Table 1. Recommendations for eight key stakeholders involved in the implementation of electronic laboratory results release based on the review of available literature and the authors' consensus from implementation experience.

Stakeholders	Considerations	Recommendations
Patients, families, and caregivers	Patients have individual preferences as to when and how they would like to receive test results	When multiple options available for receiving test results, set communication preferences for your personal preferences
	Patients' preferences for receiving test results may vary with test and clinical scenario	Prepare to not view a test result online when you feel that you would prefer to hear the result from your clinician or view at a more convenient time electronically
	Certain test results deemed sensitive by state or federal policy may not be deemed sensitive by patients. Test results deemed sensitive by patients may not be covered under current state/federal policy	Discuss ahead of time with the care team concerns about receiving test results
	Proxy access is determined by the health care organization and limits patients' ability to choose what is shared/restricted with families and caregivers	Understand what is shared in the health system where you are getting care before giving someone proxy access to your health information
Clinicians and staff	Clinicians must both abide by federal/state regulations and also engage patients in their preferences for receiving health information and desires for privacy	Discuss with patients ahead of time what the test results could show and the possibility that a patient could view the result before the clinician
	Thorough evaluation of a specific health issue may require ordering multiple sensitive laboratory studies	Use language with patients that reduces stigma and be clear with what is being ordered and why to prevent surprises to patients when viewing results electronically
	Clinicians want to get patients into timely treatment and care, especially urgent when public health is at stake	Release results immediately, if not automatically released at your organization at the time resulted by the laboratory
Health information technology/informatics	Health information systems are often asked to build complex systems of sharing and restricting data for patients and their proxies	Work with EHR vendor support to understand options and limits of technical configurations within current systems
	Health information systems can be configured in different ways to respect state and federal regulation, each with different pros and cons	Work with multidisciplinary stakeholder groups including clinicians, legal and compliance, health information management, risk management, and patient experience to determine optimal approach
	Regulations and EHR capabilities change over time	Plan to review technical configuration in EHR with regular cadence to ensure best practices are being deployed
Health care organizations	Health organizations must interpret state and federal data sharing policies in context of internal policies	Design policy that is equitable, reflects excellence in clinical practice, and can be met with currently available technical tools
	Health systems cater to different patient populations with diversity of needs and concerns	Engage with clinical leaders and vulnerable patient populations at your health care organization
	Health care systems are obliged to share laboratory data with patients and proxies, though certain patient populations may have difficulties accessing their data due to systemic inequities in digital literacy and access	Provide support to patients and families who need extra help to find and understand test results
	Clinicians within a health care system may face varying challenges around communicating test results and have different workflows	Develop policies that take clinician workflow into consideration and provide ample education and support while implementing and maintaining change
Laboratories	Patients may ask laboratories for release of or explanations about test results	Develop standard processes for answering questions from patients and guiding them to the correct resources to address their needs
	State laboratory release laws may pose challenges for laboratories that work across multiple state lines	Work with laboratory compliance managers to understand and advocate for reconciliation (or alignment) of state and federal policies
	State adolescent privacy laws may pose challenges for laboratories that work across multiple state lines	Work with laboratory compliance managers to understand and advocate for reconciliation (or alignment) of state and federal policies
EHR developers and vendors	EHR developers face challenges designing systems that can customize to individual health care organizations and their interpretation of state and federal regulation	Work with compliance managers to understand and advocate for reconciliation (or alignment) of state and federal policies
	Patients will vary in how they wish to receive test results electronically	Allow options for delayed result release at the time of ordering by the provider and options for patients to delay result receipt after the time of ordering
	Patients desire to control their individual data and who can access individual elements and for how long	Allow options for patients to control what information is released to patients and proxies beyond what is standardly configured by a health system
	Many patients are not easily able to take advantage of existing EHR capabilities to view test results due to risk factors for digital inequity (e.g., language or digital literacy)	Invest in research and development to provide systems that allow for multilingual support and include patients in system design to ensure interfaces are easy to navigate and provide health care systems tools, such as data dashboards, to determine if inequities in access to test results within a health care system exist by race, ethnicity, language, age, or other predictor of digital inequity
	Clinicians want to meet patients' needs in ways that are optimized for efficient workflows	Confer with end users on how to make innovation that fits patient needs and enhances clinician workflows
Healthcare technology innovation	Applications offer ability to consolidate data across disparate EHRs and health systems	Design applications that allow for increased patient choice for data sharing, segmentation, and restriction while maintaining patient safety and privacy concerns and following an approach grounded in health equity to ensure that historically underserved patients have the best possible access to innovative technologies
State and Federal policymakers	Policymakers are tasked with achieving maximum interoperability to improve patient outcomes, care coordination, and reduce costs while also respecting patients' rights to their data and for privacy	Standardize policies across state lines and in alignment with federal regulations, where possible
	Policymakers asked to support policy around electronic laboratory release must evaluate which test results warrant special protections prior to electronic release	Approach policymaking with grounding in health equity to make determinations if certain groups may be disproportionately impacted by restrictions in this access
	Policymakers asked to support policy around restricting results release to patients before they are communicated by their clinician should evaluate which tests warrant special protections due to harm to patients who see results before discussion with their clinician	Approach policy making with grounding in health equity to make determinations if certain groups may be disproportionately impacted by restrictions in this access. Consider both the potential risks and benefits of patients having immediate access to a specific type of test result
	Policymakers must balance public health needs with concerns surrounding patients receiving a sensitive result	Where public health or safety is at stake, consider whether restrictions on electronic release would be beneficial or harmful to patients and communities for disease control efforts
	Policymakers receive concerns from clinicians, EHR vendors, patients, and families around overly/underly prescriptive legislation surrounding results release	Engage all stakeholders in depth to evaluate concerns and collect data to support changes in policies over time

Abbreviation: EHR, electronic health record.