The 21st Century Cures Act: Inpatient Clinician Perceptions of Changes to Information Sharing at an Academic Medical Center

Abstract

Introduction To comply with the Information Blocking Rule in the 21st Century Cures Act, many hospitals began to release inpatient electronic health information such as clinical notes and results to patients immediately, starting in April 2021. We sought to understand the perceptions of hospital-based clinicians regarding the impact of these changes in information sharing on clinicians and patients. Materials and methods We developed and distributed an electronic survey to 122 inpatient attending physicians, resident physicians, and physician assistants within the internal medicine and family medicine departments at an academic medical center. The survey asked clinicians to rate their comfort with information-sharing protocols and describe their perceptions of the impact of immediate information sharing on their documentation habits and patient interactions following the implementation of the Cures Act. Results The survey response rate was 37.7% (46/122). Of the respondents, 56.5% felt comfortable with the note-sharing process, 84.8% reported omitting specific information from their notes to prevent patients from reading it, and 39.1% of clinicians agreed that patients have found clinical notes "more confusing than helpful." Conclusions Immediate sharing of electronic health information has the potential to be a powerful tool for communicating with hospitalized patients. However, our results show many hospital-based clinicians report limited comfort with the note-sharing process and perceive it to be confusing to patients. Efforts are needed to educate clinicians regarding information sharing, understand patient and family perspectives, and develop best practices to enhance communication through electronic notes.

Keywords: 21st century cures act; academic medical centers; access to information; cures act; electronic health record (ehr); information sharing; inpatient care; medical documentation; personal health information.

Figure 1. The number of inpatient notes shared and viewed in 2021. Following the implementation of the Information Blocking Rule on April 5, 2021, the absolute number of inpatient notes released to and viewed by patients increased at this institution while the percentage of viewed notes decreased

Data source: Epic MyChart Data.

Figure 2. Responses to selected survey items

Figure 3. Page 1 of the clinician survey

Figure 4. Page 2 of the clinician survey

Figure 5. Page 3 of the clinician survey

Figure 6. Page 4 of the clinician survey

Figure 7. Page 5 of the clinician survey