Health care stakeholders have been increasingly encouraged to respect and promote the active role of patients in shared decision-making and care. This shift is supported by consumers’ quick and convenient access to health information, including personal health information, via information and communication technology (ICT) such as patient portals, the internet, and social media. Patient portals are web-based platforms that provide patients with access to their personal health information contained in the health organization’s electronic health record (EHR). In other words, patient portals are tethered to an EHR. By creating a portal account, patients are provided with secure and convenient access to their information, which can facilitate their active engagement in their care. Patient portals can provide access to diagnosis, laboratory and diagnostic imaging results, medication lists, booking and viewing appointment times, sending and receiving secure messages with their health care team, and in some cases requesting prescription refills and conducting video visits, among other functionalities. Although the above definition and list of functionalities of patient portals are commonly used in the literature [1,2], taxonomies of patient portals offer a more systematic way of describing this technology [3].

One example is the recent Taxonomy of Patient Portals based on Characteristics of Patient Engagement [3] developed for health information managers and updated based on a Delphi study with 13 participants (mostly in senior roles as health informatics specialists), with experience in patient portals ranging from little to significant, from Austria, Germany, and Switzerland. The Taxonomy of Patient Portals based on Characteristics of Patient Engagement describes the patient portal in terms of 7 aspects that cover 25 dimensions with 65 characteristics. The key criterion underlying this taxonomy is the level of patient engagement. The aspects (and examples of dimensions) are portal design (eg, care sector target, medical specialty, or patient target such as outpatient), management (eg, appointment booking and prescription renewal), communication (eg, e-consult), instruction (eg, patient education), self-management (eg, visit preparation), self-determination (eg, declaration of will and study sign-up), and data management (eg, record access, health data amend, or upload) [3].

A large body of research including primary studies [4-11] and reviews [1,2,12-14] aimed to evaluate the effects of patient access to EHR. A systematic review of 10 randomized controlled trials concluded that the effects of portals are uncertain when compared with usual care [1]. Other reviews encompassed primary studies with various designs, including qualitative and nonexperimental designs, and their findings were diverse.

Brands et al [12] reported high levels of patient satisfaction and acceptability of portals. Portal use improved patients’ understanding of their health conditions [12], monitoring of health status, patient-physician interaction, and quality of care [13]. Portals promoted the use of recommended care services [12], but the results were mixed for portal effect on reducing physician and emergency department (ED) visits [13]. Contrary to what might have been anticipated by portal advocates, patients with comorbidities and a high disease burden seemed to benefit less from portals [12].

Although the beneficial effects of portals are more noticeable when patients use the portal’s active features [12] (eg, communication with health care teams, systematic monitoring of laboratory values to adjust lifestyle, and information upload), most commonly, portals are used passively to access information [14]. Patients avoid generating and managing their health data in the portal because of concerns about data validity, applicability, and confidentiality [14].

In a recent study reporting health care provider (HCP) perspective from 673 general practices in the Netherlands, 42% described their experiences with patients’ web-based access to medical records as neutral and 37% as mostly positive [4]. Two-thirds reported an increase in e-consultations and administrative work [4]. Patients’ perceptions of a Finnish portal [5] and Norwegian portal [10] were positive, with managing prescriptions and viewing test results and medical notes being the most useful [5]. Portals facilitate communication with health care teams and the monitoring of health status and care activities [7,8,10] by motivating patients to ask questions, prepare for medical appointments, and share documents with other providers [8,10]. Liu et al [6] found an indirect relationship between portal use and cancer survivors’ psychological and physical health, mediated by patient-centered communication and self-efficacy. The analysis of a large data set from primary care in the United States found overall inconsistent effects of portal use, but patients who used messaging and viewed laboratory results more often exhibited a larger reduction in no-shows compared with other user subgroups [11]. However, not all patients want to use portals and may consider them unnecessary, impersonal, incomprehensible, misery oriented, fear provoking, energy demanding, cumbersome, and impoverishing (ie, negatively changing individual and social life) [9].

