Research indicates that while the 21st Century Cures Act has increased access, comprehension gaps remain for certain patient populations.
More than two-thirds of adults in the United States now view their medical test results through online portals before hearing from a healthcare provider, according to a study led by researchers at NYU School of Global Public Health.
The findings, published in JAMA Network Open, indicate that 68.6% of adults access their results immediately. This shift in the patient-clinician relationship is largely attributed to the 21st Century Cures Act, which requires that electronic health information, including laboratory work and imaging, be released to patients as soon as results are available.
“The Cures Act has restructured the traditional pathway between the release of a test result to a patient-clinician discussion,” says Jemar Bather, assistant professor of biostatistics at NYU School of Global Public Health, in a release. “We wanted to understand whether a patient’s probability of accessing test results—and understanding of them—varies based on sociodemographic characteristics, health status, patient-centered communication, and digital health literacy.”
Comprehension and Demographic Trends
The researchers analyzed data from the 2024 Health Information National Trends survey, representing nearly 175,000,000 adults. While access has increased, comprehension of the data varies. Among those who viewed results immediately, 6.6% reported a poor understanding, 26.8% understood them fairly well, 31.7% understood them well, and 34.9% understood them very well.
Factors such as digital literacy and patient-centered communication played significant roles in how well patients understood their reports. Individuals with higher digital literacy and those who felt healthcare professionals explained things clearly reported better understanding.
Conversely, patients who reported the lowest understanding were more likely to live in the Midwest or South and had previously experienced discrimination in medical care. Those most likely to view results immediately tended to be older, female, have higher incomes, or manage multiple chronic health conditions.
Improving Communication in Portals
The study suggests that simply providing data is insufficient for ensuring patient understanding.
“Health systems give you your data, but that does not mean that they put a lot of effort into making the information easy to understand on your own,” says José Pagán, PhD, professor and chair of the department of public health policy and management at NYU School of Global Public Health, in a release. “Health systems and online patient portal developers should look for innovative ways to improve how they communicate—for instance, using artificial intelligence to summarize test results in plain language and provide easy means for follow-up questions.”
The authors conclude that while the 21st Century Cures Act has successfully expanded access, a subset of patients still struggles to interpret the information they receive. Improving patient-centered communication and portal design may help close this comprehension gap.
