Appl Clin Inform 2025; 16(02): 345-349
DOI: 10.1055/a-2494-1722
Research Article

Timing of Liver Imaging Result Release Is Associated with Patients with Cirrhosis Reviewing Results Prior to Providers

Jeremy Louissaint
1   Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, United States
,
John Deng
2   Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
,
Elliot B. Tapper
3   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, United States
,
Robert W. Turer
4   Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
5   Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States
,
Timothy P. Hogan
6   O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, Texas, United States
7   Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, United States
,
Sruthi Yekkaluri
1   Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, United States
,
Patrick Dunn
8   American Heart Association, Center for Health Technology and Innovation, Dallas, Texas, United States
,
Amit G. Singal
1   Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, United States
› Author Affiliations
Funding J.L. is funded by the American Cancer Society Institutional Research Grant (IRG-21-142-16) and the University of Texas Southwestern Dean's Scholar in Clinical Research program. R.W.T. is supported by the Texas Health Resources Clinical Scholar Award. A.G.S.'s research is supported by NIH R01 CA212008, R01 CA222900, and U01 CA283935 and CPRIT RP200554. This work was supported by resources from the University of Texas Southwestern Clinical and Translational Science Award Program (UL1TR001105).

Abstract

Background Patients with cirrhosis are at high risk for developing hepatocellular carcinoma (HCC), warranting receipt of semiannual surveillance imaging with the potential to identify abnormal liver lesions. Since the implementation of the 21st Century Cures Act's Information Blocking provision, test results are immediately released to patients through the patient portal. There is an increasing trend of patients reviewing their results before their providers.

Objective We aimed to determine whether the date and time characteristics of when the result is released to the electronic health record (EHR) are associated with patients reviewing results before providers.

Methods In patients with cirrhosis undergoing ambulatory liver imaging, the date–time characteristics of when the result was released to providers in the EHR were categorized as outside regular work hours for holidays, weekends, or outside normal business hours. Logistic regression was used to determine the relationship between results released to the EHR outside work hours and whether the patient or provider was the first to review the result.

Results We identified 850 imaging studies from 401 patients with a median age of 62 (interquartile range [IQR]: 53–69) years. Patient time to result review was shorter or equivalent to their providers for 57% of the results. A total of 170 (20.0%) of results were released outside regular work hours. There was an increased odds of the patient reviewing the result before providers for results released outside regular work hours (adjusted odds ratio [aOR] = 1.54, 95% CI: 1.08–2.20).

Conclusion HCC screening results released to the EHR outside regular work hours is associated with patients reviewing these results before providers.

Protection of Human Subjects

The study was approved by the Institutional Review Board at the University of Texas Southwestern.


Note

J.L. is the guarantor of this article.


Authors' Contributions

Concept: J.L., A.G.S., and E.B.T.


Data Acquisition: J.L., J.D.


Analysis: S.Y., J.L.


Writing: J.L.


Critical revision: J.D., P.D., T.P.H., A.G.S., E.B.T., and R.W.T.