One of the portal features that patients use the most is viewing their laboratory and diagnostic imaging test results [15,16]. Analyses of a system’s data such as portal logs in large medical centers in the United States [15] and Canada [16] demonstrated that viewing test results was the second most used portal functionality, whereas the users of the Swedish national portal identified this feature as the most important [17]. Currently, the number of research publications reporting why and how patients access their laboratory and diagnostic tests via web-based portals and what the implications of this access are for patients, HCPs, and health systems is increasing. The COVID-19 pandemic has added urgency to the use of technology to support the online delivery of health care services. However, to date, the literature has been dispersed, and no overall synthesis has been reported. Part of our interest in undertaking this review is explicitly regarding the timing of the release of test results to patients. The results can be manually released by HCPs or autoreleased either immediately or after a predetermined delay. In discussions surrounding the embargo period, increased patient anxiety and harm to patients are often cited as concerns by opponents of immediate result release. However, American health care organizations might be opting for a contentious immediate result release after the implementation of the 21st Century Cures Act.

The 21st Century Cures Act, enacted in the United States in 2016, encourages patients’ unrestrained access to electronic health information and promotes interoperability among EHR vendors [18]. The Cures Act Information Blocking Provision required the implementation of patient access by April 2021, with significant consequences for noncompliant health organizations and HCPs [18]. Importantly, this rule “does not increase the type of health information that patients and families can access; it only facilitates automatic release via patient portals and easier access electronically” [18]. In particular, the Cures Act has direct implications for the release of test results into patient portals. Although the Act did not require that all tests be released automatically, but rather upon a patient’s request, some health systems weighed the logistics and chose to revise their result release frameworks to eliminate embargo periods for most tests [19]. In other words, some health systems in the United States switched to the immediate release of nearly all laboratory and imaging results, including those considered sensitive and suitable exclusively for in-person discussions [19]. This policy context in the US foregrounds the importance of understanding past and present practices and experiences of patient web access to their test results.

The purpose of this scoping review was to analyze and synthesize published research focused on patient and HCP perspectives on patient web-based access to their laboratory and imaging tests. This review was guided by the following research questions: What are the experiences and perceived advantages and limitations for patients and family caregivers who access their laboratory and diagnostic test results via web portals? What do HCPs perceive as the benefits and drawbacks of direct patient access to test results? What factors should be considered when implementing patient access to test results via portals? And What is known specifically about the timing of result release and the effects of timing in relation to other important considerations for patients and HCPs?

This review followed a modified scoping review methodology previously used by the first author in published scoping reviews [20], which is based on selected recommendations from the Joanna Briggs Institute for scoping reviews [21] in combination with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) [22]. Initially, part of this review was undertaken as a graduate student project, which explained the multiple timelines of the searches. The review process is depicted in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart (Figure 1).

Web-based literature searches focused on patient access to laboratory or imaging results via patient portals. The initial searches were conducted at 2 points in 2020, in consultation with an academic librarian. In May 2020, MEDLINE (Ovid), Embase, CINAHL Plus, Cochrane, and Scopus were searched using both subject heading and keyword terms for articles available in English without time restrictions. To increase specificity and precision, in September 2020, the keyword search within titles and abstracts in CINAHL and MEDLINE was limited to academic journals published in English from 2005 to 2020. The results were exported to the Covidence software (Veritas Health Innovation Ltd) for screening. From September 2020 to August 2023, OP monitored new publications in key health informatics journals. In addition, an updated search was conducted in August 2023 using keyword searches within titles and abstracts in CINAHL (EBSCO) and MEDLINE (EBSCO) from September 2020 to August 2023. Multimedia Appendix 1 provides the complete search strategies.

Articles were selected based on the following inclusion criteria: (1) phenomenon of interest: patients accessing their laboratory or diagnostic imaging test results via patient portals; (2) population: patients or family caregivers, HCPs, and health systems; (3) technology: tethered patient portals, personal health records that allow patient access to laboratory or imaging results, or web portals for patients accessing laboratory and imaging results (we were interested in actual, existing portals or usability testing of actual portal prototypes designed for clinical settings); and (4) the type of publications: primary peer-reviewed research of any design (qualitative, quantitative, and mixed methods), directly focused on the phenomenon of interest.

