A provision of the Cures Act that allows patients timely access to their electronic medical information—in some cases before their physicians—represents both a challenge and an opportunity for radiologists, according to presenters at a Monday debate session.
Signed into U.S. law in 2016, the 21st Century Cures Act was created to help speed innovation in medicine. The compliance phase began in 2021.
"Although this law was in the works since 2016, it caught many organizations off guard," said session moderator Jennifer Kemp, MD, radiologist and Quality Chair at Diversified Radiology in Denver. "Many people were ill-prepared or illiterate regarding what this new rule meant or how to deal with it."
The provision means that imaging results are no longer subject to any unofficial embargo until the primary care or emergency physician can talk with the patient. Patients appear to strongly support the move. A study co-authored by presenter C.T. Lin, MD, professor at the University of Colorado Medical School and Chief Medical Information Officer at UC Health, found that 96% of patients preferred seeing their results immediately. Of patients with abnormal results, 94% preferred immediate release of results.
(Left to right) Krishnaraj, Lin, Mezrich and Kemp
"Most people are very comfortable googling their results and then waiting to talk with their clinician," Dr. Lin said.
This desire is increasing the urgency for more structured, standardized reporting that will allow radiologists to include pertinent information for physicians while making the reports more digestible for patients.
"We need to be aware that we're writing for two audiences: the doctor and the patient," said Jonathan Mezrich, MD, JD, MBA, LLM, associate professor at Yale University School of Medicine in New Haven, CT. "We don't want to lose the information but we do have to be sensitive to the jargon and acronyms we use."
Researchers are already studying the potential of large language models like OpenAI's ChatGPT to serve this purpose.
"Early work shows that when you place a report into ChatGPT and ask for a summary at a certain grade level, it does a pretty good job," said Arun Krishnaraj, MD, MPH, vice chair of Quality and Safety and Chief of Abdominal Imaging at the University of Virginia. "It's not perfect, but it will continue to evolve and get better and will probably be here sooner than we expect."
Perhaps the biggest concern over the provision among radiologists is the fear that it will increase patient anxiety and confusion and lead them to misinterpret information. These fears have spurred a movement toward anticipatory guidance, in which discussions about the range of results and the notification process are moved upstream to the time of ordering and questions are solicited from patients in advance of the results.
"Anticipatory guidance means no result is surprising to any of my patients," Dr. Lin said.
To further emphasize his point, Dr. Lin took out a ukulele and serenaded the audience with a clever reworking of the Elton John classic, "Rocket Man."
"And some results patients won't understand," he sang. "Anticipatory guidance is our plan."
Has your department been affected by the 21st Century Cures Act? #RSNA23
— RSNA (@RSNA) November 27, 2023
Access the presentation, "21st Century Cures Act Information Blocking Provision: Friend or Foe?," (M4-CNPM05) on demand at Meeting.RSNA.org.
