ARUP Offers Lab Algorithms for Disease Diagnosis Support

I have a continuing interest in the use of algorithms to assist physicians in the diagnosis of disease. Most clinicians have such test-ordering rules firmly entrenched in their memories for common diseases. However, they frequently need guidance when evaluating their patients for esoteric conditions. ARUP Laboratories, one of the country's premiere reference labs, provides such assistance on their web site with ARUP Consult. On the left hand side of the ARUP Consult web page is a direct link to 45 algorithms that are intended for use by physicians in lab test selection and interpretation. Alphabetically, these algorithms range from acromegaly to Zollinger-Ellison syndrome.

Above is an example of the algorithm from the set that is used to assess the possibility of celiac disease or gluten-sensitive enteropathy. The format and information flow of all of these algorithms could not be any clearer and is an indication of the large effort that was devoted to their development (and maintenance).

Another way to approach the possible diagnosis of celiac disease from the ARUP Consult web page is to first link to disease categories, then to gastrointestinal disease , and then to celiac disease. A page is then displayed with four tabs specific for this disease. They are: (1) clinical background, (2) tests, (3) references, and (4) algorithm. This last tab links to the same algorithm displayed above. This web-based ARUP Consult is a valuable teaching resource that should be known and used by all clinicians.

This discussion leads me to the related and larger question about how to make lab testing algorithms such as these available to a broader group of clinicians. In particular, I am interested in access by medical students and residents in order to inculcate in them life-long habits of appropriate test ordering. Perhaps ARUP would be willing to license these algorithms for integration into the LISs of ARUP client hospitals. When placing web-enabled test orders, a link to the relevant lab algorithm could be displayed when a clinician orders one of the lab tests contained in one of the algorithms. In many cases, this would be an order for an esoteric lab test. In this way, access to the algorithms could be offered in a non-intrusive fashion to a broader group of clinicians and greater value could thus be derived from them.