Open access to pathology reports: potential harms and proposed solutions

The Cures Rule permits patients to unfettered, immediate access of their documented health information unless medical providers 'block' this information. While the transparency of open notes has perceived benefits for clinic-based progress notes, the extension of the Cures Rule in its current form to include pathology reports could lead to unintended harms. Several consequences for both patient and provider are identified by examining hypothetical cases, inspired by patient and provider experiences, of misunderstood diagnoses and unexpectedly discovered cancers in seemingly benign tissue. Identified consequences include patient confusion, increased distress, harm to the patient-provider relationship, and moral injury to providers. These unintended consequences may be mitigated through several harm-reducing strategies: informed release, individualized delay, and the 'pop-up' warning. While each presented harm-reducing measure has pros and cons, they all have the potential to improve patient care from where it currently stands.