Standardizing hub-and-spoke lab networks flexibly

• Design each spoke laboratory around its hospital’s testing volumes, clinical needs, patient populations, and turnaround-time requirements
• Use modular platforms that can scale capacity without introducing entirely different workflows or technologies
• Evaluate laboratory solution providers on interoperability, automation and robotic readiness, training, local-market expertise, and their ability to support change

A hub-and-spoke laboratory network connects high-volume central laboratories with smaller hospital laboratories, regional centers, and outpatient clinics. Dr. Frieder Hänisch, Head of Hospital Laboratory Management at MVZ Labor Limbach Heidelberg, and Dr. Ulla Ruffing, Lean Expert and Head of Laboratory Diagnostic Studies, are leaders at the Limbach Group—one of Germany’s largest medical laboratory networks, with more than 33 laboratories and 7,000 employees.

In this interview, Dr. Hänisch and Dr. Ruffing discuss how standardizing equipment, software, and systems across sites promotes consistency and strengthens operational performance and quality assurance. They also explain why standardization cannot be approached as a one-size-fits-all solution. As critical infrastructure, laboratory networks must build resilience and IT security into their operations. Their advice to laboratory leaders is to seek laboratory solution partners who understand their client’s requirements and are flexible enough to adapt to their continually evolving needs.

Dr. Hänisch: The Limbach Group emerged in 2011 from a network of already existing independent central laboratories in Germany and has grown steadily since it was formalized. To date, the group grows organically and inorganically, having added locations and hubs in several cities, so it's a dynamic environment.

We are a medical knowledge and service provider. We take in the requirements and the needs of our customers, both from outpatient settings as well as from hospitals. External market demands determine our structure and the requirements for our operational setup. Due to the impact of health policies on the hospital market in Germany, we have to cover a range of needs from a 20-bed rehabilitation site, up to a maximum-care hospital with more than 1,000 beds.

Dr. Ruffing: From the study side, we see that there are different requests from larger hospitals versus smaller hospitals, including totally different sizes or numbers of samples. So for us it's also interesting to see what fits best for which kind of request, and at the lowest cost.

Dr. Hänisch: In general, the answer is quite simple: As many as possible. There are three core analytical groups for the spoke labs, which are clinical chemistry, hematology, and coagulation. There's some variation, for example, in immunohematology and blood unit management. What we really pay attention to is that the measurements and the core values are comparable across different sites. A patient typically requires rapid on-site measurements as well as less time-critical but more specialized measurements, which can be conducted at the central lab. In this regard, we pride ourselves on the capability of providing immediate, on-site clinical decision expertise combined with a full range of roughly 3,000 biomarkers at our central lab here in Heidelberg.

We recognize trends in the German hospital landscape towards regional networks and an increased demand for cost-efficient, highly available, highly autonomous on-site laboratory solutions.

Dr. Hänisch: What we think works best for an on-site hospital lab is a rather small portfolio that can be run as a daytime lab, for one or two shifts. This menu might cover approximately 100 biomarkers, including around 30 clinical chemistry markers, five hematology profiles, routine coagulation tests, and more than 20 cardiac, endocrine, organ-function, and inflammation markers—for example, FT3, FT4, PCT, NT-proBNP, high-sensitivity troponin T, and TSH. It could also include seven urine markers and a small selection of tests performed on aspirate samples. Depending on local clinical needs, the menu could be expanded to include a limited number of PCR panels.

The Point of Care (POC) standard remains blood sugar and blood gas analyzers distributed across the wards. Depending on the guidelines for emergency and stroke units, the setup may be complemented with additional special-purpose POC testing devices.

Outside of tests, a spoke laboratory should be thinking ahead in terms of laboratory equipment. Equipment should not only be well–designed for human interaction, but also robotics-ready. The latter is critical to cover business continuity during night times and temporary staff shortages.

Dr. Hänisch: The right answer always feels like a moving target. We have to be in conversation with the key decision-makers at the hospital and, at the same time, take an active advisory role. Our advice has to be grounded in state-of-the-art process optimization and cost control measures. We don't try to push for a one-size-fits-all solution. We assess what our partners need and try to incorporate those needs. Sometimes, we find the economic and medical decision-makers have competing priorities, and we are not always in a position to resolve conflicting objectives. However, we do try to navigate with a clear mind towards implementing future-proof and flexible lab solutions. The goal is to have a portfolio ready that fits all the possible solutions, ranging from small, Point of Care units to highly automated, robot-assisted, fully autonomous labs.

Satellite labs are starting to need to be more scalable in terms of throughput and their on-site portfolio compared to a few years ago. The trend is in the direction of downscaling more often than upscaling. I would argue that a minimal on-site setup in combination with smart connections to larger laboratory sites is the best practice for today.     

Another important consideration in the German Market is that there's huge pressure to reduce the total number of hospital beds in 2026, which creates a level of uncertainty for hospitals and their business partners. Although we value long-term partnerships, we also must accept the reality of shorter-term commercial arrangements. Because these arrangements involve greater risk for everyone involved, that risk may need to be reflected in pricing. We therefore aim to be as flexible as possible to adapt to the changes our hospital partners have to navigate.

