The 21st Century Cures Act, a landmark legislation signed into law in 2016, aimed to revolutionise healthcare delivery by addressing information blocking and promoting patient-centred care. A crucial aspect of this legislation was ensuring patients' timely access to their electronic health information, including radiology reports. Implemented in April 2021, the Act aimed to remove barriers that previously limited patients' immediate access to their health information, including imaging test results. In a significant shift towards promoting patient-centred care, a study recently published in the American Journal of Roentgenology evaluated the effects of the 21st Century Cures Act on patients' access to their radiology reports and the implications for healthcare professionals.


Background and Historical Context

Before the Act, healthcare systems commonly imposed time-limited embargos on the release of radiology reports to allow ordering providers ample time to review and coordinate care. Such practices potentially heightened patient anxiety and limited their autonomy in managing their health. However, the Act's information-blocking provisions mandated that patients be granted immediate access to certain electronic health information, including imaging results, with only a few exceptions for patient safety or privacy.


Study Design and Methodology

Conducted across three campuses of a prominent U.S. academic health system, this retrospective study compared patient access to radiology reports before and after the Act's implementation in April 2021. The health system updated its policies and IT infrastructure on January 1, 2022, to comply with the Act's regulations. Key findings were based on data from 388,921 patients who underwent outpatient imaging examinations during the pre- and post-implementation periods.


Increased Patient Access and Role Reversal between Patients and Providers

The study analysed data from 388,921 patients who underwent outpatient imaging examinations. Results showed that 77.5% of patients accessed their reports before implementation, which increased to 80.4% post-implementation. A significant change was observed in the sequence of report access. Before the Act, patients accessed reports before providers in only 18.5% of cases. Post-implementation, this percentage surged to 44.0%. Meanwhile, provider acknowledgement of these reports remained consistent at 100%. Older patients (60 years and above) exhibited longer access times compared to younger demographics. Additionally, disparities were noted based on gender and race, with women and White patients more likely to access reports promptly.


Implications for Healthcare Providers

The Act's implementation has accelerated the time patients take to access their imaging results. This immediate access aligns with patient preferences, as highlighted in previous surveys where the majority favoured shorter delays in accessing test results.


However, simultaneous access by patients and providers could have unintended consequences and pose some challenges. Patients might misinterpret medical terminology, leading to unnecessary anxiety, especially for benign findings. Furthermore, while some patients prefer early access to prepare for consultations, others might prefer receiving "bad news" verbally from their provider.


To address these concerns, radiologists could proactively contact ordering providers about critical findings or adjust report language to provide clearer context. The study underscores the need for radiologists to adapt their communication strategies to ensure timely and appropriate notification to ordering providers. The Act's provisions allow for delays in reporting findings related to patient safety or privacy concerns. Radiologists must exercise discretion in such cases, ensuring critical information is communicated promptly to ordering providers.


The 21st Century Cures Act has undeniably enhanced patients' access to their radiology reports, promoting transparency and empowerment in healthcare. However, it has also posed challenges in balancing immediate access with clear communication and patient understanding. As the healthcare landscape continues to evolve, it becomes imperative for providers and institutions to adapt and refine their practices to best serve patient needs while maintaining the quality and clarity of medical communication.


Source: American Journal of Roentgenology

Image Credit: iStock



Jordan R. Pollock, Skye A. Buckner Petty et al., Patient Access of Their Radiology Reports Before and After Implementation of 21st Century Cures Act Information-Blocking Provisions at a Large Multicampus Health System, American Journal of Roentgenology 2024, 10.2214/AJR.23.30343

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21st Century Cures Act, healthcare delivery, patient-centred care, radiology reports, patient access, healthcare professionals Discover how the 21st Century Cures Act impacts patient access to radiology reports & healthcare provider dynamics. Learn more in this insightful study.