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.

To the best of our knowledge, there is no federal regulatory policy mandating that all test results be sent to and reviewed by patients’ PCPs. In fact, the results reporting standards of the Clinical Laboratory Improvement Amendments, a Centers for Medicare and Medicaid Services program that ensures quality laboratory testing, requires that laboratory results be released to the ordering clinician and—as mandated by the 21st Century Cures Act—the patient.^1,2 As the AMA STEPS Forward® EHR Inbox Reduction Checklist phrases it, “You order it, you own it”.³ 

To support this transparency, the Office of the National Coordinator for Health Information Technology guidance emphasizes that the ordering clinician should be identifiable on all ordered tests and test reports in the electronic health record (EHR). This guidance also stresses that, if available, the clinician responsible for follow-up should be listed as well.^4,5 Unless the patient’s PCP is the ordering physician or the physician responsible for follow-up, they do not need to be notified of test results. However, if the patient’s PCP requests a copy of a test result from another clinician or health system, this request should be honored because an unnecessary delay could be considered information blocking under federal regulation.²

Studies have demonstrated that EHR inbox burden significantly contributes to physician burnout and decisions to reduce clinical hours or leave medicine altogether.⁶ In an analysis of PCP inbox management, findings showed that most inbox time is spent on addressing test results.⁷ 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 delivery of test results to a physician’s inbox is a critical part of the diagnostic and treatment process. The Joint Commission identified closed-loop communication as a National Patient Safety Goal in 2005.⁸ “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. However, when test results are reported to multiple clinicians, there can be confusion concerning whose responsibility it is to review test results, communicate them with patients, and initiate follow-up: the ordering physician/allowed non-physician practitioner or the patient’s PCP. 

Health systems have begun developing standards and policies that guide staff on how diagnostic test results should be reviewed and followed up on. For example, Veterans Health Administration policy places responsibility upon the ordering clinician for initiating follow-up of abnormal test results unless another qualified clinician was authorized to receive test results in the ordering clinician’s absence.^4,9

Physicians and other staff at a large not-for-profit regional hospital medical center became inundated with lab result alerts to the point they were no longer meaningful nor manageable and contributed to burnout. A message for each individual result was sent at the exact time the result was generated, even when it was part of a test panel. This meant that multiple alerts for one test could be sent to staff inboxes nearly simultaneously or hours apart.

To find a solution to this issue, the hospital worked with a health care data integration company to implement a new message delivery system that automated the generation, consolidation, and delivery of certain message types. Through their solution, all results for a single order, including a panel, were aggregated into one result message. The consolidated messages were then sent to the EHR on a specified schedule, preventing physicians from being overwhelmed with a constant stream of lab result alerts. With consolidated patient results delivery, physicians could better focus on diagnosing and providing informed medical care to patients.

• 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: Reviewing Test Results (PDF)

1. Hamilton T. Clinical Laboratory Improvement Amendments of 1988 (CLIA) – Issuance of Revised Survey Procedures and Interpretive Guidelines for Laboratories and Laboratory Services in Appendix C of the State Operations Manual to Facilitate the Electronic Exchange of Laboratory Information. Published online March 1, 2010. Accessed March 26, 2023.
2. 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.
3. AMA STEPS Forward®. EHR Inbox Reduction Checklist for Health Care Organizations. In: AMA STEPS Forward® Playbook Series. Taming the Electronic Health Record Playbook—EHR Inbox Reduction Checklist for Health Care Organizations.; 2023. Accessed March 26, 2023. https://www.ama-assn.org/system/files/ehr-inbox-reduction-checklist.pdf
4. Kwan JL, Singh H. Assigning responsibility to close the loop on radiology test results. Diagnosis (Berl). 2017;4(3):173-177.
5. The Office of the National Coordinator for Health Information Technology, Safety Assurance Factors for EHR Resilience. Self-Assessment: Test Results Reporting and Follow-Up.; 2016. Accessed March 26, 2023.
6. Sinsky CA, Shanafelt TD, Ripp JA. The Electronic Health Record Inbox: Recommendations for Relief. Journal of General Internal Medicine. 2022;37(15):4002-4003.
7. 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.
8. 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/
9. Department of Veterans Affairs. Communicating Test Results to Providers and Patients.; 2022. Accessed March 26, 2023. https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=10366# (PDF)

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.