetration in the population, the possibilities for errors also grow: The risk of not meeting commitments to clients, the loss of traceability. That's where the challenge of the digital side comes in—to help us maintain our service levels, which we've taken on as core values and which set us apart competitively in the medical environment, and also to keep improving every day. The digital side was key to being able to keep growing while maintaining our quality levels. Interoperability is also very important, because we navigate waters where there are many systems, and that's a complexity to manage. Digital solutions have helped us a great deal to achieve our objectives and maintain our accreditations.

Q: Interoperability between systems, yes—but you also have 23 processing centers, so there's a geographic dimension: The interconnection between them. Could you have done it without technology? Perhaps the real question is, could you have—and at what cost?

Barrantes: It can be done—but for you to have real control of the operation, and to be able to stake your reputation that you're meeting clients' expectations and needs, is very difficult. For example, we monitor our entire operation through digital tools at very specific points—the pain points of the service: Turnaround time, management of critical results, quality control, analyzer connections, interfaces. All of that real-time monitoring lets us be sure our operation centers are meeting the needs they were designed for. Without digital tools it would be very difficult—we'd need enormous resources, and in the end there simply wouldn't be enough time to do so many things.

Q: You mentioned accreditations and quality. I'd like you to go deeper on how the tools you have today help you directly—beyond simple quality control, because I'm learning it goes much further than that.

Barrantes: When we talk about quality, it's a culture, I think. In laboratories, we have many highly optimized processes that we monitor frequently, because any deviation from them has a very significant impact on the quality of the results—and on the quality of the clinical decisions that get made, given the impact the laboratory has across the entire health system. And yes, the laboratory holds several accreditations; we've invested a great deal in achieving them. It starts with accreditation from the College of American Pathologists, which accredits the whole laboratory—every test, the complete menu. It's not a simple task; anyone involved in accreditations knows it's an enormous amount of work, but also very satisfying, because it means you have control of your operation. We also hold ISO 15189 in all of the laboratory's most important departments; accreditation with U.S. bodies under ISO 17025; accreditation from the American Association of Blood Banks for forensic paternity testing and the blood bank; and ISO 9001 for the whole operation. And the most recent one, which I'm very proud of, is the My Green Lab accreditation, which we obtained recently. That lets us add another leg to the table—the environment, which is also very important to us. Those of us who work in health can't be indifferent to the environment harming health, when we're working for people's health. So it's important that caring for the environment, and having responsible environmental practices, runs across our entire organization. There's a lot of important work being done in the laboratory that makes us more friendly to the environment and to the community, and we pass that on to our families and to the community as a whole—a small seed that we think will help the Dominican Republic a great deal to become more conscious of the environment.

Q: You mentioned reaching patients on time—what we sometimes call TAT (turnaround time) internally. How did these digital tools impact your turnaround times, and help you meet them?

Barrantes: You know that time is gold now. In our operations, time is one of the determinants of service quality that our clients value most—so we don't leave time uncontrolled. With digital tools we can measure each stage of the care process: from when the patient requests an appointment, is in the waiting room, has the sample taken, the sample is transported to the processing laboratory, enters the preanalytics, moves along the distribution tracks, the assay is run, it's validated, it's reported. Those are the different stages of running a laboratory test, and we monitor all of them. And not only that—we set indicators for each of those stages and monitor them both in real time and retrospectively, to analyze how well we're meeting what we offer to physicians and clinics. We have, for example, some sentinel tests that we know are very critical, and we keep a close eye on them. So we can proactively make decisions before the clock goes from yellow to red and tells us we're out of compliance—we can direct our efforts and take action so as not to miss the times, and keep providing a quality service to our users.

Q: That's great, because you shift from being reactive to being proactive—anticipating, all for the patient's benefit.

Barrantes: Exactly. As I said, digital tools have brought us enormous value, because they make the health of our operation visible in real time, and we can make timely decisions before any delay or bottleneck becomes a snowball. When we have a situation—and situations do arise in laboratories: An analyzer that fails or disconnects, a delay in delivering a sample—we can direct resources to mitigate it, and the client doesn't perceive it, because internally we resolve the situation and take corrective action. And for accreditations, the digital tools are fundamental, because the auditors can see our entire dashboard live and give traceability to any analysis—the tracking of the patient. We're not filling in records the day before; they're seeing it in real time, seeing how things are working and what the laboratory did to mitigate any risk. That gives a lot of value to audits, and people feel great confidence that we're working for patient care.

Q: And I imagine it's a relief for you: If an audit arrives, you know you have all the information and clear processes, and can go through it more calmly.

Barrantes: Yes—audits and inspections are part of our day-to-day now. We can't say we prepare a week beforehand, because honestly we take it as normal; it's almost continuous. The inter-laboratory programs are continuous—hundreds of them throughout the year. We're very transparent: Our clients can visit us, and we give tours so they can see the laboratory and how we work. It's not that we all dressed up and tidied everything that day—they see it as it normally is. The idea is to build trust with our clients: That they see we make every effort, with the best international quality practices, and that we always set very high bars for continuous improvement. That's the mindset of the laboratory, and our founder and president always transmit that ideology within it.

Q: It's very clear from your side, from Referencia's—but on the other side, do the clients you serve, and the patients, perceive this as a differentiator?

Barrantes: Yes, of course. As I said, turnaround time is something people see, and the digital tools help us enormously. We've had cases—it's a bit of an anecdote—where the patient, while still waiting to get to their car and leave the parking lot, already has a notification on their phone that their urine test is ready. And they say, "No, that must be an error," because they're not used to results arriving so fast. Well, precisely—it's because we've done a whole analysis and use artificial intelligence and autovalidation rules, so that results which are normal, for a patient who has a history we can compare against, can be autovalidated. The software can do a lot of the repetitive tasks, and if the patient is within what's considered normal, it autovalidates—which also takes a lot of the workload off the laboratory staff, who can then focus their efforts on giving clinical utility to the results and doing more quality-assurance work.

Q: And at the same time you standardize—you'll always get the same result, no matter who's behind it.

Barrantes: We have laboratories all over the country. Imagine standardizing the way hundreds of people think when they're in front of a result, deciding whether it needs to be repeated or not, validated or not. If you already have a tool, then whether it's patient 1 or patient 500, it applies the same criterion—no interruptions from phone calls, none of those normal human situations, like a relative who's feeling a bit unwell today, that generate variability in decision-making. We standardize that with the digital tools; and whatever can't be standardized is exactly where our people come in, with more time and more judgment, to assess the results and make a decision.

Q: We've talked a lot about the impact on patients. But these tools surely also had an internal impact—on your staff, on how they relate to one another, and on the work environment. What is the internal impact of implementing so much technology?

Barrantes: With a laboratory this integrated, automated, and digitally advanced, people have the perception that what it does is remove the people doing the tasks. There's fear—at first. In fact, the biggest impact on our staff is that, first, they no longer have to do repetitive tasks—chasing a tube, searching for one tube among hundreds, using little slips of paper, walking back and forth. We measured the distances people walked before the projects we implemented, and they were basically running a marathon by the end of the workday. It's incredible—it's not an exaggeration. And once people are set up in this new laboratory design, this new way of working, they never look back, because it gives them confidence, it empowers them, they become specialists in what they do, they manage their own work. People who might previously have been working through worklists, hunting for what was pending, are now the ones managing the workflows, managing the instruments, seeing what's happening with the shipments. Their role changes and they become more specialized—and we take great advantage of that, because we bring them into strategic decisions. Things change every day and have to be improved, and we very much take the view of the people involved in the processes: People who perhaps didn't have the knowledge before, but who through all this development have built new competencies that help us meet our objectives as a laboratory. It's helped empower them and give them a purpose, which is so important. It's definitely a before and after for people—a reaccommodation: Instead of doing repetitive tasks that are tiring and wear you down, doing more strategic work, more assurance work—basically making sure that what we do stays the way we designed it.

Q: Imagine you have in front of you a laboratory director who wants to start down this path of digitalization, and probably has some fears. What would you advise? Where should they start?

Barrantes: The first thing is to start. Resistance to change will always be there—whether you have resources or not, whether you're public or private, that challenge will always exist. I always think you have to make a list of priorities; that's where the pain points are. I use a phrase we use a lot in the Dominican Republic: Go for the easiest wins first—what we call los mangos bajitos, the low-hanging mangoes. Grab the low-hanging mangoes first, to start generating small victories that will strengthen the system. But you have to have a vision of where you want to go, and be very clear about what you need to get there. Do a whole plan, because it will require human resources and IT resources—and go little by little, building it up piece by piece toward the final objective. We're in constant growth, constant rebuilding; it's not something where you arrive and it's done, because technology and medicine move so fast that we have to keep innovating to stay up to date. It's the same situation for every laboratory. Resources, though scarce, can be put to good use. It's important to form a team—and sometimes even the detractors should be part of that team, so that they themselves become agents of change and can do, with what they have, the things they've planned: Little by little, small victories, starting with what's easiest and then incrementally adding more. Don't try to make a radical change, because IT projects have an enormous challenge—many people think things through in an office, but when it's materialized in the field, on the floor, it's not as successful. So you have to involve people to achieve those objectives.

Q: Mauro, it's been a pleasure. Surely in future editions we'll want to have you back to tell us about the new innovations you're adopting at Referencia.

Barrantes: Thank you very much. With great pleasure—and to all our colleagues: In the Dominican Republic there's a laboratory that is your friend, and we're ready to help you in any way we can.

This interview was conducted in Spanish, on the navify® podcast; the answers were translated and lightly edited for readability, preserving the speaker's meaning and voice as closely as possible.