The Pittsburgh Reference Library Alliance (RLA) represents a successful response by hospital laboratories to the new realities of medical economics and practice. By using informatics technology to integrate the laboratory resources of community hospitals and academic medical centers across western Pennsylvania, the RLA has created a large virtual laboratory that can compete for price with large national referral laboratories. More significantly, the combination of medical expertise, the ties to academic and community centers, and the regional medical database of the RLAs allowsThe hospital-based laboratory has not fared well during the past decade. Large commercial reference laboratories have successfully used economies of scale and aggressive marketing policies to create a low price per test that could not be matched by isolated hospital laboratories. Some pundits have envisioned a time when clinical testing will be done by one or two large national reference laboratories with hospital laboratories providing only stat, inpatient services. Today, most industry analysts estimate that almost half of all clinical laboratory testing is now performed outside the context of a hospital. If the trend to make laboratory testing a commodity continues, the capability and knowledge that has driven the tremendous advances in laboratory medicine will, at best, shift out of the hospital environment and, at worst, expire altogether. This situation poses serious implications for the medical profession.
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