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Patient data access speeds up after 21st Century Cures Act

The faster pace of patient data access calls into question how providers prepare clinical notes and communicate with laboratory testing sites.

Patients are waiting less time to access their imaging and radiology reports today, according to a new report, a trend that’s the credit of the 21st Century Cures Act and the information blocking rules that were intended to improve patient data access.

But as the odds that a patient will see their imaging results before their ordering provider increase, it’s going to be important to augment the imaging interpretation and note-writing process to ensure a good patient experience, researchers advised.

The Cures Act information blocking provisions affected patient data access by requiring healthcare providers, hospitals, and health systems to grant patient access to lab results and clinical notes immediately.

In the radiology space, this meant patients faced no lag time in seeing the results of their imaging tests. Previously, radiologists might send imaging tests to the ordering provider, who would then share the results with the patient during a conversation. Now, the note that the radiologist prepared must become available to the patient and the ordering provider at the same time.

This latest study, published in the American Journal of Roentgenology (AJR), compared how long it took patients at three hospital campuses across the country to access their radiology reports before and after Cures Act implementation, which happened in January 2022.

“After implementing institutional policies to comply with Cures Act information-blocking provisions, the time for patients to access imaging results decreased, and the proportion of patients who accessed their reports before the ordering provider increased,” Nelly Tan, MD, the study’s senior and corresponding author and member of the radiology department at Mayo Clinic in Phoenix, AZ, said in a statement emailed to journalists.

Prior to the Cures Act going into effect, the hospitals included in the study had a policy of embargoing imaging results for 36 hours.

This embargo was intended to give the ordering clinician time to review radiologist notes and then contact the patient and discuss results. Ideally, this would allow the ordering clinician to contextualize any abnormal results and translate medical jargon and other unclear communication for the patient.

The Cures Act got rid of any latitude the studied hospitals had in delaying patient data access, which the researchers acknowledged could influence not just how patients learn about their test results but also how radiologists may write up result reports before they’re posted to the patient portal for patients and ordering providers to view.

If the turnaround time on patient data access were to speed up and patients were to access the report before the ordering provider, it could cause a paradigm shift in how patients consume their health information.

This study looked at the first two factors—whether the Cures Act sped up the time in which patients accessed their radiology reports and whether the patient viewed the reports before the radiologist—and ultimately found that the regulation did.

Before Cures Act implementation, it took patients a median time of 47.3 hours before they accessed their test results via the patient portal. After implementation, it took 8.9 hours. Pre-implementation, 18.5 percent of patients saw their imaging results before their ordering provider compared to 44 percent of patients who did post-implementation.

Said otherwise, just under half of patients looked at their lab results before the ordering provider, who might be the patient’s primary care or specialty provider, could consume them.

The jury’s still out as to how immediate patient access to test results affects the patient experience. One separate study has shown that patients, even those receiving abnormal results, want to view their tests via the patient portal as soon as possible. In another study, researchers found that patient data access under the Cures Act increased the number of complaints a hospital received.

Indeed, there could be downfalls to patients immediately accessing their imaging results, the AJR report authors wrote.

“The concurrent release of reports to patients and ordering providers could also have adverse consequences,” they said in the study’s discussion section. “For example, a patient’s lack of understanding of certain medical terms could create unnecessary worry regarding a benign finding. In addition, patients and providers may prefer that a new or unexpected serious diagnosis be first communicated through direct conversation, potentially in person.”

However, the authors acknowledged that the Cures Act provisions continue to stand, noting that federal officials have asserted that the possibility of “a serious and unexpected finding cannot be the sole basis for delaying results release,” they said.

Instead, healthcare professionals need to reconsider how they can present test findings and clinical notes to create a good patient experience. For radiologists, this means supporting better communication with ordering providers in cases where the radiologist detects abnormal results. The radiologist can alert the ordering provider of the abnormality before the interpreted results are finalized.

Radiologists can also change the way they write their reports with a specific emphasis on patient health literacy.

“In addition, radiologists may choose to tailor the language of the report, to provide greater context and explanation for certain findings in the event that the patient accesses the report before the ordering provider; for example, the radiologist could include a comment that a particular incidental finding is benign,” the report authors advised in conclusion.

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