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 known 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, require that laboratory results be sent to the ordering physician or advanced practice provider (APP).  Additionally, 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).¹

Studies have demonstrated that EHR inbox burden significantly contributes to physician burnout and decisions to reduce clinical hours or leave medicine altogether.² In an analysis of PCP inbox management, findings showed that most inbox time is spent on addressing test results.³ Further, in cases where multiple tests are ordered for a single patient, each individual result is often sent as a separate inbox notification, unnecessarily increasing the inbox volume.

The Joint Commission identified closed-loop communication as a National Patient Safety Goal in 2005.⁴ “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. Unless the patient’s PCP ordered the test or has agreed, in advance, to follow up on the result, they do not need to be automatically notified of, or routinely forwarded, test results.  When test results are reported to multiple physicians without prior agreement, there can be confusion concerning whose responsibility it is to review the results, communicate them to the patient, and initiate follow-up.

In today’s complex health care environment, there are many situations where the ordering physician is not readily available for result management; the PCP should not become the all-too-easy default for result management of tests they did not order. In instances when the PCP has agreed to take responsibility for test result follow-up, the PCP should be identified on all orders and results, along with the ordering physician or APP.

Access these AMA STEPS Forward® resources for more information on result management and specific strategies to reduce inbox burden:

1. Taming the EHR Playbook
2. A Systematic Approach to Reducing EHR Inbox Burden Toolkit

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

Health care leaders can deimplement policies which automatically send results of all tests to a patients’ PCP by default and create thoughtful and sustainable systems for safe and timely result management. 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. 

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

• “EHR Inbox Management: Tame Your EHR Inbox” STEPS Forward Toolkit–Ed Hub Module
• STEPS Forward EHR Inbox Reduction Checklist for Health Care Organizations (PDF)
• The Electronic Health Record Inbox: Recommendations for Relief
• Download this myth: Must all test results be reviewed by patients’ primary care physician? (PDF)

1. Office of the National Coordinator for Health Information Technology, Health and Human Services Department. 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program.; 2020. Accessed March 26, 2023.
2. Sinsky CA, Shanafelt TD, Ripp JA. The Electronic Health Record Inbox: Recommendations for Relief. Journal of General Internal Medicine. 2022;37(15):4002-4003.
3. Akbar F, Mark G, Warton EM, et al. Physicians’ electronic inbox work patterns and factors associated with high inbox work duration. Journal of the American Medical Informatics Association. 2021;28(5):923-930.
4. 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.