In Reply We thank Bindraban et al for their comments and concerns regarding our article,¹ and we agree that not all components (education, targeted feedback, electronic medical record [EMR] change) may be needed to reduce daily testing. In the article by May et al² that was mentioned in their Letter to the Editor, the intervention used was EMR based, allowing only single orders for laboratory testing (ie, no recurring orders). This may be a feasible method in some institutions, but not all have the buy-in from key clinical groups and administrators to enact such a change. At Mount Sinai Hospital, for example, we have not yet had institution-wide approval for limiting recurring orders, and the EMR constraints preclude our ability to even limit recurring orders for specific groups who do approve. Based on discussions among our multi-institutional committee and others, we suspect we are not alone, and many have implemented EMR changes that are less than ideal, including removing recurring order defaults from order sets, or placing best practice advisory warnings.

在答复中，我们感谢Bindraban等人对我们的文章¹的评论和关注，我们同意可能不需要减少日常测试的所有组成部分（教育，定向反馈，电子病历[EMR]更改）。在May等人的文章^2中正如他们在致编辑的信中提到的那样，所使用的干预措施是基于EMR的，仅允许单个订单进行实验室测试（即没有重复订单）。在某些机构中，这可能是一种可行的方法，但并非所有机构都需要关键临床小组和管理人员的支持才能实施此类更改。例如，在西奈山医院，我们尚未获得机构范围内的限制重复订单的批准，而EMR限制使我们无法限制批准的特定人群的重复订单。根据我们的多机构委员会与其他机构之间的讨论，我们怀疑我们并不孤单，并且许多人实施了不理想的EMR更改，包括从订单集中删除重复出现的默认订单，或放置最佳实践咨询警告。