The degree to which some of the benefits of the Cures Act apply to the emergency department setting is not clear. “[The Cures Act] is supposed to help improve the patient doctor relationship and improve trust and communication amongst patients and providers, but this has only really been studied in nonemergency, acute care settings, such as the outpatient clinic,” said Dr. Gowda. One difference lies in the very nature of the emergency physician–patient relationship, which by nature is brief and limited, and any opportunity to educate patients plummets when that ED visit ends. Even patients who are inclined to reach out post-visit are likely to have a difficult time. “We come and we go. We work weird hours,” Dr. Yore said. “An oncologist’s relationship with their patient may be measured over months and years, whereas I have 180 minutes with each patient, by and large.”

Potential Pitfalls

In a recent survey of ACEP members on the 21st Century Cures Act, two thirds of 134 respondents reported cases where patients knew their test outcome before their providers could discuss it with them. This increased the likelihood of patients discovering a bad result on their own. Dr. Gowda cites an instance in which a woman discovered that she had had a miscarriage by reading the final impression of her radiology report. “I feel like providing patients this information without a human interaction can create more harm than good,” she said.

A more common scenario is the patient who experiences undue anxiety over an abnormal but clinically irrelevant test result. “When an ED patient is scared and these results are trickling in electronically, a trivial abnormality or errant phrase may get magnified or misinterpreted,” explained Nicholas Genes, MD, PhD, FACEP, an emergency physician at New York University (NYU) Langone Health, clinical associate professor in the department of emergency medicine at NYU Grossman School of Medicine and chair of ACEP’s Health IT Committee. “I remember a patient with a history of anxiety who brought up so many details from prior notes that what should have been a quick visit ended up feeling like a cross examination where I had to discuss my own and other doctors’ medical decision making. Being transparent is usually a great thing, but sometimes in a busy ER we don’t need to revisit clinical notes written months ago.”

Although Dr. Genes believes that note sharing is generally a good thing, he would like to see ED patients’ notes digitally released toward the conclusion of their visit, after the physician has had an opportunity to review results and explain Dr. Nicholas Genes them. In efforts to enact a change, he has worked with Jeff Davis, director of regulatory and external affairs at ACEP’s Washington, D.C., office, on outreach to the ONC. They formally requested that regulations be altered to allow for emergency departments to delay sharing lab results and clinical notes with patients for a 24hour period or at the least until the patient is discharged from the emergency department. The recommendation was not accepted, however, and ACEP’s effort to advocate for regulations that support the unique needs of the emergency department continues.