Overcoming Reporting Challenges Posed by the Cures Act

How radiologists can write reports that provide even more value to both patients and physicians

William Mehan
Jonathan Mezrich
Sandip Basak
Randy Miles

In October of 2020, the 21st Century Cures Act Final Rule went into effect, supporting the seamless and secure access, exchange and use of electronic health information. It mandated the immediate release of electronic health information to patients, providers and payers.

Prior to this legislation, institutions would often place an embargo on their radiology reports, giving the treating physicians a few days to review the report and contact the patient with an explanation of the findings and a plan for moving forward although sometimes creating anxiety for patients who had to wait to receive the information.

Now, patients will often see the reports before their physician. While this may empower patients to take ownership over their care and reduce anxiety for some who no longer have to wait, it can also create anxiety and confusion among patients who don’t understand the medical terms within the report. While the more readily available reports will undoubtedly bring welcome news to some, other patients could receive bad news without the support of their care team.

This puts more pressure on radiologists to write reports that are clear and impactful for two very different audiences: physicians and patients. Even though that presents interesting challenges, it also offers a unique opportunity to elevate the role radiologists play in patient care. 

Determining the Impact of Immediate Information

William Mehan, MD, MBA, a diagnostic neuroradiologist at Massachusetts General Hospital (MGH) and assistant professor of radiology at Harvard Medical School, both in Boston, co-authored a Current Problems in Diagnostic Radiology study that surveyed MGH providers to determine how the embargo lift affected patient care with the hospital’s referring providers.

Of the 249 respondents, 78.3% said a patient had contacted them with questions regarding report findings and 84% experienced a spike in patient calls.   

Jonathan Mezrich, MD, JD, MBA, an emergency radiologists and assistant professor of radiology in the Department of Radiology and Biomedical Imaging at Yale School of Medicine in New Haven, CT, is the author of a Radiology study on patient electronic access to final radiology reports. In telephone survey calls to 83 hospitals, in which his research team posed as mock patient family members, Mezrich found that the hospitals had seen a small increase in phone calls from patients but claimed that lifting the embargo was a relatively smooth process.

Meanwhile, Sandip Basak, MD, neuroradiologist and president at University Radiology Group, a large provider of diagnostic imaging and subspecialty radiology services throughout New Jersey, and Randy Miles, MD, MPH, chief of breast imaging at Denver Health and associate professor of radiology the University of Colorado, both acknowledged that patient feedback to the embargo lift has been minimal.

“We need to maintain the integrity of these reports because it’s a primary source of communication between the radiologists writing the report and the referring physician, other radiologists and members of the care team. But we can take the extra step of supplementing our reports with definitions of technical and medical terms and categorizing our findings as benign or probably benign, when applicable, to bring peace of mind to the patient reading the report.”

Randy Miles, MD, MPH

Mastering the Art of Writing for Two Audiences

As hospitals around the country are experiencing different reactions to the Cures Act, there may be steps radiologists can take to minimize patient anxiety—and the associated phone calls. And it starts with the way reports are written.

“We need to maintain the integrity of these reports because it’s a primary source of communication between the radiologists writing the report and the referring physician, other radiologists and members of the care team,” Dr. Miles noted. “But we can take the extra step of supplementing our reports with definitions of technical and medical terms and categorizing our findings as benign or probably benign, when applicable, to bring peace of mind to the patient reading the report.”

Dr. Basak agreed, saying that radiologists can’t water down their reports, but they can make reports more actionable for referrers and patients by providing recommended next steps and focusing on the question at hand rather than adding in incidental findings that could distract or worry the patient.

“We’ve always been sensitive in the way we write reports, but I think that’s more important now that patients may be reading results more carefully,” Dr. Basak said. “For example, if a patient can’t complete their test, we’re very careful in the language we use because we don’t ever want the patient to feel that they’re being blamed.”

Dr. Mezrich noted that Yale has attempted to cut back on jargon and acronyms in their reports and may eventually include links to approved websites and glossaries to help the patient understand the findings.

Though online radiology glossaries are readily available through RSNA’s RadiologyInfo.org or the Mayo Clinic, Dr. Mehan noted that Massachusetts General Hospital has developed a glossary that’s linked in each patient’s report.

“As we built our glossary, we worked with patient advocacy groups to ensure the language was reassuring yet accurate and as simple as possible,” Dr. Mehan said. “The National Institutes of Health recommends patient material be written at an 8th grade reading level, so that was our goal when creating this glossary.”

Leaning Into More Frequent Communication with Physicians

Another tactic radiology departments and practices are taking is increasing communication with the referring physician.

If a report contains anything the patient might find alarming, more radiologists are picking up the phone to give physicians the heads up that patient questions will be coming. Dr. Basak noted that this is especially true with minor findings that might not catch the eye of a physician but may alarm the patient who doesn’t understand what they’re reading. 

Not only are radiologists making a greater effort to alert physicians’ offices when a report is being released, but both Drs. Basak and Mehan note that they will call physicians’ personal cell phones, so communication can happen more quickly. Likewise, Dr. Miles has taken advantage of Epic’s messaging platform to quickly answer patient questions asked via the ordering physician.

Finding Creative Solutions to Mitigate Patient Anxiety

Looking to the future, Dr. Mezrich anticipates that a move to more structured reporting will help satisfy the needs of both patients and physicians.

“More structured and standardized reporting may allow us to include pertinent information for physicians and academics while making the reports more digestible for patients,” he explained. “For example, we may want to include incidental findings that could become important down the line, and a structured report will allow us to tuck it into an area where the patient won’t get distracted by it.”

Many facilities are also trying to schedule radiology exams as close to the time of the patient’s appointment as possible, so the patient will meet with their physician as soon as their results are released. Dr. Mezrich also suggested that facilities consider hosting office hours for patients with questions about their results.

Dr. Miles has had success with setting expectations with patients in the exam room.

“I’ll let them know that they’ll receive their report before their physician has had a chance to review them, and that the physician will need time to respond,” he said. “Patients respond well to this tactic, and it buys the ordering physician some time to reach back out to me with follow-up questions if necessary.”

Elevating the Role of Radiology in Patient Care

Not only does the Cures Act empower patients to take control of their health, but it offers a unique opportunity for radiologists to demonstrate their value to both patients and providers.

“This new change gets radiologists out of the dark and let’s patients know we’re a part of their healthcare team,” Dr. Mezrich pointed out. 

“This is an opportunity for radiologists to become more patient-centered,” Dr. Miles concluded. “In the not-so-distant past, radiologists were considered the doctor’s doctor. The Cures Act provides radiologists an additional opportunity to directly interact with patients through our reports and to demonstrate our vital role to patient care.”

For More Information

Access the Radiology study, “Patient Electronic Access to Final Radiology Reports: What Is the Current Standard of Practice and Is an Embargo Period Appropriate?

Access the Current Problems in Diagnostic Radiology study at journals.elsevier.com/current-problems-in-diagnostic-radiology.

RadiologyInfo.org is the Radiology Resource Information for Patients

Patient-friendly definitions and explanations can be found at RadiologyInfo.org, the public information website produced by RSNA and ACR.

Offering easy-to-understand definitions, videos and pictures of more than 250 procedures, exams and disease topics, the website explains the role of radiologists in their health care and can help patients understand examinations and terminology noted in their radiology report. There is a special section, “How to Read a Radiology Report,” which explains what a patient may see and read in their electronic report. The website offers information in English and Spanish.

Direct your patients to RadiologyInfo.org