Reply to B. Chin-Yee et al

Abstract

Thank you for reading and appreciating our work on test utilization management in hematopathology. 1 We are grateful that the article has resonated with you and that our solution to the silos in decision making has mirrored your own. The use of the term Choose Wisely Together exactly captures the sentiment we tried to convey, and we intend to use that terminology in the future, attributed to your team. 2 We also instituted an ad hoc testing option for our clinicians (see fourth sentence under MATERIALS AND METHODS subheading Decision Support Application), which we termed as the do regardless option for the clinicians to request testing regardless of the marrow findings or applicable standard ordering protocol (SOP). This option enabled complete testing that might be required for any number of reasons, including but not limited to specific clinical trials/ studies that might proscribe certain testing. In addition, we enabled pathologists to also order off the SOPs as they felt clinically indicated on the basis of what they observed. Indeed, the decision support application (DSA) contained built-in hints for specific clinical scenarios that might not apply to every case in a given disease category. These hints were used to ensure that BCR::ABL1 testing was performed only on relevant patients returning for follow-up of their B lymphoblastic leukemia (HINT: Is this patient Ph positive?). Another hint was used if eosinophilia is prominent in a proliferative marrow (HINT: Is there eosinophilia?) to remind the pathologist to add on relevant fluorescent in situ hybridization (FISH) studies to evaluate for a myeloid/lymphoid neoplasm with eosinophilia. The DSA readily allowed both ordering providers and the pathologists to ensure appropriate testing-certainly choosing wisely together!