The Screening Laboratory of 1980

THE SCREENING LABORATORY OF 1980* RICHARD L. REECE, M.DA The aim of the screening laboratory of 1980 will be to make knowledge productive—to convert results automatically into a form physicians can quickly assimilate and effectively use. In most instances, this form will be a list of diagnostic probabilities. The laboratory's performance in achieving this aim will be the standard by which it is judged. And this aim will influence the automated screening laboratory's organization , its use of the computer, and the clinical pathologists' duties. I shall predict what I think the biochemical screening laboratory of 1980 will be like. Necessarily this vision lacks documentation; it is not, however, without foundation. Over the past 2!4 years our laboratory has sent 110,000 computer unified and interpreted reports to practicing physicians in Minnesota. This article will show these reports to be of fundamental importance in the screening laboratory of the future. Dr. Russell Hobbie, professor of physics at the University of Minnesota, and I have written of our experience with the computer [1-5].1 Reorganizing the Laboratory The screening laboratory of 1980 will have a production-line approach to providing accurate results and to converting these results into a language that clinicians can easily understand. Though the laboratory will use production-line techniques and statistical methods, it will produce clinician-oriented results. The future laboratory will transform abnormal results into a differential diagnosis. It will accomplish this partly through reorganization. This reorganiza- *Adapted from an address given at Hartford Hospital, Hartford, Connecticut, January 1973 as part of a symposium to honor T. Stewart Hamilton, M.D., administrator at Hartford Hospital for 20 years. !Department of Pathology, Metropolitan Medical Center, 900 South Eighth Street, Minneapolis , Minnesota 55404. I am indebted to Russell Hobbie, professor of ph>sics at the University of Minnesota, who developed the computer program that produced results shown in figures 1 and 2. 'Copies of the computer program are available to any nonprofit organization wishing to verify our results. Perspectives in Biology and Medicine · Winter 1974 | 227 tion will result from new perception: that the goal of the screening laboratory is to offer diagnostic possibilities or probabilities with every abnormal result or set of abnormal results. To achieve this goal, the laboratory will be split into three major divisions : Receiving, Processing, and Transmitting. Receiving Division People in the Receiving Division will collect, centrifuge, prepare, sort, preserve, identify, and route specimens. They will also organize and enter into the computer information that affects the meaning of laboratory tests. This information will include age, sex, upright or supine posture, drugs being taken by patient, and condition of the specimen—hour and day drawn, degree of lipemia, and presence of hemolysis. Processing Division Members of the Processing Division will be charged with the responsibility of producing accurate, fast, and economical results. They will operate a serum chemical analyzer, capable of doing 50 tests or any combination of those tests; several smaller instruments for measuring Jiighvolume single tests; a hematology analyzer, with the capacity of performing complete blood counts, white cell differentials, platelet and reticulocyte counts, sedimentation rates, and the major coagulation tests; an automated instrument for measuring materials for radioactive or radioimmunoassay techniques; and a small multitest urine analyzer. Results from all of these instruments will be capable of being unified into one common report. Most of the division's energies will be devoted to producing a single large profile that measures most measurable functions of most organ systems. In essence, this profile will give an integrated comprehensive picture of the patient's metabolism. There will also be time devoted to developing new methods and to building profiles to pursue diagnostic leads suggested by the large profile. Transmitting Division By 1980 the Transmitting Division will be growing rapidly. Indeed, it may be the largest branch of the laboratory. There pathologists, other physicians, scientists, statisticians, pattern-recognition experts, and programmers will congregate to decide how best to provide comprehensive , readable, unified problem-oriented reports that tell a story about the patients' problems. By 1980 physicians will demand such reports, for most of them will have cut their academic teeth on Lawrence Weed's concept of problem-oriented medicine...