When you or a loved one is sick and you don’t know what’s wrong, you want answers as quickly as possible. But sometimes when answers arrive too quickly and without context, they can cause otherwise preventable harm.
Clinicians around the country say current federal regulations are inadvertently causing psychological and emotional distress for some patients. The 21st Century Cures Act (“the Cures Act”) requires test results to be sent to patients as soon as they’re available, even before clinicians have an opportunity to review them and explain to patients what they mean. When those results contain a life-changing diagnosis, unexpected findings, or technical definitions, that’s what causes fear, anxiety, and misunderstanding for patients.
When the Cures Act was enacted in 2016, it solidified the important idea that a patient owns their own medical records. The Act set up a policy framework for access to medical information, like test results, requiring this information to be immediately shared with the patient.
Nearly 10 years after enactment, patients have experienced unintended consequences of the immediate availability of test results. The Novant Health Center for Public Policy Solutions (“the Center”) believes this issue needs an extra look from policymakers, and clinicians are speaking up to offer a balanced solution.
When results arrive too quickly
Dr. Jason Connelly is a practicing family medicine clinician and the interim chief health information officer at Novant Health. He joined experts, lawmakers, and legislative staff for a conversation, hosted by the Center, about the Cures Act and policy solutions that create better protections for patients. Dr. Connelly shared how this issue affected one of his patients: a woman who, at 48 years old, was already a stage 3 breast cancer survivor.
“She had to have a double mastectomy and hysterectomy to prevent reoccurrence. So, she has this heightened awareness of what cancer means to her,” said Dr. Connelly.
When the patient reported pain in her left side, Dr. Connelly suspected a kidney stone. He ordered a CT scan to confirm the diagnosis and help direct the next steps in care.
“When the result came through showing that she indeed had a kidney stone that needed to be addressed, there was also a mention of a mass in her other kidney that was asymptomatic,” said Dr. Connelly.
Dr. Connelly was in clinic seeing other patients when the results were released and couldn’t review them until later the same day.
“By that time, the patient had seen the result and already contacted the office, almost in hysterics, thinking she had metastatic disease,” Dr. Connelly said.
Stories like these are happening at all levels of care, from the bloodwork results after an annual wellness visit, to tests performed at the emergency department.
“Patients go to the emergency department seeking urgent care and they are receiving text messages of their results before the ED physician has a chance to step back in the room. That’s how immediate these come across under the current regulation,” Dr. Connelly said.
Why it's happening
“One of the things the Act really wanted to do was to give patients access as soon as possible, and to the greatest extent possible, control over their own health information and data. We fundamentally agree with that. That is a foundational principle now to empowering patients as consumers, and greater transparency efforts,” said David Tyson, director of policy and regulatory affairs with Novant Health.
A provision in the Act that established those patient rights prohibits “information blocking.” Information blocking is any action that interferes with a patient’s ability to access, exchange, or use their own health information.
A clinician or organization that restricts a patient’s access to their own information is considered an “information blocker” and can be fined up to $1 million per violation.
This definition has created an issue for patients and providers.
“It really puts providers in a bind because they want to make sure that patients get the information they need in the proper context, in the most compassionate way possible, but if they do that by waiting to release test results until they can speak with their patient, the way the regulations are structured, they’re looking at really high fines,” said Darryl Drevna, senior director of regulatory affairs at the American Medical Group Association (AMGA).
The policy solution
The 21st Century Cures Act tried to anticipate potential harm and includes exceptions to prevent it. The Act allows information blocking only if a piece of information or test result could cause physical harm to a patient.
However, the current, narrow definition does not include emotional and mental harm.
During its recent panel discussion with lawmakers, the Center proposed a solution that would expand the definition of “preventing harm” under information blocking exceptions to explicitly include emotional and psychological harm. This small tweak to current federal policy could vastly improve outcomes. It would allow a 72-hour delay for the electronic release of targeted test results and give clinicians time to talk with their patients and deliver challenging results with context and compassion.
“That’s the fix. Give clinicians the flexibility … to delay that result just a little while so that patients can receive it in a way that they can understand and that they can process that keeps the humanity in healthcare,” said David Tyson.
State solution
States are also taking action to prevent patient harm. In 2025, Texas passed legislation to create an exception to the federal rule, allowing a 72-hour delay for certain results delivered via electronic health records (EHRs) or patient portals, to give clinicians time to communicate with patients first.
The Texas exceptions only apply to specific results:
- Pathology or radiology reports with a reasonable likelihood of showing malignancy, or
- Test results that may reveal a genetic marker.
The Texas law does not prevent clinicians from sharing sensitive results immediately by direct phone calls, in-person conversations, or video or telehealth interactions. It simply delays the unaccompanied electronic release of the results.
“We talked to our colleagues in Texas about this issue and it was largely positive. The General Assembly there acted quickly and enthusiastically to correct this,” said Elizabeth Outten, lead for the Novant Health Center for Public Policy Solutions. “So, there is model legislation out there from a state, if state lawmakers choose to engage on this issue.”
A solution that improves health
A key to successful patient care is trust built with clinicians over time. When patients receive test results before their clinician has the opportunity to pick up the phone and put those results into context, talk through next steps, discuss a care plan, and importantly, show they care and are concerned about the patient’s wellbeing, it can harm the clinician-patient relationship.
Making this policy change would help protect patients, preserve their rights, and avoid damaging the clinician-patient relationship, ultimately leading to better health outcomes.
“I do believe that the ultimate outcome is not a delay in good care,” said Dr. Connelly. “It is actually improving the care that is given and allowing us the best opportunity for the best outcome, even in the face of bad news.”
