Implications of mass automated instruments on medical practice.

Abstract

The clinical laboratory is in a stage of change which has been the direct result of an influx of technology and the current demand for lower costs and increased productivity. There is no significant trend anticipated in the future which would forestall this particular process. The practicing physician can anticipate a fairly marked reduction in the cost of individual tests and, likewise, a marked increase in the amount of available information. There will be a larger clerical function involved in the review of such information along with a series of relevant problems related to the actual size of the new data base. One of the most significant problems related to this increase in numerical reporting will be the statistical problem of the "abnormal-normal." Statistical misclassification must be considered with each abnormal test and a specific approach must be taken to these tests to minimize the inconvenience to the patient. It is recommended that any unsuspected abnormal test(s) that is discovered be repeated as a single test(s) through a reference method. Reordering of the test battery or screen will only offer another possibility for statistical misinterpretation. If the test on isolated evaluation does appear abnormal, then this should call for the routine evaluation of this particular condition. Multivariate statistical analysis could eliminate this probability dilemma, yet is presently experimental and is not in routine use within any clinical setting. We can look forward to the evolution of such a process through the mechanism of a hospital and laboratory communication system which will allow the physician to work with an evaluation process capable of handling these large volumes of numbers (22). Such programs are on the horizon and should be anticipated within the next five years in some of the larger centers that have this new instrumentation.