{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:12:44Z","timestamp":1787008364175,"version":"build-2736575974"},"reference-count":63,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T00:00:00Z","timestamp":1673222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>There is considerable variation in ordering practices for the initial laboratory evaluation of monoclonal gammopathies (MGs) despite clear society guidelines to include serum free light chain (sFLC) testing. We assessed the ability of a clinical decision support (CDS) alert to improve guideline compliance and analyzed its clinical impact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We designed and deployed a targeted CDS alert to educate and prompt providers to order an sFLC assay when ordering serum protein electrophoresis (SPEP) testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The alert was highly effective at increasing the co-ordering of SPEP and sFLC testing. Preimplementation, 62.8% of all SPEP evaluations included sFLC testing, while nearly 90% of evaluations included an sFLC assay postimplementation. In patients with no prior sFLC testing, analysis of sFLC orders prompted by the alert led to the determination that 28.9% (800\/2,769) of these patients had an abnormal \u03ba\/\u03bb ratio. In 452 of these patients, the sFLC assay provided the only laboratory evidence of a monoclonal protein. Moreover, within this population, there were numerous instances of new diagnoses of multiple myeloma and other MGs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The CDS alert increased compliance with society guidelines and improved the diagnostic evaluation of patients with suspected MGs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajcp\/aqac151","type":"journal-article","created":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T19:16:33Z","timestamp":1667502993000},"page":"192-204","source":"Crossref","is-referenced-by-count":6,"title":["Use of Clinical Decision Support to Improve the Laboratory Evaluation of Monoclonal Gammopathies"],"prefix":"10.1093","volume":"159","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6550-1688","authenticated-orcid":false,"given":"Daniel S","family":"Pearson","sequence":"first","affiliation":[{"name":"Department of Pathology Medicine, Massachusetts General Hospital , Boston, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dustin S","family":"McEvoy","sequence":"additional","affiliation":[{"name":"Massachuscetts General Brigham , Somerville, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandakolathur R","family":"Murali","sequence":"additional","affiliation":[{"name":"Department of Pathology Medicine, Massachusetts General Hospital , Boston, MA , USA"},{"name":"Medicine, Massachusetts General Hospital , Boston, MA , USA and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4130-0758","authenticated-orcid":false,"given":"Anand S","family":"Dighe","sequence":"additional","affiliation":[{"name":"Department of Pathology Medicine, Massachusetts General Hospital , Boston, MA , USA"},{"name":"Massachuscetts General Brigham , Somerville, MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,1,9]]},"reference":[{"key":"2023032715363089800_","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1046\/j.1365-2141.2003.04355.x","article-title":"Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group","volume":"121","author":"Kyle","year":"2003","journal-title":"Br J Haematol."},{"key":"2023032715363089800_","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.blre.2015.12.001","article-title":"Monoclonal gammopathy: the good, the bad and the ugly","volume":"30","author":"Glavey","year":"2016","journal-title":"Blood Rev."},{"key":"2023032715363089800_","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1515\/cclm-2015-0580","article-title":"Laboratory testing requirements for diagnosis and follow-up of multiple myeloma and related plasma cell 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