Researchers from the Yale School of Medicine conducted a telephone survey of 70 top hospitals in the U.S. and found that patients experienced delays in access to their radiology reports that ranged from a day up to indefinitely. Federal regulations requiring immediate patient access to finalized reports have taken effect, however, and it's time for radiologists to support the immediate release of radiology reports to patients, according to presenter Dr. Jonathan Mezrich.
"More direct communication directly from patients should benefit the specialty, as it will increase the profile of radiology, giving patients a greater awareness of the radiologists participating in their care," he said. "And it may reduce the liability risk for radiologists by decreasing the risk of failure to communicate findings. Even if the treating physician does not read the radiology report, the patient might."
Enacted under the 21st Century Cures Act of 2016, the so-called information blocking provision was included in the ONC Cures Act Final Rule and requires that electronic reports -- including radiology reports -- be released to patients once they've been finalized. There are some exceptions, though, related to patient safety, privacy, security, and feasibility. The rules took effect on April 5, although enforcement rules haven't been finalized yet.
Healthcare institutions have traditionally taken varied approaches to patient portal access, according to Mezrich. Some have historically provided early patient access to reports, while others have made use of built-in delays -- so-called embargo periods -- in order to give treating clinicians the chance to first review results with patients.
"A delayed approach may allow for more patient-tailored, emotionally sensitive provision of information," Mezrich said. "There may also be desired differences in approach for oncological and inpatient settings."
To assess the current standard of practice for providing patients access to their radiology reports, the researchers conducted a telephone survey of 83 top hospitals listed in the 2019/2020 U.S. News & World Report Best Hospitals in the U.S. rankings. Using a "secret shopper" approach, the researchers posed as a potential patient family member to determine whether the institution used an embargo period.
The researchers were able to obtain responses from 70 (84%) of the 83 hospitals, although not every respondent answered every question, Mezrich said. Of these 70 hospitals, 64 (91%) offer online patient portal access to radiology reports.
Embargo periods varied among these institutions:
- 1-3 days: 22 (34.4%)
- 4-6 days: 8 (12.5%)
- 7-14 days: 6 (9.4%)
- Indefinite: 13 (20.3%)
- Don't know: 15 (23.4%)
The researchers acknowledged several limitations to their study, including its reliance on the U.S. News & World Report hospital rankings. As a result, it may not be representative of all U.S. institutions, Mezrich said. Furthermore, not every respondent answered every question and responses were gathered from a single individual at every institution.
Mezrich noted that early online access enables patients to participate in their own healthcare, be their own advocates, and prevent errors. However, early patient access also engenders issues related to feasibility, as well as the concern for emotional harm to the patient, Mezrich said.
Communicating a dire diagnosis electronically rather than in person may be dangerous for emotionally fragile or suicidal patients, according to Mezrich. There is also concern about information security, as well as the potential for patients to be confused by technical reports.
However, "advancing technology solutions will address useability and security issues over time," he said.
Furthermore, institutions offering patient portal access may gain a competitive advantage, providing a business incentive for institutions to overcome many of these hurdles, he said.
"Radiologists will need to be cognizant that patients will be directly reading the reports and will have to decrease use of jargon and write more for that audience," he said.
Although there are some advantages to having treating physicians read the reports first and serve as a human interface to safely and compassionately relay results, patients' rights to their healthcare information and ability to actively participate in their care may outweigh this approach, he said.
"Given the looming mandate under the final rules, radiologists should embrace the immediate release of radiology reports, except in rare, limited patient safety circumstances," Mezrich said.
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