Myth or fact? Primary care physicians must review all test results

Tanya Albert Henry , Contributing News Writer

Primary care physicians often get copied on emails of test results for each individual test that other physicians order for their mutual patients. The resulting alerts overwhelm inboxes, contribute to burnout and hinder physicians’ ability to easily access the information that is pertinent.

So, does a patient’s primary care physician really need to receive—and then review—every test result a patient has?

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It is a myth, according to the latest research that the AMA has done through its “Debunking Regulatory Myths” series. This series aims to provide regulatory clarification to physicians and their care teams. It is part of the AMA’s practice-transformation efforts and provides physicians and their care teams with resources to reduce guesswork and administrative burdens so their focus can be on streamlining clinical workflow processes, improving patient outcomes and increasing satisfaction.

The 21st Century Cures Act does mandate that test results go to the patient.

But “to the best of our knowledge there is no federal regulatory policy mandating that all test results be sent to and reviewed” by patients’ primary care physicians, the AMA says. “In fact, the results-reporting standards of Clinical Laboratory Improvement Amendments, a Centers for Medicare & Medicaid Services program that ensures quality laboratory testing, requires that laboratory results be released to the ordering clinician.”

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An AMA STEPS Forward®checklist (PDF) that helps physicians reduce inbox clutter puts the concept of which physicians need to receive patient test results this way: You order it, you own it.

And The Joint Commission in 2005 first identified “closing the loop”—ensuring that physicians communicate test results with their patients in a timely way—as a patient-safety goal. This helps prevent missed or delayed diagnoses.

If test results go to multiple physicians, this goal can be undermined. That is because the practice can create confusion about whether the ordering physician or the patient’s primary care physician is responsible for reviewing the test results, discussing the findings with the patient and initiating the follow up.

Guidance from the Office of the National Coordinator for Health Information Technology advises that a patient’s primary care physician does not need to be notified of test results unless they are the ordering physician or physician responsible for follow up.

Research has shown that the EHR inbox burden is a significant contributor to physician burnout and physicians’ decisions to reduce the number of hours they spend in the clinic or to leave medicine altogether. To improve patient care and reduce physician inbox burdens, health systems have started to implement changes.

For example, Veterans Health Administration policy says the ordering physician is responsible for initiating the follow up with a patient about abnormal test results unless another physician was authorized to receive test results in the ordering physician’s absence.

One large nonprofit regional hospital medical center—inundated with laboratory result alerts—worked with a health care data-integration company to implement a message delivery system that moved away from sending messages for every result, including those ordered as part of a panel.

Now, all the results for a single order, including a panel, are aggregated in a single result message. Those messages go into the EHR inbox on a specific schedule so physicians can focus on their patients and providing them with informed medical care.

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Learn more with the “AMA Debunking Medical Practice Regulatory Myths Learning Series,” which is available on AMA Ed Hub™ and provides regulatory clarification to physicians and their care teams. For each topic completed, a physician can receive CME for a maximum of 0.25 AMA PRA Category 1 Credit™.

Physicians are encouraged to submit questions or ideas they have about potential regulatory myths. The AMA’s experts will research the matter. If the concern turns out to be a bona fide regulation that unnecessarily burdens physicians and their teams, the AMA’s advocacy arm can get involved to push for regulatory change.