Klinisk Biokemi i Norden Nr 3, vol. 10, 1998 - page 28

A computerized system for notifying ofdrug
effects on laboratory tests
JARl FORSSTRÖM
1
,
TIMOTAKALN, MARITAKAILAJÄRVF, PAULAGRÖNROOS2,
KERTTU IRJALA
2
1
Medical Informatics Research Centre in Turku (MIRCIT), University ofTurku
2
Central Laboratory,
Turku University Central Hospital
INTRODUCTION
Many drugs may affect laboratory test results
(Salway 1990,Young 1995,Grönroos 1997).These
effects often cause misinterpretation of clinical
laboratory data andmay lead towrong diagnoses,
unnecessary treatments and further laboratory tests.
The number of registered human drugs is
increasing rapid!y. New laboratory tests come into
clinical use and new laboratory methods are
developed for old analytes. Therefore, it has
become very difficult to be aware of even the
elinieallymost importantdrug effects on laboratory
tests. As over 5000 human drugs and at !east 500
laboratory tests are in routine use, together they
make 2.5million combinations. Therefore it is not
surprising that the effects of drugs on laboratory
tests are not systematically evaluated. Most often
the information is published in sporadic case
reports with a limited number of patients.
The medical literature reports approximately
30.000 different drug effects on laboratory tests.
However, the reliabilityofthesepublications varies
agreatdeal. Somearebasedon animal studies only.
Some report the effects on a certain patient group
but lack the effects on a normal population.
Furthermore, there is often insufficient informa–
tion about the natureof the effect. Some clinicians
mayhave reportedthe effect as biological without
taking into account that theeffectmaybe analytical
and specific to a certain laboratory test method.
Accordingly, there may be contradietory
publications on a certain drug effect on a certain
laboratory test. Therefore, an individual publication
maybemisleading.
It
wouldbe important to collect
all relevant and available published information
on a certain effect to draw correct conclusions of
the current knowledge.
94
Several investigators have collected reference
listings concerningdrug effects on laboratory tests
(Tryding et al. 1986, Salway 1990, Young 1995,
Tryding et al. 1996). These data are, however,
unsuitable for on-line notification as they do not
includemeta-analysis of the effects. International
initiatives have been taken to harmonize the way
drug effects on laboratory tests are evaluated and
reported (Tryding et al 1987).Although thiswork
has made usmore aware of the importance of the
problem, it hashad littleeffect on clinical practice.
Usually, only clinicallaboratories are familiarwith
the drug effects on laboratory tests and transfer–
ring this information to the wards has been
extremely difficult.
In 1991, theMedical InformaticsResearchCen–
tre inTurku (MIRCIT)and theCentralLaboratory,
both part of Turku University Central Hospital,
started ajoint projectcalledCANDELA (Computer
Assisted Notification of Drug Effects on
LAboratory test results). The aim was to provide
automaticwarnings to clinicianswhen aelinieally
significant drug effect on a laboratory test was
detected. The project has lead to an extension to
the MULTILAB laboratory information system
that yields automatic warnings of drug effects to
clinicians. Thepilot testing has been running from
the beginning of 1996 and the warnings (now
available for hormonal analyses) will come into
routine use in 1998.
AUTOMATICDECISION SUPPORT
Many attempts to develop experts systems and
decision support systems (DSSs) inmedicine have
been reported in the literatureduring thepastdeca–
des (Shortliffe et al. 1990). Considering the !arge
numberofpublicationsonDSSs, surprisingly few
Klinisk Kemi
i
Norden 3, 1998
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