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Reference Information Model for Clinical Laboratories. RILA as a Laboratory Management Toolbox. Henk M.J. Goldschmidt, ed. Amsterdam, The Netherlands: IOS Press, 1998, 261pp., $74.00. ISBN 90-5199-414-1.

University of Oklahoma Health Sciences Center, Department of Pathology, Oklahoma City, OK 73104

This book represents an application of data collection and models beginning with a definition of RILA, which stands for Reference Information Model for Clinical Laboratories. Such a representation model (RILA) contains information about the essential processes within the laboratory organization and the connections between these processes, along with the information to be created, shared, altered, and used. This approach takes advantage of the concept that information obtained from a standard information model can be used to effectively design and optimize an organization (such as a clinical laboratory) without the effort, delay, and expense required to generate new information from scratch.

The book focuses on the importance and value of information and the fact that the information must be stored on "open" systems and in highly structured, uniform, and well-defined databases so that the exchange of information between computer systems within the organization can be facilitated. Such openness also allows the organization substantial cost savings because of the resulting freedom to select the "best of breed" in terms of information systems and subsystems.

The structured approach described by the authors begins with defining all entities and their attributes within the organization, followed by the processes by which these entities are created, changed, or deleted. The organization follows an "object" orientation, in which objects have a relationship with each other based on the sharing of information or a so-called "event". Hence, the authors describe an information system model that places data and procedures for an object into a certain class, with the class of the object determining how the object will react to a data event. Using this approach, maintenance of the information system can be concentrated on certain modules.

The authors point out that the system design focuses on data design and integrity and not processes; therefore, as the business environment inevitably changes, the design of the database is robust and more constant. Because RILA is based on a relatively constant data-oriented approach, the authors point out that it is then feasible to apply the standard information model mentioned above to clinical laboratory design and optimization. The authors list various reference information models currently available in healthcare, yet they describe a lack of acceptance and movement to this open, data-oriented model, particularly in the healthcare sector.

The purpose of the RILA project is to optimize a clinical laboratory, focusing first on chemistry and hematology departments and then using the resulting reference information to optimize different laboratory departments with similar processes. The general setup for the project uses organizationally independent reference information (RILA) and organizationally dependent information (i.e., characteristics and procedures), followed by applications to be developed for total quality management (TQM), workflow analysis, and cost/product management. The authors describe the iterative process by which the reference information model is compared to a tentative "test" model, with subsequent analysis based on the "desired" model.

The book includes many illustrations and figures involved in the RILA process, with particular attention devoted to process/entity charts that show a matrix of various data elements involved in the processes required when performing laboratory testing. The matrix characterizes information as to whether it is "used" or "created" by the process. Such analysis allows the clustering of process/entry into eight areas or subsystems. Subsequent chapters deal with the application of RILA to a typical laboratory situation, with the focus on relationships, processes, and the organization matrix. Each activity involved in the testing process is carefully analyzed and listed clearly in tables and figures.

The book concludes with a detailed description of information management and automation in the hospital and how this overlaps and coordinates with similar laboratory activities. Focus is given to the various automation layers and boundaries of information areas from the laboratory perspective.

In summary, this book illustrates the use of information in an active process whereby the laboratory can be reorganized and refined to maximize efficiency. No doubt, such approaches will provide a road map to the future, in which automation and informatics will dominate the landscape of laboratory practice.

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