Clinical problem solving--the role of expert laboratory systems.

The objective was to determine whether or not a laboratory based computer diagnostic program could aid the clinician in solving problems, outside his or her field of expertise, by expertly interpreting ¿Emergency Room' haematological and biochemical data and providing a list of possible diagnoses. The program, which uses Fuzzy Sets and pattern recognition as its Inference Mechanism coupled with a data base comprised of haematological and biochemical responses to disease collected over a period of 10 years in a teaching hospital, analysed data published in two leading journals--the 'Clinical Problem-Solving' section of the New England Journal of Medicine and the 'Lesson of the Week' feature of the British Medical Journal. It was found that the computer program often presented diagnoses not thought of by the clinician. With such a system, sometimes as few as three routine investigations suggested the diagnosis. The diagnostic accuracy could be improved with a more structured approach to ¿Emergency Room' laboratory investigations. It is concluded that the computer, programmed to recognize a disease by the pattern of its response to routine haematological and biochemical investigations, could contribute significantly to diagnosis.