We excluded studies that (1) tangentially mentioned the percentage of patients viewing test results or mentioned patients hypothetically interested in viewing test results; (2) addressed other forms of ICT and patient access to information other than test results; (3) focused on genetic portals, which are contextually unique in that genetic tests are not routinely released into mainstream patient portals but rather specialized portals are designed (one example is the study by Williams et al [23]); (4) focused on inpatient portals for hospitalized patients, which are contextually unique areas requiring separate analyses; (5) focused on software development and implementation as well as portals developed for research purposes (one example is the study by Fraccaro et al [24]); (6) used hypothetical scenarios on simulated patients (one example is the study by Bar-Lev and Beimel [25]); and (7) were situated outside of high-resource countries (this was seen as contextually unique). We also excluded review papers and gray literature. This review was limited to primary research, and the analysis of other sources was outside the scope of this study. However, our findings suggest the potential usefulness of analyzing selected gray sources, such as health care organizations’ result release portal policies. Refer to Multimedia Appendix 1 for detailed tables of the inclusion and exclusion criteria.

We used the Covidence systematic review management software to remove duplicates and screen citations. Refer to the PRISMA flowchart for details (Figure 1). In May 2020, LW screened titles and abstracts, followed by LW and OP’s independent review of the selected full texts, and disagreements were resolved by consensus. During this stage, 15 articles addressing patient perspectives met the inclusion criteria [26-40]. In September 2020, SS and OP independently screened titles and abstracts, followed by an independent review of the selected full texts, and disagreements were resolved by consensus. During this stage, 7 articles addressing HCP perspectives met the eligibility criteria, of which 3 were new [41-43], whereas 4 were already identified in the previous search as they included both patient and HCP perspectives [29,35,36,39]. In the updated search in August 2023, OP and WG independently screened titles and abstracts, followed by an independent review of the selected full texts, and disagreements were resolved by consensus. During this stage, 7 articles met the inclusion criteria [19,44-49]. A list of articles compiled by OP during the ongoing monitoring of new publications from September 2020 to August 2023 was compared with the results of the updated search, and 2 new articles [50,51] meeting the inclusion criteria were added.

In total, 27 unique articles were included in the data extraction, analysis, and synthesis, 4 of which captured the perspectives of both patients and HCPs. The articles focused on patient perspectives (n=24) and HCP perspectives (n=7) were thematically analyzed, and the results were reported separately for each group. This granular approach produced a comprehensive summary sensitive to patient characteristics and portal technology, which is a step toward building evidence to inform the result release framework policies and help HCPs appreciate the benefits and challenges that patients report when viewing their test results via web portals.

LW, SS, and OP developed and piloted the Microsoft Excel table for data extraction. Categories for data extraction included citation, country, health care setting, portal type or brand, study purpose, design, methods of data collection, sample, findings (separately from patients and providers and for each method of data collection, eg, self-reports vs system log analysis), and limitations. At different stages of the review project, LW, SS, AK, JS, and WG extracted data from the included articles, whereas OP, EKA, AK, and JS reviewed the extracted data for completeness and accuracy.

Data extraction and thematic analysis were informed by sensitizing concepts and insights from sociological practice theory and science and technology studies. Specifically, sociomateriality and actor-network perspectives summarized elsewhere by the first author [52-54] and translational mobilization theory [55] describing the invisible organizing work of HCPs (ie, nurses) provided valuable lenses for our engagement with the articles. Thus, theme generation has been informed by assumptions about the benefits of contextualized descriptions, technology as agential, the importance of viewing patient portals as interacting in patients’ everyday lives that involve multiple human and nonhuman elements, and health care practices as encompassing not only direct caregiving roles but equally important the organizing work. This organizing work includes the creation of working knowledge, patient care trajectory articulation, and transitions of care [55], all of which change with the introduction of EHR and patient portals.

