Must all test results be reviewed by patients’ primary care physician?

This resource is part of the AMA's Debunking Regulatory Myths series, supporting AMA's practice transformation efforts to provide physicians and their care teams with resources to reduce guesswork and administrative burdens.

There is no federal regulatory policy mandating that all test results be sent to and reviewed by patients’ primary care physicians (PCPs).

The results reporting standards of the Clinical Laboratory Improvement Amendments (CLIA), a Centers for Medicare and Medicaid Services (CMS) program that ensures quality laboratory testing, requires that laboratory results be released to the ordering physician or APP. 

To support the correct routing and timely management of test results, the Office of the National Coordinator for Health Information Technology guidance emphasizes that the ordering physician or APP should be identifiable on all orders and results in the electronic health record (EHR).

Unless the patient’s PCP ordered the test or has agreed, in advance, to follow up on the test result, they do not need to be automatically notified of, or routinely forwarded, test results.

The Joint Commission identified closed-loop communication as a National Patient Safety Goal in 2005.¹ “Closing the loop” on test results—ensuring test results are communicated with patients and acted on by care teams in a timely manner—helps prevent missed or delayed diagnosis and protects patient safety.

When test results are reported to multiple physicians or APPs, there can be confusion concerning whose responsibility it is to review test results, communicate them with patients, and initiate follow-up. 

In today’s complex health care environment, there are many situations where the ordering physician is not available for result management; sending the result to the patient’s PCP has often been an easy answer to a thorny problem. The following examples may be helpful to consider when reviewing your organizational strategy for test result management:

Clinical scenario: Result is finalized after the patient leaves the ED or is discharged from an inpatient stay
Ordering physician: Ordering physician is no longer available
PCP: PCP is unaware of the reason for the test or the clinical scenario
Example of a possible management option: Centralized staff working from pools to manage results

Clinical scenario: Radiologist orders a blood test before an imaging study which was ordered by a specialist
Ordering physician: Neither radiologist nor specialist feel comfortable managing an abnormal result 
PCP: PCP is unaware of the reason for the test or the clinical scenario
Example of a possible management option: Create RN pool to review and route abnormal results to PCP with concise summary of the clinical scenario

Clinical scenario: Test is ordered by a resident rotating through a specialty clinic who has moved on to the next rotation
Ordering physician: Ordering physician is no longer available
PCP: PCP is unaware of the reason for the test or the clinical scenario
Example of a possible management option: Create results routing schema based on the encounter provider (the specialist) not the ordering provider

National guidelines and regulations state that the ordering physician or APP is responsible for result management--not the patient’s PCP. 

When the ordering provider isn’t readily available, the PCP can be a too-easy choice for routing those types of results. However, PCPs don’t have the context to manage the result without a lengthy chart review. Establishing a clear process for test result routing and management that is consistently followed can help reduce unnecessary inbox burden and cognitive load for physicians helping them focus on their most important work.  

The majority of results should route to the ordering provider and only the ordering provider. When complex and high-risk scenarios are identified, health care leaders have a responsibility to identify these scenarios and create thoughtful and sustainable systems for safe and timely result management.

• D-260.995 Improvements to Reporting of Clinical Laboratory Results
• Code of Medical Ethics 2.1.5 Reporting Clinical Test Results

• AMA STEPS Forward® "A Systematic Approach to Reducing EHR Inbox Burden" Toolkit
• STEPS Forward EHR Inbox Reduction Checklist for Health Care Organizations (PDF)
• The Electronic Health Record Inbox: Recommendations for Relief
• Department of Veterans Affairs Directive 1088(1): Communicating Test Results to Providers and Patients (PDF)
• Download this myth: Must all test results be reviewed by patients’ primary care physician? (PDF)

1. Ward B. Close the Loop on Test Results. Patient Safety & Quality Healthcare. Published February 18, 2020. Accessed March 27, 2023. https://www.psqh.com/analysis/close-the-loop-on-test-results/

Visit the overview page for information on additional myths.

Disclaimer: The AMA's Debunking Regulatory Myths (DRM) series is intended to convey general information only, based on guidance issued by applicable regulatory agencies, and not to provide legal advice or opinions. The contents within DRM should not be construed as, and should not be relied upon for, legal advice in any particular circumstance or fact situation. An attorney should be contacted for advice on specific legal issues. Additionally, all applicable laws and accreditation standards should be considered when applying information to your own practice.