Direct patient access to radiology reports: Up for debate

Should patients be able to receive their radiology reports directly from radiologists? Or should they only be allowed access when chaperoned by a qualified medical professional? Two experts holding opposing views on the matter go toe-to-toe in articles published online in the Journal of the American College of Radiology.

Making the case that patients should get to decide how they’d like to receive their radiology reports is Andrea Borondy Kitts, MPH, MS, a Connecticut-based patient advocate who consults with the Lahey Clinic in Massachusetts (and blogs at JACRblog.org).

Borondy Kitts draws from a wealth of personal experience, having lost her husband to lung cancer. She acknowledges risks along with benefits with direct patient access but maintains that the latter outweigh the former.

She recalls how her late husband, once diagnosed, had a surveillance CT scan every six weeks. Equipped with information from the resulting reports, the family had a chance to review treatment options prior to meeting with oncologists and so arrive at the follow-up visits with informed questions and a plan in mind.

“The right way to provide these reports to patients will vary by the specific imaging test situation and by patient preference,” Borondy Kitts writes. “I propose that patients be able to select their desired methods of receiving both images and radiologists’ reports at the time their tests are ordered.”

This would be documented in the EHR, she adds, and the default option would be the relaying of results to the patient by the ordering physician.

“At the imaging site, at the time of the test, the preferred method would be verified, similar to how identity and insurance information is identified,” she writes. “This would help avoid inadvertent early sharing of results for patients not wanting to see their results without a physician present and would also provide legal protection for any adverse effects of providing results directly to patients.”

Borondy Kitts suggests several safeguards, including patient-friendly summaries of radiology reports, report checklists and attached notes reminding patients of the risk of confusion and anxiety inherent in viewing results without a clinician to explain them.

More:

“I would not have wanted to read about an initial lung cancer diagnosis in a radiologist’s report. I would have wanted that conveyed by my primary care physician. However, I would have appreciated an option to discuss follow-on scan results with a radiologist to discuss his or her conclusions. ... I realize that radiologists’ reports do include summary statements indicating change or no appreciable change, but a more in-depth conversation would have been helpful for me.”

“As we transition to patient- and family-centered care in radiology,” Borondy Kitts concludes, “it is important to provide options for patients to receive the main product provided by radiologists: their expert opinions on what the pictures show and what these mean for the patients.”

No to direct—and distressing—patient access

Andre Konski, MD, MBA, professor of clinical radiation oncology at the University of Pennsylvania and medical director of radiation oncology at Penn Medicine’s Chester County Hospital, maintains that patient access and review of radiology reports should only take place in the presence of a qualified care professional.

To support his counterpoint, Konski shares firsthand experiences of patients in unnecessary distress over misunderstood radiology reports.

One such experience involved panicked phone calls from an old friend of Konski’s who had seen his abdominal CT report in the EHR. The scan had been ordered to investigate inflammatory bowel disease, but the report noted an incidental finding of lung nodules. The first frightened call came in. Then came a follow-up chest CT to look into the lung nodules. The report on this scan noted an additional nodule in the thyroid.

“Once again, I tried to reassure him that, most likely, given the report, the nodule would be benign,” Konski writes. “The nodule was biopsied and was indeed benign. Had he not had almost immediate access to the report, his physician could have called with the results and reassured him everything was fine and there was no need to worry.”

Konski also describes a steady stream of patients, at least one per year, who call him in distress after seeing a report of a CT scan ordered as follow-up to high-dose stereotactic body radiotherapy (SBRT). “I now, as a part of my consultation, inform patients who are about to undergo lung SBRT that follow-up CT scans may show abnormalities that could be interpreted as disease progression and not to be concerned until they speak with me,” he writes.

Further, Konski points out, the growth of nationwide EHRs means that physicians increasingly have access to patient records from far and wide. This has ramifications for those who hold that lack of immediate access to EHRs could delay a patient’s search for a second opinion:

“Recently, I was able to view, after appropriate release of information was obtained electronically, the records of a patient treated at a hospital in Philadelphia in a different health system because that system had the same EHR. Therefore, there may be less importance for immediate access to one’s medical record based upon an argument for immediate access to the medical record for second opinions.”

“I am not arguing patients should not have access to their EHR,” Konski adds, “but they should have access to them with their physicians, who are able to explain the findings on the report in a way the patient can understand and in the context of the patient’s disease course. Only then can unintended consequences of patient distress be averted.”