Most are familiar with patient portals. Some people probably have several of them, one for each doctor or dentist.
They’re quick ways to set up an appointment or ask a non-emergency question. They also store things like notes from your last visit or test results.
A federal law passed about a decade ago put new requirements in place for test results to be released to patients quickly, as soon as they were finalized in their electronic health record. That part of the law went into effect in 2021.
The idea had bipartisan support and it was meant to take advantage of advancing technology to make things more convenient and transparent for patients, but it’s had some consequences. Now, a new Texas law will delay some of that medical result-sharing.
It’s a change Dr. David Gerber fought for. He’s an oncologist based in Dallas, and he joined Texas Standard for a discussion. Listen to the interview above or read the transcript below.
This transcript has been edited lightly for clarity:
Texas Standard: Why did this law need to change?
David Gerber: We know that getting reliable access to medical records is important for understanding your condition, for planning referrals, for thinking about next steps. And we also know that it empowers patients, it increases transparency, and it makes medical decisions, really, that – decisions that are made as a team.
What the information-blocking rule stipulated was not only that all medical information needs to be available to patients, all of the records, but it needs to available immediately. Well, when you step back and you think about the implications of that, we noticed, I certainly did in my practice, that some of those test results are very confusing, anxiety-provoking, potentially life-changing.
I’m an oncologist, so I treat people with cancer and throughout my career up until that point explaining to patients that they had cancer, a new cancer, that a cancer had come back… But something that we learned to do with compassion and providing the next step’s information.
But all of a sudden, starting in April of 2021, that was largely no longer the case because the test results were being sent immediately electronically to patients before any clinician or healthcare provider had the chance to communicate that to them and explain what it meant and what would happen after that. I had patients find out that they had cancer when they were in the middle of a business dinner or when they are driving in a rush hour commute. One woman was reading a bedtime story to a toddler at night.
Conversely, I’ve had news delivered to patients through these test results that didn’t show bad news, but because they can be so confusing, they were thought to be. One woman looked at the test results of her husband’s CT scan and read the words and was so concerned that it described a near-term life-threatening situation, she’d be treated medically for an acute anxiety attack. But in reality, that CT scan showed that the treatment her husband was getting was still working.
So that takes us to this new legislation. This new legislation, which is Senate Bill 922, allows for the delayed release of the electronic test results for those most confusing and most potentially life-changing test results. And that’s currently defined as test results related to a cancer diagnosis or a genetic disease.
More specifically, it’s a 72-hour delay. Maybe it’ll be the opportunity for a phone call or a telehealth visit or an in-person visit with their physician or another member of the healthcare team before they get that complicated multi-page pathology result delivered to their in-basket.
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How involved were doctors in influencing how Texas is modifying this federal law?
This goes back probably to late 2021 when I began expressing my concerns about the effect the law was having in my oncology practice. At the time, I was not even aware that there was a clause in the federal legislation that would even allow a state to create its own law to modify the timing.
It wasn’t until several months after I published some of my first articles that I heard from a group of physicians in the state of Kentucky. They informed me that having read about some of my work and seen it, they were inspired to change the law in Kentucky. And so ultimately, when we saw that that had happened in Kentucky, I approached some advocacy organizations and the Texas Medical Association to let them know and share the concerns that I had. And ultimately, the Texas law largely resembles that in the state of Kentucky.
I’ll also add that if a patient and a doctor wanna have that result released sooner, electronically, after this law goes into effect, there’s not a penalty for that. So really what the law is doing is just allowing cancer-related test results and genetic disease test results not to automatically be released immediately every time.
Could you see this law changing again, depending on the effects we see and changing technology?
In answering this I will remind all of our listeners that I am a physician and not a lawyer and not a legislator. But there are now three state laws – there’s Kentucky, Texas, and in between the two, California created a law that addressed the electronic release of test results. The California law is quite different. It doesn’t specify the maximum delay for release and it applies to other conditions beyond genetic diseases and cancer.
So whether this law changes to encompass other conditions or changes the timeline or perhaps we find that, you know, in a few years actually the immediate release of all test results electronically is the best way to deliver medical care, I suppose it could be changed to revert back to what it’s been since 2021.
You know, I think as with any change, we will see what the effects are. And as a reminder, when we talk about test results that are related to cancer genetic diseases, I’m gonna venture a guess that among all test results that are done for all patients out there, this must be well under 1%, right?
So when someone goes to the doctor and gets their cholesterol checked, that’s gonna still be sent immediately. If there’s a concern for pneumonia and they get an X-ray, that’s sent immediately. So all of these things are still gonna be released immediately electronically.
