Are patients stressed awaiting patient portal test results?

Cures Act mandates patient data access

Starting in April 2021, healthcare organizations nationwide were beholden to the information blocking rules under the 21st Century Cures Act. Among a number of technical changes, healthcare organizations are now required to make certain patient-facing datapoints, like clinician notes and test results, available immediately.

The logic followed that patients have a right to this information and enabling patient data access would lead to greater patient engagement and activation.

However, this regulation came much to the consternation of healthcare providers, who stated that unfettered patient access to this information could damage the patient-provider relationship. In regards to immediate access to test results, some healthcare providers posited that patients would grow anxious and worried as they awaited their results and potentially misinterpret the results should they view them before their clinician.

"Now that results are immediately available, more than 40% of results classified as sensitive are reviewed by patients before their clinicians, which has been associated with a doubling in patient-initiated messages on the portal," the researchers, who hail from Vanderbilt University Medical Center (VUMC), explained. "Most portal users are satisfied with receiving test results online and prefer to receive results as soon as they become available, but some patients have reported increased worry."

Some patients worry awaiting test results

Indeed, the researchers flagged a number of common behaviors indicative of worry, like refreshing the patient portal page. In review of VUMC's patient portal for all adult patients between January 2022 and December 2023, the researchers found it was actually quite common for patients to exhibit worried behaviors while awaiting their test results.

Overall, 37.2% of patients refreshed their patient portal as they awaited test results. This trend was more common when patients were awaiting highly sensitive test results, with 39.3% of patients hitting refresh. Additionally, patients who had enabled patient portal notifications were more likely to refresh their results page for highly sensitive test results than for low-sensitivity results.

What's more, hitting the refresh button was linked with other behaviors the researchers said indicated anxiety. For example, frequently refreshing the results page was linked with messaging the provider after viewing the results.

"Refresh activity for low-sensitivity results was more commonly associated with messaging," the researchers added. "This finding suggests that frequent refreshing, a possible surrogate measure of patient worry about a result, may be a characteristic of patient attitudes and preferences rather than of the test result itself."

Importantly, the researchers noted that they simply hypothesized that refresh activity could be a proxy for medical anxiety. More analysis is needed to assess whether this is true. After all, there's any number of reasons why patients might frequently refresh the patient portal results page, including being proactive about their care or engaging in self-management.

Still, the links between patient portal refreshes and patient portal messaging are important to understand. Foremost, healthcare organizations should be laser-focused on easing patient nerves, particularly as they await test results.

However, EHR workloads, including answering patient portal messages, are mounting, putting more and more pressure on clinicians. Organizations focused on provider satisfaction might consider how they can ameliorate some patient portal messaging burdens.

Policy and health IT implications

By being able to identify patients who are worried about their test results, healthcare organizations, policymakers and health IT developers can design guardrails to create a better patient -- and provider -- experience.

Foremost, some states have proposed or passed legislation that would exempt highly sensitive test results, like those for cancer diagnosis, from information blocking rules. In these scenarios, highly sensitive diagnostic test access could be delayed until a clinician could guide patients through the results.

However, the researchers posited that personal preference, not the sensitivity or seriousness of the test results, is a better predictor of patient anxiety. In other words, it might be better to let patients themselves opt into or out of immediate access to test results.

Some health IT vendors have begun to develop this functionality, which the researchers concluded was an encouraging step forward.

Sara Heath has reported news related to patient engagement and health equity since 2015.