At the text level, thematic analysis involved a hermeneutic process of understanding the whole to understand each part and vice versa. This process was necessary to contextualize the findings reported in each article. We looked for content and patterns present across the findings of the reviewed studies to propose and populate initial themes (eg, negative emotions patients feel when viewing test results) and for findings mentioned infrequently (eg, patients’ comments about the timing of result release). Themes were generated inductively and were not limited to the formal themes (subheadings) proposed in the original studies. Examples include the rarely articulated or novel themes related to the test result-release framework (mode and timing), patients’ views of portals as archives, patients serving as a link connecting fragmented health services because of patients’ ability to share test results with providers lacking EHR access, and a more nuanced presentation of factors contributing to patient anxiety when viewing their test results via portals.

The 27 reviewed articles were published between 2007 and 2023, with the majority (n=22, 81%) published in 2016 or later. Studies were conducted in the United States (n=21, 78%), the Netherlands (n=3, 11%), Canada (n=2, 7%), and Denmark (n=1, 4%) using quantitative (n=17, 63%), mixed methods (n=9, 33%), and qualitative designs (n=1, 4%). The most frequently used methods of data collection were surveys (n=16, 59%), interviews (n=8, 30%), and analyses of EHR data (n=9, 33%). Where surveys or interviews were used, the samples consisted of patients, family caregivers, and HCPs, such as physicians, oncologists, or nurses. Among 17 studies that provided the portal name or brand, at least 8 (47%) studies were conducted in health care facilities using the EPIC patient portals. Three studies [19,27,31] were conducted in the same setting, University of Iowa Hospitals and Clinics, and involved analyses of the EPIC Reporting Workbench from 2016, 2017, and 2020 to 2021.

Most reviewed papers reported patient access to a variety of test results, mostly laboratory but also imaging. A subgroup of articles originating in the United States focused specifically on patient access to radiology and imaging results [26,29,30,33,34,40,51]. This focus appears to reflect a unique practice in this country whereby (1) radiology services often implement their own web portals (rather than, or in addition to, supplying results to the patient portals tethered to the main EHRs) and (2) radiologists can directly interpret the results to patients. According to Mangano et al [33], the Radiological Society of North America tried to encourage radiologists to enhance their visibility among patients, including the practice of direct communication of imaging results to patients, which might be one factor explaining the relatively high number of studies focused on releasing imaging results. We report findings from these articles from either patient perspectives or HCP perspectives depending on the sources of data.

The detailed participant groups, sample sizes, health care settings, and portal technology are presented in Table 1.

Table 2 lists 9 themes generated from 24 studies focused on patient perspectives and 6 themes generated from 7 studies focused on HCP perspectives. If the study included data from patients and HCPs [29,35,36,39], we reported these findings separately, in respective sections. Williams et al [42] does not address patient access to tests results but provides important findings on the effects of physician access to electronic test results. For this reason, we decided to report the findings of this study. Krasowski et al [31] study was difficult to categorize as it mostly supported themes in the patient perspective section while also providing valuable data about health organization’s result release practices. We extracted all these data but placed this study [31] in the patient perspective group.

The results consist of 2 parts. First, we report patients’ perspectives on accessing their test results via the patient portal, which includes 9 themes. Articles in this group [19,26-40,44-51] analyzed data from patients, family caregivers, and organizational electronic systems. Second, we report HCP perspectives on patient access to test results, which consists of 6 themes. Articles in this group [29,35,36,39,41-43] analyzed data from HCPs and organizational electronic systems.

In this scoping review, we examined 27 research studies reporting patient and HCP perspectives on patient web access to their laboratory and imaging test results using patient portals. Most of the studies were published after 2016 and originated in the United States. Among the themes comprising patient perspectives, 3 were addressed in 10 or more articles: demographic factors associated with portal use, information seeking to clarify results, and benefits of viewing test results. In contrast, 2 themes—the mode and timing of result release and behavioral changes motivated by viewing one’s test results—were addressed in 6 articles. Only 7 articles included HCP perspectives or analyzed the patterns of result release. Among the themes comprising HCP perspectives, changes in the workload and HCP perception of benefits of patient access to results were addressed the most, whereas the mode and timing of result release and concerns about patient anxiety were addressed the least. Only one article analyzed patient quality outcomes in relation to hospitals’ HIT, including HCPs’ access to test results in the electronic records. The findings of our review are too numerous to be summarized in their entirety. Several findings, namely, sociodemographic factors of patients who view their results or mixed effects on HCP workload, rehearse well-known findings from other studies. Thus, we focus on the selected findings.

