Patient-Reported Experiences With Viewing and Understanding Test Results in Patient Portals: Cross-Sectional Survey Analysis

Background: 21st Century Cures Act information blocking regulations led to many organizations altering policies to electronically release test results to patients immediately upon their availability. Objective: This study aims to understand the prevalence and variation in how often patients view test results in the patient portal before hearing from their health care provider (HCP), are given the option to decide how results are communicated, and understanding of results viewed before hearing from their HCP. Methods: In this cross-sectional analysis, we analyzed data from the 2024 Health Information National Trends Survey on US adults with complete information who received test results via patient portal (n=6045). We examined the share of all patients and “portal users” (accessed their portal in the last year) who viewed test results in their portal, viewed results before hearing from their HCP, and were given the option to decide how results were communicated. We examined patients’ understanding of results viewed before hearing from their HCP and compared it with their understanding of other health information. Finally, we examined differences in weighted proportions of outcomes by individual characteristics using survey-weighted linear regression. Differences were assessed using design-adjusted Wald tests. Results: In 2024, 70% of patients (92% of portal users) viewed results in their patient portal, and 58% (76% of portal users) viewed the results before hearing from their HCP. Overall, 28% of patients and 33% of portal users reported being given the option to decide whether they wanted to receive test results before hearing from their HCP. Only 66% of patients reported that they understood the results they viewed in their patient portal. Provider encouragement, higher education, and digital literacy were most strongly associated with higher rates of viewing test results overall and before hearing from their HCP (eg, 70% of those encouraged viewed results vs 24% not encouraged; <.001). Associations with age and chronic condition were also observed but were weaker. While higher education and digital literacy, age, and provider encouragement were strongly associated with being given the option to decide how to receive results, only high digital literacy and provider encouragement were strongly, positively associated with understanding results viewed before hearing from their HCP (eg, 77% of patients with high digital literacy understood results compared to 53% of those with low digital literacy; <.001). Conclusions: This study is the first to provide a national estimate of patients who access immediately released test results and whether patients are given the option to decide how their results are communicated to them. While most patients view results before discussing them with their HCP, rates varied by individual characteristics, and substantially fewer patients report being given the option to decide how results are communicated. Incorporating patient preferences in portal communications may empower patients while preserving immediate access.