Patients' health care data has long been siloed, existing largely in paper files stored on doctor offices’ shelves or in electronic systems that couldn’t interact with each other. The emergence of patient portals has made accessing and sharing health care data easier for patients, but the process often still moves at what can feel like a snail's pace—especially if a patient is anxiously awaiting the results of a lab or pathology test.
It’s been common practice to delay releasing lab and pathology results to patient portals for a certain period, particularly for abnormal results. This allowed clinicians to review the results before patients could access them and determine how best to deliver the results to patients. But because of new federal requirements, many provider organizations are now removing those delays.
A mandated, major shift in lab and pathology test results release
The Office of the National Coordinator for Health IT's (ONC) new information blocking requirements, which took effect last month, aim to make it easier and faster for patients to access their electronic health information (EHI). ONC has made it clear that providers largely can no longer delay the release of EHI to patients, including lab and pathology test results.
In removing the delays, lab and pathology test results become available to patients at the same time as clinicians—and, sometimes, patients may even see their results before their clinicians have had a chance to review them. That’s sparking understandable concerns among clinicians who worry some patients may not know how to interpret or react to their results without guidance from their provider, potentially causing unnecessary alarm.
It’s important to remember, though, that patients not only have a right to access this data, but they’re also beginning to expect that they can access their EHI quickly, as they can with so many other types of data today. Immediate results release can therefore help to foster an environment of transparency between clinicians and patients, further engage patients in their care, and limit anxiety that can occur while awaiting test results.
How to prepare patients for immediate results release
While the switch to immediate results release presents an opportunity for providers to empower patients to be more hands-on when it comes to their care, provider organizations and clinicians will need to set expectations and equip patients up front with the information they need to understand their results and any next steps. Organizations should take these four steps:
1. Inform patients about immediate results release. Patients need to know that if they undergo a lab or pathology test, the results will become available to them at the same time the results become available to clinicians. If this isn’t what patients are used to, organizations should proactively inform patients of the change. There are many methods to communicate these expectations: clinicians should have these conversations with patients as part of their workflow for ordering tests, and staff can broach this topic with patients during check-in or check-out touch points. Also consider adding a note when releasing results to clarify that clinicians have not yet reviewed the results and will add interpretation later.
2. Outline potential outcomes and treatment options up front. Organizations need to ensure that patients know why they’re undergoing the tests ordered by clinicians, what the results of the tests could be, and what those results may mean for the patient’s health and care—particularly in the event of an abnormal result. When ordering a lab or pathology test for a patient, a clinician should discuss any potential results and what those results would mean in terms of treatment plans. These conversations can be difficult, especially if a patient is being tested for a new or worsening medical condition, but having them up front can help align expectations and prepare patients for their results. Organizations also can provide educational materials describing the possible outcomes and next steps associated with commonly used tests. Staff could give those documents to patients and/or include that language along with test results released to the patient portal.
3. Tell patients how and when you’ll follow up. Not knowing the process for communicating test results outside the patient portal can be stressful for patients. It’s important to let patients know whether, when, and how clinicians will follow up with them about their test results. That means setting clear expectations with patients about what types of test results will warrant follow up, who will follow up with them, how they’ll be contacted for follow up, and how long it will take for follow up to occur. Patients also need to know how they can get in touch with someone on their care team if they have additional questions.
4. Address whether exceptions are needed and allowed. Even with the most comprehensive communication strategy, some clinicians still may have concerns about releasing certain types of test results directly to a patient portal, particularly when testing for serious conditions such as cancer and neurogenerative diseases. Keep in mind that ONC’s information blocking requirements do permit providers to delay results release under certain exceptions, such as if a clinician believes that immediate results release without concurrent counseling could cause patient physical harm. But those delays must be limited and implemented on a case-by-case basis, and they should truly be an exception, not a rule.
A need for broader conversations—and an organization-wide approach
There are many ways organizations can prepare clinicians and patients for immediate results release, and that means it’s vital for organizations to set clear policies on how to navigate this transition. As you evaluate your organization’s approach, start by determining:
1. Clinicians’ and other staff’s roles and responsibilities for communicating with patients, including:
- What roles clinicians and staff will have in informing patients about immediate results release, and when;
- Beyond the ordering clinician, are other staff available to and responsible for providing explanations of possible test results to patients, and how; and
- Who on a patient’s care team will handle any necessary follow up or questions from patients regarding their test results.
2. How your organization will handle exceptions, including:
- Will clinicians be able to delay certain results’ release, when appropriate, within the EHR workflow;
- What documentation will you retain to show that delays are covered under ONC’s exceptions for instances of preventing physical harm or accommodating patient’s expressed privacy preferences; and
- How will you work with your IT department to implement these changes?
Ultimately, immediate results release policies reflect just one part of an organization’s broader strategy for sharing data and empowering patients, as test results are one of many data elements covered under ONC’s information blocking provision. If you need help navigating the new normal of data sharing, Advisory Board’s Quality Reporting Roundtable can help.