RETURN TO ABSTRACT LISTING


Objective:
The information blocking provision of the 21st Century Cures Act requires clinical information, including radiology reports, to be immediately available to patients after entry into the electronic health record, spawning novel communication challenges. We evaluated public opinion of radiology reports on Twitter, a leading social media platform, before and after this provision took effect on April 5, 2021.

Materials and Methods:
We retrieved 27598 tweets containing queries: radiology report, radiology results, radiologist report, radiology release, radiology Cures Act, MRI report, x-ray report, xray report, ultrasound report, or CT report from October 5, 2020 to October 4, 2021. Initial screening for relevant tweets was performed by one reviewer. Two reviewers then categorized user type and theme(s) related to the post using an a priori specified coding system created during review of 100 random tweets. Duplicates, posts outside the US, and posts with only links or ads were excluded. Tweets were grouped as “pre-Cures” (6 months before) and “post-Cures” (6 months after). Descriptive statistics and N-1 Chi-square tests, to compare proportions, were calculated.

Results:
The final 1173 tweets were posted by 1047 unique users (64% patients, 12% non-radiologist physicians, 4% radiologists). Activity increased over the study period, with 40% (n=472) pre-Cures and 60% (n=701) post-Cures. Common topics were: frustration (23%), anxiety (18%), desire for autonomy (13%), barrier to access (12%), delay (11%), and early notification before referring provider (10%). Early notification was the only theme that significantly increased between the study periods (+5%, p<.01). Of tweets discussing individual experience with radiology reports (n=983/1173), 59% were negative and 20% were positive, with no change between study periods (p>.05). Common negative post themes were: frustration (37%), anxiety (30%), and delay (19%). Common positive post themes were: gratitude for radiologists (46%), appreciation of autonomy (39%), and active participation in care (15%). Of tweets specifically expressing opinions about early access to reports (n=807/1173), 74% preferred early access, and 14% did not, with decreased preference for early access between study periods (p<0.03). More patients than physicians, who expressed an opinion, preferred early access (79% vs. 36%, p <0.01). Common themes for those preferring early access were: frustration with prior policy (29%), autonomy (21%), and delay (21%). Common themes for those against early access were: early notification before provider (62%), anxiety (36%), and poor comprehension (26%).

Conclusion:
Twitter activity surrounding radiology reports increased after the Cures Act information blocking provision took effect, partly due to conversation about early notification before referring providers. Users reported more negative than positive experiences with reports, although they still preferred early access. While the Cures Act appears to be a positive step for patient autonomy and open access, work remains to mitigate patient anxiety and improve communication.