An important but underrecognized benefit of patient access to their test results is that in the reality of fragmented health services, portals serve as archives [36-38] and assist patients to act as an information link between service providers who do not have access to the same clinical information systems [37].

Patient anxiety is a shared theme across the patient and HCP perspectives. Our findings show that 2 main factors contribute to patients’ negative emotions and anxiety: viewing abnormal or incomprehensible test results. Each of these factors seems to be mediated (albeit in various ways and to various degrees) by the mode (manual vs autorelease), timing of result release (immediate vs delayed), and whether the latter permits timely direct communication between patients and HCPs (text, phone call, and visit) either before or shortly after the result is released into the portal.

An observation that can be drawn from the reviewed studies is that the timing of the result release is important for all stakeholders. For patients, the timing was consequential for how they felt about and what steps they took in response to these results. Both “too early” and “too late” availability of test results was capable of generating anxiety, producing a flurry of actions to seek additional information, and altering patients’ comprehension of test results. HCPs in several studies have conveyed their dislike for immediate release [29,31,41,43]. The concern was that patients may view the results before the provider has had a chance to review them in detail or, alternatively, before other results are available [31]. Oncologists generally supported no less than a 7-day embargo period [43].

Considering the ubiquity of references to time among patients, it was surprising that studies reporting patients’ views rarely provided detailed information about the organizational result-release framework. One explanation is that patients themselves were not always sure when the results were released, as can be seen in Robinson et al [37]. Only a limited number of articles included detailed background information on health organizations’ result release frameworks, including timing [27,31,35,36].

To mitigate patient anxiety, aid patients’ comprehension of results, and prevent unwarranted increases in HCP workload, 3 main strategies have been suggested in the reviewed studies. First, ordering HCPs should educate patients about the purpose and potential findings of the tests being ordered when the tests are ordered. Patients did not experience negative emotions when viewing their results because the physician explained why the tests were being performed when they were ordered, and half of the participants were told to check the portal for their results [20]. However, this proactive patient education, although helpful, did not address all the limitations that patients face when viewing test results via portals [28].

The second strategy is to enhance the visual display of test results, which was mentioned as patients’ suggestions for portal improvement. The third strategy is to add written interpretations of the test results released into a portal. Patients liked being able to rely on physician annotations and interpretations; knowing that the physician was looking at the results relieved concern and anxiety. However, despite the HCP’s awareness of the benefits of providing written commentary, this was not commonly done, leaving patients searching for alternative sources of information, including the internet and family members.

Although it is important for health organizations to implement EHRs and support HCPs’ access to test results to support treatment decisions, more ICT does not necessarily improve the quality of patient care, as hospital size and staffing levels can have greater effects on reducing patient readmission rates and perceived quality of care [42]. This point is echoed in the broader portal literature that patients do not consider portals to replace human interaction but rather complement it [54,56].

Our findings support some better-established themes in research on patient portals, while expanding other themes. For example, Antonio et al [2] reported that one of the most widely used and useful portal features is access to the test results. At the same time, patients consistently notice that medical terminology creates challenges in comprehending test reports and that electronic links to credible reference materials might help [2].

