4 things radiologists should know about Pennsylvania’s patient notification law

Pennsylvania (PA) Act 112, requires imaging facilities in the state to notify patients of abnormal imaging results. Authors of a Sept. 28 case study published in the Journal of the American College of Radiology examined what this law does and how it might impact patients and radiologists.

The “Patient Test Result Information Act” became law on Oct. 24, 2018, and defines abnormal findings as a “finding that would cause a reasonably prudent person to seek additional or follow-up medical care within 3 months,” wrote Gregory S. Mittl, MD, MBA, with Hospital of the University of Pennsylvania’s department of radiology in Philadelphia, and colleagues.

Below are important facts radiologists should know about PA Act 112:

1. Why was the legislation passed?

Representative Marguerite Quinn first sponsored the bill in 2007 after two constituents—and friends—died from a malignancy that was detected on imaging, but never appropriately followed up with.

2. What does it mandate?

Patients must be notified of abnormal findings within 20 days of the finalized radiology report and the notification must include the name of the ordering physician or nonphysician clinician, study date, date the results were sent to the ordering provider, contact information so the patient can request the full report and the following letter:

“You are receiving this notice as a result of a determination by your diagnostic imaging service that further discussions of your test results are warranted and would be beneficial to you. The complete results of your test or tests have been or will be sent to the health care practitioner that ordered the test or tests. It is recommended that you contact your health care practitioner to discuss your results as soon as possible.”

Patients can receive notifications through various methods, including: mail, email, medical record system alert, fax or in-person. Fines for noncompliance have been delayed until Dec. 23.

3. The law impacts many stakeholders

The goal of this legislation is to improve follow-up for abnormal findings, with potential benefits and challenges for patients, radiologists and imaging centers, according to Mittl and colleagues.

For example, patients may have trouble understanding the notifications, potentially increasing anxiety. On the flip side, such information puts the patient at the center of their own care and offers actionable information to improve outcomes.

And for radiologists or referring providers, the law can mitigate liability and offers a shared responsibility to notify patients.

4. Health systems are taking different approaches

Health systems across the state have started to implement direct patient notification; most approaches vary by practice setting.

Penn State Health, for example, has used a “hard stop approach” which requires radiologists indicate if a patient notification is needed for PA Act 112 within the dictation software prior to signing the radiology report. A daily structured query language report then creates a list of outpatients who require notification letters.

Other organizations, such as Geisinger Health, have implemented a standard notification system across departments for all emergency department, outpatient and point-of-care imaging exams completed by radiologists and nonradiologists.

Most larger systems are focusing on long-term IT-based approaches that can be integrated into the EHR; those not connected to larger health systems, the researchers noted, will “likely” still benefit from automated approaches when compared to the high costs of paper and postage notification methods.

While the long-term impact of this law will require data analysis and time, it’s never too early for health systems to prepare.

“Imaging practices outside of PA can use this time to proactively develop notification systems using existing and potential results notification workflow,” the analysts wrote. “ Open exchange of lessons learned and best practices in this first year of implementation will be of value to imaging facilities and the patients they care for, within, and outside of PA.”