To Embargo or Not to Embargo? No Consensus on Releasing Patient Radiology Reports

Despite a mandate to give patients timely and easy access to their radiology reports, many healthcare institutions have a built-in delay or embargo for releasing and making radiology reports available to patients. But, even that isn't a standardized practice.

Under the 21st Century Cures Act, providers are required to make electronic medical test reports, including those from radiologist, available to patients once they’re finalized. But, few facilities are following this requirement to the letter, according to a team of investigators from the Yale School of Medicine.

“Many [facilities] have made use of built-in delays or embargo periods, during which radiology reports were not released to patients, either because of technologic feasibility hurdles, or, in many cases, to give ordering clinicians the opportunity to first receive, review, and discuss the radiology report with their patients,” said the team led by Jonathan L. Mezrich, M.D., JD, MBA, assistant professor of emergency radiology.

To determine how prevalent the embargo period is, Mezrich’s team conducted a telephone survey of 70 “top hospitals” recognized in the 2019-2020 U.S. News & World Report. They published their results on May 4 in Radiology.

Based on the outcome of the survey, during which investigators posed as patients and family members interested in patient portal protocols, the team determined that 64 facilities (91 percent) offer online portals, and of those, 22 hospitals (34 percent) reported using a 1-to-3-day embargo period. Eight hospitals (13 percent) had 4-to-6-day delay, six facilities (9 percent) waited between 7-to-14 days, and 13 hospitals (20 percent) used an indefinite period. The remaining 15 institutions (23 percent) didn’t know.

Related Content: 5 Strategies to Streamline Patient Access to Radiology Reports

In addition, only 52 percent of hospitals confirmed they would send radiology reports to the referring clinician prior to making them available to the patient.

“However, there appears to be no standard with respect to embargo periods, with many institutions incorporating at least some period of delay into the process,” the team said. “Early patient access to their health information is valuable because it allows patients to better participate in their healthcare and to become their own advocates.”

It is possible that giving patients earlier access would reduce the likelihood that details found in the reports will be lost in the shuffle, they said. It could also improve compliance with follow-up recommendations – existing research shows that up to 15 percent of referring clinicians do not radiology reports, so they may never convey the radiologist’s guidance to the patient.

Still, the team said, there are several reasons why facilities could still resist giving patient’s earlier access to their radiology reports, and it is likely that these obstacles could fall into a patient safety, security, privacy, or feasibility exception under the Cures Act.

For example, hospitals could highlight these issues:

• Early access isn’t feasible because they lack a streamlined system to make reports seamlessly available to patients.
• Emotional harm to the patient who learns of a devastating diagnosis via an impersonal radiology report rather than an empathetic referring provider.
• High-level medical language contained in radiology reports may be confusing to patients.
• Early access limits a radiologists’ ability to make additions or corrections to reports before they are made available.
• Security of electronically accessible reports cannot be guaranteed.

Still Mezrich’s team said, the march toward greater use of patient portals is continuing, so radiology must prepare for the high likelihood that patients will soon have open access to reports on their imaging findings.

“It is inevitable that radiologists will need to begin drafting reports for a lay audience, either through the use of structured reporting or decreased use of medical jargon, or both,” the team said. “Greater interface with patients through early receipt of radiology reports may even prove beneficial to the field of radiology, as patient will have a greater awareness of those providing their care; it may also decrease liability risks of lack of communication and may pave the way for other avenues of patient interaction.”

In addition, radiologists should build a habit of consulting with referring providers as promptly as possible to ensure that any findings are communicated in the safest most compassionate way.

Ultimately, the team said, radiology should view this continued push toward information transparency as a helpful move in healthcare.

“Given the benefits to patients, radiologists, and possibly institutions in providing early access, radiologists should embrace the final rule as a positive step in patient autonomy,” the team concluded.

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