Review of "Practical Informatics for Cytopathology"

Directing a cytology laboratory is one of the most complex jobs in the laboratory. The workflow is complex due to the extensive quality assurance and other regulatory requirements imposed by the clinical laboratory improvement Act of 1988 (CLIA 1988) in addition to the usual tasks of accessioning, processing, routing different specimen types appropriately, and reporting. The advent of the CLIA 1988 regulations made it virtually mandatory that cytology laboratories be computerized to effectively manage their workflow and efficiently compile and summarize the quality assurance data necessary to meet the CLIA 1988 mandates. Practical informatics for cytopathology is a brief (204 pages), informative book which provides a succinct introduction to all aspects of informatics pertinent to cytology laboratories. It will be most helpful to the cytotechnologist or cytopathologist who has a directorial or supervisory role and who has the task of interfacing with the computer professionals in a clinic or hospital, or representing the cytology section when a laboratory is evaluating and comparing candidate systems to replace an existing system. It is not a comprehensive textbook covering the topic in sufficient detail for someone training to be a laboratory informatics professional. However, the reader of this book will have a basic understanding of the terminology and concepts of informatics in discussions with information technology professionals. While all of the chapters provide suitable introductions to their topics, several are especially useful for those who are seeking to quickly familiarize themselves with the basic concepts that are relevant to a specific topic. The introductory chapter gives a short overview of the field, mentions the major federal regulatory acts that pertain to laboratory informatics and provides the names and websites of the major professional societies and other resources. The next two chapters cover basic principles of computing and networking at a very basic level, but with enough detail to allow the informatics beginner to have an idea about what is happening “under the hood” in a computer, and to be able to follow the conversation in a system planning meeting with the institution's informatics team. The next chapter discusses various types of databases. This chapter clarifies the distinction between spreadsheets (which are “flat” databases) and other types of databases that are commonly used in laboratories such as hierarchical and relational. This chapter also provides explanations of data warehouses and data mining, both terms which are likely to be heard in discussions of laboratory informatics. The next four chapters address “laboratory information systems (LISs),” “LIS operations and regulations,” “reporting,” and “quality management.” In the aforementioned context of a cytology supervisor or laboratory director who needs to quickly familiarize him or herself with basic concepts of laboratory informatics pertinent to cytopathology, these four chapters are probably the most useful in the book. Chapter 6 covers most of the important concepts necessary for understanding the architecture of LISs. Chapter 7 addresses the regulatory requirements pertinent to LISs, and the basic concepts pertinent to ongoing maintenance of a system. Chapter 8 briefly discusses the building of reports in an LIS, a topic with more complexity than one might think. Chapter 9 addresses quality management. The introduction of the CLIA regulatory requirements over the two decades ago adds such complexity to quality management that computerization of the laboratory is all but required. Helpful examples are provided such as for cytology–histology correlation. The relation between reporting, quality management, and database architecture is not discussed, but admittedly such a discussion might have been beyond the scope of this work. The quality management chapter also provides a brief list of references which will be of interest to many readers. The other chapters lack such a reference list and although there is a short and well-chosen list of references at the end of the book, the reader who wishes to dig deeper into a particular area will need to search on their own. Fortunately, with online search tools, this will not be terribly difficult. Other chapters of general interest are devoted to telecytology, coding (CPT, ICD10, and SNOMED), barcoding, and digital imaging. Telecytology is of increasing relevance due to the increasing requests for rapid onsite evaluation for specimen adequacy of specimens procured by endoscopists, radiologists, or other clinicians. Telecytology allows such evaluations to be performed remotely, and thus utilizes the cytopathologists’ time more efficiently. Many cytologists will already have some familiarity with coding; however, barcoding is a “black box” to many, and the chapter on that topic shines a little light inside it. The chapter on digital imaging provides a good explanation of the basics principles of digital imaging including whole slide imaging as well as some direction on how to improve suboptimal images, but additional detail would have been helpful in this section and would not have been beyond the scope of the book. There are also chapters on project management, informatics projects, research informatics, bioinformatics, Lean Six Sigma, electronic medical records, automated cytology, and online cytology resources. At the end of the book, there is a listing of key definitions and recommended readings. In summary, practical informatics for cytopathology provides an introduction to informatics as applied to cytopathology. Cytologists who are not conversant with informatics will find it informative, and some will be inspired to delve deeper into the topic after reading this book.