Abstract：
BACKGROUND. To implement provisions of the 21st Century Cures Act that address information blocking, federal regulations mandated that health systems provide patients with immediate access to elements of their electronic health information, including imaging results. OBJECTIVE. The purpose of this study was to compare patient access of radiology reports before and after implementation of the information-blocking provisions of the 21st Century Cures Act. METHODS. This retrospective study included patients who underwent outpatient imaging examinations from January 1, 2021, through December 31, 2022, at three campuses within a large health system. The system implemented policies to comply with the Cures Act information-blocking provisions on January 1, 2022. Imaging results were released in patient portals after a 36-hour embargo period before implementation versus being released immediately after report finalization after implementation. Data regarding patient report access in the portal and report acknowledgment by the ordering provider in the EMR were extracted and compared between periods. RESULTS. The study included reports for 1,188,692 examinations in 388,921 patients (mean age, 58.5 ± 16.6 [SD] years; 209,589 women, 179,290 men, eight nonbinary individuals, and 34 individuals for whom sex information was missing). A total of 77.5% of reports were accessed by the patient before implementation versus 80.4% after implementation. The median time from report finalization to report release in the patient portal was 36.0 hours before implementation versus 0.4 hours after implementation. The median time from report release to first patient access of the report in the portal was 8.7 hours before implementation versus 3.0 hours after implementation. The median time from report finalization to first patient access was 45.0 hours before implementation versus 5.5 hours after implementation. Before implementation, a total of 18.5% of reports were first accessed by the patient before being accessed by the ordering provider versus 44.0% after implementation. After implementation, the median time from report release to first patient access was 1.8 hours for patients with age younger than 60 years old versus 4.3 hours for patients 60 years old or older. CONCLUSION. After implementation of institutional policies to comply with 21st Century Cures Act information-blocking provisions, the length of time until patients accessed imaging results decreased, and the proportion of patients who accessed their reports before the ordering provider increased. CLINICAL IMPACT. Radiologists should consider mechanisms to ensure timely and appropriate communication of important findings to ordering providers.
摘要：
背景：为了实施《21世纪治愈法》解决信息屏蔽的规定，联邦法规要求卫生系统为患者提供即时访问其电子健康信息的元素，包括成像结果。目标：比较《21世纪治愈法》信息阻止条款实施前后患者对放射学报告的访问。方法：这项回顾性研究包括2021年1月1日至2022年12月31日在大型卫生系统内的三个校区接受门诊影像学检查的患者。该系统于2022年1月1日实施了符合《治愈法》信息屏蔽规定的政策。在实施前36小时的禁运期后，患者门户发布了影像学结果，而不是在实施后报告定稿后立即完成。提取有关门户中的患者报告访问和EMR中的订购提供者报告确认的数据，并在各个时期之间进行比较。结果：该研究包括388921例患者中1,188,692例检查的报告（平均年龄，58.5±16.6岁；209,589名妇女，179,290人,8非二进制，34缺少性别信息）。共有77.5%的报告在实施前被病人查阅,与实施后的80.4%相比。从报告定稿到患者门户发布报告的中位时间为实施前36.0小时，而实施后为0.4小时。从报告发布到患者首次进入门户的中位时间为实施前8.7小时，而实施后为3.0小时。从报告定稿到患者首次就诊的中位时间为实施前45.0小时，而实施后为5.5小时。总共18.5%的报告是在实施前由患者在订购提供者之前首次访问的，与实施后的44.0%相比。实施后，年龄<60岁的患者从报告发布到首次患者就诊的中位时间为1.8小时,而年龄≥60岁的患者为4.3小时.结论：在实施机构政策以遵守《治愈法》的信息封锁规定之后，患者获得成像结果的时间减少，并且在订购提供者之前访问报告的患者比例增加。临床影响：放射科医师应考虑确保及时和适当地将重要发现传达给订购提供者的机制。