Dr. Hänisch: Operationally, there is great demand to provide business continuity at all times. On-site hospital labs play a vital role in many emergency scenarios, and a cascade of negative events can occur within the hospital if on-site labs are not available. To address this operational responsibility while managing cost pressures, we standardize both laboratory equipment and software platforms wherever possible. However, standardization has practical limits. For example, some hospitals own their laboratory information system (LIS) or middleware licenses, while others require certain services to be hosted on-site. Our goal is to remain flexible enough to accommodate each hospital’s technical and contractual requirements.

Dr. Ruffing: We try to facilitate a kind of core setup to be able to relocate people on short notice to help out on different sites for short periods of time. What we are trying to build is the same lab processes, the same standards, more or less the same devices, and the same software layers, so that the user in the lab is able to do the same day-to-day business in a different location to help out and keep the network running.

Dr. Hänisch: First, we limit the number of order-entry software solutions we provide to our hospital partners. Second, we aim to support only a small number of middleware solutions. Third, we consolidate and standardize laboratory equipment wherever possible. Taken together, these measures decrease the maintenance requirements for our software systems and allow us to focus on data interoperability.

However, the reality is that we must be able to connect with a heterogeneous environment of hospital information systems and electronic patient record systems. Recognizing that there is no one-size-fits-all solution, I strongly prefer an adaptable approach that provides the best possible fit for each hospital partner.

In addition, both our business partners and labs are increasingly becoming part of the healthcare sector’s critical infrastructure. This makes operational resilience, business continuity, and IT security increasingly important.

Dr. Hänisch: Extending standard operating procedures (SOPs) from central laboratories to spoke sites provides clear economic value. This is true both from an operational standpoint—for example, by reducing the administrative workload for hospital laboratory teams—and from a quality-assurance standpoint. In my experience, laboratory teams give very positive feedback when they can rely on identical software interfaces and consistent device setup and maintenance procedures, even across multiple generations of analyzers.

The tricky part is demonstrating that value on the balance sheet.

Dr. Hänisch: I think it is tremendously important. In Germany, we implemented the electronic patient record relatively recently, and we also face an increasingly consolidated hospital market. The hospital sector will share more data with outpatient settings, and vice versa. Hence, the requirement for standardization extends across all healthcare providers.

However, I would argue that there is an intermediate step to consider: the standardized reporting of bioanalytical methods, units, and nomenclature. At this stage, standards such as Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT), and Medical Information Objects (MIOs) provide a meaningful way to exchange structured medical data among the healthcare professionals who ultimately make therapeutic decisions.

Extending this idea, a unified language can enable AI tools to aggregate and interpret complex laboratory results—including multiple biomarkers, some of which may be outside the normal range—for patients with comorbidities.

Coming back to short-term, actionable steps, we will continue to use the same laboratory testing platforms in hospital laboratories and the central laboratory. Ideally, only the throughput capacity will differ according to the needs of each site.

Dr. Ruffing: What's really important is the element of familiarity. Whenever there is a new device, a new generation, it's very important that people who've been using the old one and are familiar with the old process are able, with a short period of training, to do the switch. It’s essential that the software is easy to use, the system is easy to use, that systems and software platforms are comparable, and that there is good connectivity between different LIS systems. That's something where we really try to listen to our staff who are working with the devices. 

Dr. Hänisch: The next features I would prioritize are remote access and the readiness for robotics. Right now, in 2026, I don't yet see humanoid robotics in clinical laboratories. However, that might change in 3 years. The device has to have the capability to be ready for that technology shift, because we are thinking in five-year time periods. Whatever infrastructure I implement on-site now has to be workable in five years time.

The maintenance requirements of the devices themselves are also important. Zero-maintenance devices are particularly valuable, provided that we know the total number of samples each device is designed to process over its service life. An automated, usage-based alert should notify the laboratory manager when the device is approaching that limit, and it is time to order a replacement.

Dr. Hänisch: Laboratory managers rely on a laboratory solutions provider who has a deep understanding of laboratory processes and market knowledge. Both help immensely to anticipate the basic project requirements and pain points of a lab network. I am always evaluating whether a partner can provide a solution blueprint that offers a good initial fit and the capability to adapt the blueprint to create the best possible fit for our lab network. Not every provider can do that.

More specifically, it's the knowledge base of our lab solutions partner in understanding our customers. That's really key, because it's so much easier if I can talk to a solutions provider who understands my clients’ needs and pressure points as well.

This is what really makes a difference, impacts long-term organizational development, and shapes our own business development decisions.

When it comes to mission-critical business decisions, a mismatch in company size can be a significant hurdle. Another important aspect is geographic focus. Some market participants are primarily driven by the needs of non-European healthcare markets. In my experience, this can make it challenging to develop a shared understanding of German and European regulatory requirements, including Rili-BÄK and the IVDR, as well as the specific demands of Germany’s highly regulated laboratory market. This means a laboratory solutions provider with a strong European focus may be easier to work with.

Dr. Ruffing: What I would look at is a lab solutions provider that can be a partner, and who has the experience and the scale to withstand or undergo the transformational forces that we are seeing in the German laboratory market at the moment. That is very key. I would recommend looking for maximum flexibility in terms of scaling, but not by jeopardizing standardization in terms of systems and software.

Dr. Hänisch: Also, take feedback and insights from the labs within your own network. For example, we have several clinical expert groups operating across our sites. Together with our study department located here in Heidelberg, we are able to gather early insights. The study department is a valuable resource that provides a feedback loop for organizational knowledge sharing across the organization. The study department contributes heavily to our internal opinion-forming and downstream decision-making.