21st Century Cures Act information-blocking rule has no impact on patient complaints in radiology

The information-blocking rule under the 21st Century Cures Act—requiring providers to grant patients immediate access to their radiology reports—appears to have no impact on patient complaints.

That’s according to a new single-center analysis from Vanderbilt University Medical Center published Friday in JAMA Health Forum [1]. The Cures Act first went into effect in December 2016 and entered its first compliance phase in April 2021. It aims to help increase patient access to health information, also including consultation notes, physical exams, lab and pathology work, and discharge summaries.

To better understand the law’s impact, researchers at VUMC analyzed nearly 8,500 unsolicited patient complaints logged at their institution between 2020 and 2022. They found that such grievances increased from over 3,000 in the year leading up to the information-blocking rule’s implementation to nearly 5,500 in the year after.

“In this cohort study with interrupted time-series analysis, the Cures Act [information-blocking rule] was not associated with a change in the monthly rate of [unsolicited patient complaints] at a large academic medical center,” lead author Robert J. Dambrino IV, MD, with Vanderbilt’s Department of Health Policy, and colleagues wrote Sept. 29. “A qualitative review of the complaints suggests that there are unintended consequences of complex medical information being immediately available to patients. Further study of the effects of this legislative mandate with multi-institutional data and a longer time horizon may be helpful for further understanding of this law’s effect on [unsolicited patient complaints].”

Prior to Jan. 1, 2021, Vanderbilt’s policy was to release radiology reports three business days after results were available, pathology reports 15 calendar days later, and to never electronically share clinical notes. After the law change went into effect, the Tennessee institution began providing immediate access to all three via its patient portal.

After the rule went into effect, topics covered in the complaints included concerns with results from radiology or pathology, disagreements over documentation, anxiety stemming from unexplained findings and dissatisfaction with medical team communication. Many gripes appeared to stem from patients gaining access to reports before they were able to speak with a physician.

“For example, a complaint about a magnetic resonance imaging (MRI) report was as follows: ‘patient waiting for Dr. *** to call her with results from MRI … very upset and concerned that her MRI results mention lymphoma,’” the study reported. “Another patient complained, ‘I spent all weekend terrified after reading some terrifying information … I could not reach my doctor to discuss.’”

For practice leaders, one key takeaway from the study is the need to prep patients for the receipt of their results.

“Without adequately preparing patients and adjusting clinical systems, the increased messaging seen in the immediate release of electronic health information could increase the workload of clinicians and their clinical staff,” the authors noted. “To mitigate this increased messaging, clinicians and healthcare organizations can prepare patients for the possibility that results may be posted at the same time or even before the clinician has a chance to review them. Practices could build in processes to ensure that patient questions are answered in a timely manner.”

Read much more in JAMA at the link below.