From the Journals

Immediate release of patient test results may have unintended consequences


(Reuters) – The benefits of the immediate release of test results to patients may be outweighed by decreased patient well-being and increased clinical workload, researchers argue in a recently published paper.

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The study examined data on a total of 3.22 million test results for 294,799 patients that were released on a patient portal for Vanderbilt University Medical Center from Jan. 1, 2020, through April 16, 2021. The study period spanned the implementation of the 21st Century Cures Act, which mandated immediate release of test results, medication lists, and clinical notes to patients via electronic health records; prior to this it was common to release only a small subset of this type of information via electronic patient portals.

One concern with the implementation of the Cures Act was that patients might see medical information or test results before it was viewed by clinicians, potentially leading to confusion or distress for patients or creating extra work for clinicians, the study authors argue in JAMA Network Open.

For the study, researchers examined how the implementation of the Cures Act altered the timing of patients’ review of test results that would have previously had a delayed release.

Before the Cures Act took effect, test results categorized for a delayed release in electronic health records were viewed by patients before clinicians in 10.4% of instances. After the Cures Act, these same types of test results were viewed by patients before clinicians in 40.3% of instances.

Prior to the Cures Act taking effect, clinicians received a median of 77.5 messages per day from patients within six hours of reviewing a test result, the study also found. After the Cures Act, clinicians received a median of 146 daily messages sent by patients within six hours of viewing test results.

The study did not analyze the content of these messages, the authors note.

“More research is necessary to determine the optimal timing for result release,” said lead study author Bryan Steitz of the department of biomedical informatics at Vanderbilt University Medical Center in Nashville, Tenn.

“In our current research, we’re learning that the majority of patients want to receive their results without delay, even if that means getting them before their health care provider,” Mr. Steitz said by email.

Some patients prefer getting results at home and surrounded by loved ones over getting their results alone in a doctor’s office, Mr. Steitz said.

“Health care institutions and electronic health record vendors should consider adding functionality to the patient portal that enables patients to indicate their test result release preferences that balances information availability and potential feelings of anxiety,” Mr. Steitz added.

With the immediate release of records becoming a reality, clinicians and health care institutions should consider how they can prioritize precounseling patients on the clinical meaning of test results within the context of the patient’s health, Mr. Steitz said. This might better prepare patients to understand test results that they view before their clinician.

“A key benefit of receiving these results through the patient portal is that patients can now facilitate communication between providers and ensure that their care team has access to the most up-to-date information,” Mr. Steitz said.

Providing this up-to-date information also allows patients to review, research, and consider the results of their test before meeting with their provider, Mr. Steitz added.

“This can better enable shared decision making between patients and providers to ensure that treatments meet the patient’s social needs and values,” Mr. Steitz said.

Reuters Health Information © 2021

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