Radiology Adjusts to The 21st Century Cures Act
Radiologists are part of the patient’s care team, yet questions remain about patient communication
Since it went into effect in early 2021, the 21st Century Cures Act Final Rule has triggered a profound transformation in health care. The rule mandates seamless and secure access, exchange and use of electronic health information, and requires immediate release of electronic health information to patients, providers and payers.
The result? A radiologist can no longer think of themselves as a “doctor’s doctor,” according to Jonathan L. Mezrich, MD, JD, MBA, an emergency radiologist and associate professor in the Department of Radiology and Biomedical Imaging at the Yale School of Medicine in New Haven, CT. Dr. Mezrich and colleagues published a special report in Radiology on the effect of patients having electronic access to radiology reports.
“Some patients who only interfaced with a treating physician probably never realized there were other doctors involved in their care,” Dr. Mezrich said. “But now, they receive a report in real time, with a radiologist’s name and contact information listed. Some patients may even reach out to their radiologist with questions. I’ve had a few patients call me.”
This accessibility is helpful in enhancing the visibility of radiology as a specialty and in giving radiologists a degree of patient contact that has otherwise been lacking, he said.
“This essentially lets us get out of the dark shadows of the reading room and into the limelight,” Dr. Mezrich said.
Colbey Freeman, MD, agrees that the Act has created an opportunity for radiologists to demonstrate their value to patients.
“The mechanism—meaning in-person in the clinic, over the phone or by video conference—and timing of when the information is communicated seem to be significant variables in determining patient perceptions of radiologists,” said Dr. Freeman, a neuroradiologist and assistant professor of radiology at the University of Pennsylvania in Philadelphia, who will present at RSNA 2024 on this topic.
Getting Used to a New Reality
Radiologists and clinicians must adjust to the new landscape where patients often access reports before providers, noted Nelly Tan, MD, associate professor in the Department of Radiology at Mayo Clinic in Phoenix, AZ.
Dr. Tan and colleagues recently published a study in the American Journal of Roentgenology on patient access of radiology reports.
“While the core radiology report maintains technical terminology and details for referring physicians, adding additional language that includes radiologist’s synthesis of the finding, for example, ‘likely cyst’ for ‘low density subcentimeter lesion in the liver,’ can improve patients’ understanding,” Dr. Tan said. “At the end of the day, patients, like providers, want to know what the radiologist thinks the findings mean and what the next steps are, if any.”
This approach, she said, enables radiologists to address the specific needs of both audiences without diluting clinical accuracy or adding more work.
Clarifying things as being “benign” or “normal variants” where applicable should also be done to alleviate concerns, Dr. Mezrich said.
“I expect that multimedia-enhanced reports—meaning reports that incorporate links to images, video and web resources—may be the next step in interfacing with patients, but it may still be a while before we can implement this in a time-efficient way,” he noted.
AI, which already assists to a certain extent with automated segmentation, identification of critical findings such as free air or pulmonary embolus, and body composition, among many other applications, may further help radiologists with text-based aspects of radiology reporting.
“Within the next year or two, large language models will aid in every aspect of radiologic patient care, from clinical decision support for exam orders, study protocols, image interpretation, radiology reporting, and patients’ understanding of their reports. Large language models will improve the quality of care,” Dr. Tan said.
According to Dr. Freeman, AI may also serve a role in automating or semi-automating notifications or nudges to referring providers regarding important findings and recommended follow-up.
“The lay media seems to focus on advances in AI models for reading radiology studies, but I am particularly excited about AI’s potential to reduce the burden of certain aspects of radiologists’ workloads,” Dr. Freeman said.
A Changing Legal Landscape
In response to the 21st Century Cures Act, California put a law into place that requires a hold to be placed on a report if it includes a new or recurrent malignancy, so the referrer has time to call the patient.
“California's approach balances patient autonomy with the emotional impact of receiving sensitive health information before seeing a doctor. This traditional approach favors medical paternalism over trusting patients to choose how they receive their health information. Data indicates that waiting for results can cause more anxiety than bad news itself,” Dr. Tan said. “A system where providers must choose to impose an embargo, rather than it being the default for these patients, would be more effective in granting access while reducing emotional distress identified through provider-patient interactions.”
The best approach for communicating emotionally sensitive information is a call to the patient’s provider and let them know that a concerning report is about to be released so they can follow up promptly, Dr. Mezrich noted.
In his view, the California law undermines the notion that health care should be transparent, that patient autonomy should be respected and that patients should be their own best advocates in their care.
“Patients are always free to wait until their providers are available before accessing their online information, but many will opt not to, and that is their choice,” Dr. Mezrich said. “It is unclear to me whether we should be re-implementing embargoes to protect patients from themselves.”
For More Information
Access the Radiology article, “Patient Electronic Access to Final Radiology Reports: What Is the Current Standard of Practice, and Is an Embargo Period Appropriate?”
Access the American Journal of Roentgenology article, “Patient Access of Their Radiology Reports Before and After Implementation of 21st Century Cures Act Information-Blocking Provisions at a Large Multicampus Health System.”
Read previous RSNA News articles about communicating with patients: