A knowledge-based information system for monitoring drug levels

The expert system shell SMR has been enhanced to include information system routines for designing data screens and providing facilities for data entry, storage, retrieval, queries and descriptive statistics. The data for inference making is abstracted from the data base record and inserted into a data array to which the knowledge base is applied to derive the appropriate advice and comments. The enhanced system has been used to develop an intelligent information system for monitoring serum drug levels which includes evaluation of temporal changes and production of specialized printed reports. The module for digoxin has been fully developed and validated. To demonstrate the extension to other drugs a module for phenytoin was constructed with only a rudimentary knowledge base. Data from the request forms together with the S-digoxin results are entered into the data base by the department secretary. The day's results are then reviewed by the clinical pharmacologist. For each case, previous results may be displayed and are taken into account by the system in the decision process. The knowledge base is applied to the data to formulate an evaluative comment on the report returned to the requestor. The report includes a semi-graphic presentation of the current and previous results and either the system's interpretation or one entered by the pharmacologist if he does not agree with it. The pharmacologist's comment is also recorded in the data base for future retrieval, analysis and possible updating of the knowledge base. The system is now undergoing testing and evaluation under routine operations in the clinical pharmacology service. It is a prototype for other applications in both laboratory and clinical medicine currently under development at Uppsala University Hospital. This system may thus provide a vehicle for a more intensive penetration of knowledge-based systems in practical medical applications.