The use of expert systems for improving test use and enhancing the accuracy of diagnosis.
The experience with BloodLink and LAS provides strong evidence that electronic knowledge support has a significant and lasting effect on laboratory test ordering by physicians. Compliance with CPG is also improved despite the ability of the guideline process to keep up to date. As discussed previously, the limitations to the application of protocols and CPG can be eliminated by electronic knowledge support. Indeed, this technology may be considered the future salvation of evidence-based medicine. It is also apparent that using the expert system to provide interpretations of the results ensures optimal use of the tests. The ability to reduce costs by 20% using stringent use control measures is meaningless if by misunderstanding, all of the potential information is not understood. In the future, as computer connectivity becomes pervasive within the practice of medicine, systems, such as BloodLink and LAS, will be used routinely for many aspects of care. Molecular genetic testing and proteomics will become a major component of routine medical practice. The complexity of what to order, the implications of performing the tests, on whom to do them, and what the vast array of data mean, will demand the use of CARTKS. It is becoming increasingly popular for patients to obtain their own results and to manage their own medical record. In some jurisdictions patients may order their own tests. We will undoubtedly see the development of knowledge support tools that are designed for patient use. The CARTKS provided by computer systems is the most powerful approach to use control and it has the additional benefit of doing so while enhancing medical care.
MDS Metro Laboratory Services, 4489 Viewmont Avenue, Victoria, BC V8Z 5K8, Canada. mmcneely@mdsmetro.com
Michael D D
MD
McNeely
D020000:Decision Support Systems, Clinical; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003951:Diagnostic Errors / Q000517:prevention & control*; D005103:Expert Systems; D006801:Humans; D010338:Pathology, Clinical / Q000379:methods*; D015203:Reproducibility of Results