In efforts to enhance patients’ ability to interpret test results in a portal, various studies examined whether the format for result presentation influences patients’ understanding, perception of risk, and the follow-up steps [24,25,57]. This literature corroborates our findings related to patients’ difficulties in interpreting the test results. In a controlled study, Fraccaro et al [24] found that 20 kidney transplant patients (mean age 52 y, knowledgeable about their disease, relatively high level of education, regular computer users, and mostly portal users) viewing hypothetical scenarios related to their health condition had difficulty estimating the gravity of laboratory results and whether or not action was required, particularly in response to medium-risk results (compared with high or low risk). As many as 65% of participants underestimated the need for action at least once [24]. Contrary to what might have been expected, the accuracy of the interpretation and estimation of risk did not improve with visual and graphical cues and other variations in the result presentation [24]. Some solutions include patient education before using a portal and integrating the natural tendency to view information (left to right and top to bottom) to display important information and avoid information overload [24]. Other recommendations in the literature include adding a brief written explanation to accompany graphs, tables, and charts; indicating the level of urgency rather than simply a deviation from the norm; and including in the report the type of follow-up required [25]. Furthermore, stating the level of variation that is considered clinically significant may assist patients in delineating which laboratory values are of concern as opposed to fluctuations within an acceptable range [57]. Individualizing the frame of reference to the patient’s age, condition, or other factors and providing thresholds for concern would make the results more meaningful [57]. Ultimately, however, patients’ difficulties in interpreting test results raise patient safety concerns and suggest limits to portal potential [24].

Patient characteristics associated with viewing web-based test results that we found in our review (predominantly female, White, and higher level of education) are also recognized in the literature [2,58]. In addition, research into patient portal use is typically in consensus that health literacy and comfort with navigating health care technology is higher in young adults (aged 25-39 y). However, this should be taken with caution to avoid agist assumptions, as other studies found that the medical necessity to track one’s test results, especially for oncology patients, motivates older people (aged >70 y) to use the portal [54].

Similar to the study by Pillemer et al [36], Alpert et al [59] discussed increased patient anxiety as a significant deterrent of releasing results before a physician has a chance to review them or follow-up with the patient to explain and answer questions; however, many groups of patients prefer quick results release. One example is patients diagnosed with cancer, among whom portal uptake and access to test results are high [60]. Phadke et al [61] found that patients with breast cancer prioritize obtaining results as quickly as possible; however, specific patient communication preferences differ depending on age, cancer stage, and education level. Arenson [62] found that patient preference for the method of receiving results varied, but immediate release into a portal was preferred if it was followed by a prompt call or office visit. Evidently, timely access to test results is particularly important for people with cancer. Patients are interested in viewing clinical information via a portal despite potential occasional “concerns of loss of patient confidentiality, health information inaccuracy, and disruption of the current patient–doctor relationship” [34].

Our discussion of patient information-seeking behavior has tapped into the growing scholarly field of health literacy. Unlike publications in this field [63-65], the studies we reviewed did not focus on patients’ strategies for evaluating the trustworthiness of web-based sources of medical information.

Our findings confirm that providing patients with laboratory results allows them to monitor their results, provides them with additional time to find information specific to certain conditions, and helps them prepare questions for HCPs based on the results [54,66]. In contrast, the complexity of the link between patient access to personal health data, changing health behaviors, and achieving clinical improvements is well recognized in the portal literature [2,67]. This is reflected in our findings, whereby the theme of patients pursuing behavioral changes and self-monitoring their health by observing trends in laboratory values was one of the least saturated in our review.

Efforts to implement patient portals should mitigate the potential of technology to widen health disparities [20] and advocate policy changes to help those with lower socioeconomic status gain access [68]. HCPs can help engage patients in their care and promote patient autonomy and informed decision-making by understanding patient access to test results via a portal and, when necessary, guiding patients on how to sign-up and use portals. However, portal implementers and health organizations should also support physicians and nurses by ensuring that they are well aware of this technology and have the time to teach patients. Encouraging patient portal use has additional benefits, as in some cases (eg, travel or emergencies), patients can provide their medical history via access to their home portal. This provision would also allow HCPs, both internal and external to the patient’s usual health care network, to avoid duplicate testing.

In primary and outpatient health settings, nurses are often assigned the role of triaging patient messages received via portals; however, this contribution often remains invisible in the literature. Nurses can capitalize on their expertise and negotiate a more structured role in explaining results to patients and answering patient concerns and questions about the results. Nurses can triage portal messages and decide whether follow-up appointments are necessary, thus benefiting patients and the health system. These nurses’ roles should be formally recognized rather than remaining invisible ad hoc arrangements. To mitigate the issue of patient anxiety arising from accessing uninterpreted test results in real time, nurses can collaborate with physicians to ensure that patients are aware of the purpose of the tests, the timing of result release, anticipated findings, and further steps. Timely and adequate communication between HCPs and patients is the key to the successful implementation of a direct result release via portals, and nurses should be recognized as important health care team players able to support this communication process and patient outcomes.