Supplementary Material



Publication History

Received: 10 July 2024

Accepted: 30 November 2024

Article published online:
16 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Singal AG, Llovet JM, Yarchoan M. et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology 2023; 78 (06) 1922-1965
  • 2 Konerman MA, Verma A, Zhao B, Singal AG, Lok AS, Parikh ND. Frequency and outcomes of abnormal imaging in patients with cirrhosis enrolled in a hepatocellular carcinoma surveillance program. Liver Transpl 2019; 25 (03) 369-379
  • 3 HealthIT.gov. Information Blocking. Accessed February 16, 2023 at: https://www.healthit.gov/topic/information-blocking
  • 4 Steitz BD, Sulieman L, Wright A, Rosenbloom ST. Association of immediate release of test results to patients with implications for clinical workflow. JAMA Netw Open 2021; 4 (10) e2129553
  • 5 Bhalla S, Prasad T, Xie D, Gerber DE. Contemporary trends in reviewing test results through the electronic patient portal among patients with cancer. JAMA Oncol 2024; 10 (01) 139-140
  • 6 Louissaint J, Kyalwazi B, Deng J. et al. Patients with cirrhosis rapidly review potentially abnormal hepatocellular carcinoma surveillance results through the patient portal. Am J Gastroenterol 2024; 119 (11) 2331-2333
  • 7 Graham SA, Pickus SK, Lockwood KG, Buch LS, Dunn P, Paruthi J. Business vs after-hours use of an artificial intelligence-powered digital health platform among insured patients. JAMA Netw Open 2023; 6 (09) e2333511
  • 8 Wood KE, Pham HT, Carter KD, Nepple KG, Blum JM, Krasowski MD. Impact of a switch to immediate release on the patient viewing of diagnostic test results in an online portal at an academic medical center. J Pathol Inform 2023; 14: 100323
  • 9 Steitz BD, Padi-Adjirackor NA, Griffith KN, Reese TJ, Rosenbloom ST, Ancker JS. Impact of notification policy on patient-before-clinician review of immediately released test results. J Am Med Inform Assoc 2023; 30 (10) 1707-1710
  • 10 Turer RW, Martin KR, Courtney DM. et al. Real-time patient portal use among emergency department patients: an open results study. Appl Clin Inform 2022; 13 (05) 1123-1130
  • 11 Winget M, Haji-Sheikhi F, Brown-Johnson C. et al. Electronic release of pathology and radiology results to patients: opinions and experiences of oncologists. J Oncol Pract 2016; 12 (08) e792-e799
  • 12 Giardina TD, Modi V, Parrish DE, Singh H. The patient portal and abnormal test results: an exploratory study of patient experiences. Patient Exp J 2015; 2 (01) 148-154
  • 13 Steitz BD, Turer RW, Lin C-T. et al. Perspectives of patients about immediate access to test results through an online patient portal. JAMA Netw Open 2023; 6 (03) e233572
  • 14 Leonard LD, Himelhoch B, Huynh V. et al. Patient and clinician perceptions of the immediate release of electronic health information. Am J Surg 2022; 224 (1 Pt A): 27-34
  • 15 Rotholz S, Lin C-T. “I don't think it should take you three days to tell me my baby is dead.” A case of fetal demise: unintended consequences of immediate release of information. J Am Med Inform Assoc 2023; 30 (07) 1301-1304
  • 16 O'Brien E, Vemuru S, Leonard L. et al. Information transparency with immediate release: Oncology clinician and patient perceptions. Am J Surg 2024; 227: 165-174
  • 17 Leonard LD, Cumbler E, Schulick R, Tevis SE. From paternalistic to patient-centered: Strategies to support patients with the immediate release of medical records. Am J Surg 2021; 222 (05) 909-910
  • 18 Arvisais-Anhalt S, Ratanawongsa N, Sadasivaiah S. Laboratory results release to patients under the 21st Century Cures Act: the eight stakeholders who should care. Appl Clin Inform 2023; 14 (01) 45-53
  • 19 van Mens HJT, Hannen GEG, Nienhuis R, Bolt RJ, de Keizer NF, Cornet R. Evaluation of patient-friendly diagnosis clarifications in a hospital patient portal. Appl Clin Inform 2023; 14 (03) 455-464
  • 20 Khanchandani AT, Larkins MC, Tooley AM, Meyer DB, Chaudhary V, Fallon JT. The impact of curated educational videos on pathology health literacy for patients with a pancreatic, colorectal, or prostate cancer diagnosis. Acad Pathol 2022; 9 (01) 100038
  • 21 Chen S, Guevara M, Moningi S. et al. The effect of using a large language model to respond to patient messages. Lancet Digit Health 2024; 6 (06) e379-e381
  • 22 Liu S, McCoy AB, Wright AP. et al. Leveraging large language models for generating responses to patient messages-a subjective analysis. J Am Med Inform Assoc 2024; 31 (06) 1367-1379
  • 23 Yoon E, Hur S, Opsasnick L. et al. Disparities in patient portal use among adults with chronic conditions. JAMA Netw Open 2024; 7 (02) e240680
  • 24 Louissaint J, Lok AS, Fortune BE, Tapper EB. Acceptance and use of a smartphone application in cirrhosis. Liver Int 2020; 40 (07) 1556-1563