Do all test results need to be reviewed by the patient’s primary care physician?

This resource is part of AMA’s Debunking Regulatory Myths series, supporting AMA’s practice transformation efforts to equip clinicians and their care teams with resources to reduce the guesswork and administrative burden.

All test results must be submitted and reviewed by the patient’s primary care physician (PCP).

As far as we know, there is no federal regulatory policy that mandates that all test results be submitted to and reviewed by patient PCPs. In fact, the result reporting standards of the Clinical Laboratory Improvement Amendments, a program of the Centers for Medicare and Medicaid Services that ensures quality laboratory testing, require that laboratory results be released to the ordering physician and, as required by 21st Century Cures Act, to the patient.^1.2 As AMA STEPS Forward’s EHR Inbox Reduction Checklist states, 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 physician should be identifiable on all ordered tests and test reports in the electronic health record (EHR). This guidance also emphasizes that, where available, the physician responsible for follow-up should also be listed.^4.5Unless the patient’s PCP is the prescriber or the physician responsible for follow-up, they do not need to be informed of the test results. However, if the patient’s PCP requests a copy of a test result from another physician or health care system, this request should be honored because an unnecessary delay could be considered an information lockout under federal regulation.²

Studies have shown that the EHR inbox load contributes significantly to physician burnout and decisions to reduce clinical hours or drop out of medicine altogether.⁶ In an analysis of PCP inbox management, the results showed that the majority of inbox time is spent routing test results.⁷ Also, in cases where multiple tests are ordered for a single patient, each individual result is often sent as a separate inbox notification, unnecessarily increasing inbox volume.

Delivering test results to a doctor’s mailbox is a critical part of the diagnostic and treatment process. In 2005, the Joint Commission identified CCTV as a national patient safety goal.⁸ Closing the loop on test results by ensuring that test results are communicated to patients and handled by care teams in a timely manner helps prevent missed or delayed diagnoses and protects patient safety. However, when test results are reported to multiple physicians, there can be confusion as to who is responsible for reviewing test results, communicating them to patients, and initiating follow-up: the ordering physician/licensed non-medical professional or the PCP of the patient.

Healthcare systems have begun to develop standards and policies that guide staff on how diagnostic test results should be reviewed and followed up. For example, Veterans Health Administration policy places responsibility on the ordering physician for initiating follow-up of abnormal test results unless another qualified physician has been authorized to receive test results in the ordering physician’s absence. .^4.9

Physicians and other staff at a large non-profit regional hospital medical center were inundated with alerts about lab results to the point that they were no longer meaningful or manageable and contributed to burnout. A message for each individual result was sent at the exact moment the result was generated, even when it was part of a test panel. This meant that multiple alerts for a test could be sent to staff mailboxes almost simultaneously or hours apart.

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

1. Hamilton T. Clinical Laboratory Improvement Amendments of 1988 (CLIA) Issue of revised investigation procedures and interpretive guidelines for laboratories and laboratory services in Appendix C of the state operating 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 the Department of Health Informatics, Health and Human Services. 21st Century Cures Act: Interoperability, Information Lockdown, and ONC Health IT Certification Program.; 2020. Accessed March 26, 2023.
3. AMA goes one step further. EHR Inbox Reduction Checklist for Healthcare Organizations. In: LOVE STEPS FORWARD Series of playbooks. Taming the Electronic Health Record PlaybookEHR inbox reduction checklist for healthcare 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 come full circle on radiological test results. Diagnosis (Berl). 2017;4(3):173-177.
5. The office of the national coordinator for health information technology, security assurance factors for the resilience of electronic health records. Self-assessment: Test results report 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. Doctors mailbox work patterns and factors associated with high mailbox work duration. Journal of the American Medical Informatics Association. 2021;28(5):923-930.
8. Ward B. Come full circle on the test results. Patient safety and 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. Communicate test results to providers and patients.; 2022. Accessed March 26, 2023. https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3148

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Disclaimer: The AMA’s Debunking Regulatory Myths (DRM) series is intended to convey general information only, based on guidelines issued by applicable regulatory agencies, and not to provide legal advice or opinions. Content within DRM should not be construed as, and should not be relied upon for, legal advice in any particular circumstance or factual situation. A lawyer should be contacted for advice on specific legal matters.