As the reviewed studies demonstrate, the result release framework (ie, the policies on the timing and method of result release in a particular organization) is an obscure “background” that influences HCPs’ work and patients but is rarely explicitly acknowledged. It would be beneficial for HCPs to be aware of the timing and method of result release to explain the process of receiving results to patients. Understanding the result release framework in their organizations can also assist HCPs in contributing to policies and procedures for result releases. Clinicians working alongside informaticians ensure that ICTs are configured and implemented in such a way as to support care processes rather than create unintended obstacles. They can also recommend systems that include the interpretation of results that are dictated in lay terminology instead of only medical terminology that patients often do not understand.

It is important to consider the embargo period in relation to the patient population, physician specialty, and type of results being released. Methods of result notification should suit the environment and work practices of HCPs while meeting patient needs. It is also important to involve clinicians (eg, physicians and nurses) when considering options for manual versus autorelease, which can have implications for provider adoption of technology. However, adherence to the Cures Act might mean that health organizations in the United States are switching to immediate release without adequately assessing the consequences for patient safety.

Most studies included in this review reported the first few months following the implementation of direct result release into the patient portal. Future research can report longitudinal data on how provider attitudes and practices change when supporting patients viewing test results via a portal. New studies can elucidate strategies by which health care settings deal with the consequences of direct result release (eg, what new roles emerge within teams to support patient inquiries). Crucially, future research should provide details about not only the type of portals, but also the result release frameworks and other organizational policies guiding direct result release to the portal. Few studies have analyzed the factors and processes related to organizational decisions in result release frameworks. Furthermore, it is unclear whether and how clinician stakeholders (especially less visible stakeholders such as nurses) are involved in decision-making processes. Another interesting direction arises from the observation that patients are conscious about “not disrupting clinic flow” when weighing the necessity for a follow-up to clarify test results in the portal. Future studies could focus on how portals and patient access to test results affect health-service provision.

The data available for this review were restricted to data in the included articles. Although we conducted a systematic search, there is a possibility that not all relevant studies were retrieved. The inclusion of gray sources, articles not written in English, and those addressing low-resource countries might have produced different results. Most of the included studies were performed in the United States. In contrast, the degree of contextual similarities across the included studies (high-resource countries, similar portal technology, and including the EPIC patient portal in several studies) provides stronger support for our findings. Although no formal quality appraisal was completed (in line with the scoping review methodology), we paid attention to methodological rigor and explicitly reported methodological details consequential to the interpretation of the findings. For instance, some authors noted poor response rates despite having adequate numbers of participants or that sample sizes or sociodemographic composition may have affected the results.

The strengths of this review include the separate reporting of patient and HCP perspectives. Although many primary research studies and reviews address patient portals overall, and access to test results is one of the most (or most) used portal features, there were no published reviews focusing on patient access to test results via portals. Furthermore, all findings in this review are contextualized by providing details about health settings, clinical specialty, portal type, and the result release framework based on the information available in the primary studies. This information is necessary to develop an understanding of what works for whom, where, and in what circumstances.

The results of this review illuminate patient and HCP perspectives on patient access to laboratory and imaging test results via a portal. The findings emphasize that all stakeholders have an interest in patient access to timely and comprehensible test results, yet there are challenges. Both patients and providers recognize the many opportunities to improve communication, patient engagement, and relationships with the health care team through the introduction of patient portals. Critical to this desire is support for patients via resources such as provision of normal laboratory ranges, physician comments, and an opportunity to discuss results with a health professional in a timely manner to decrease anxiety or confusion. Health organizations and portal administrators must also consider the sensitive nature of certain results (eg, in oncology), as patients may be especially anxious to receive and interpret the tests and their consequences on health. Decisions regarding the result-release framework require the involvement of clinicians. With the increasing implementation of patient portals internationally, our findings can inform various stakeholders about how to make test releases via portals that support patients and providers.