New Virginia law delays release of certain test results

Here’s what emergency physicians need to know

A Virginia law taking effect July 1 will change how and when certain diagnostic results are released to patients. It’s a shift that could have significant implications for emergency departments.

How does Virginia’s law interact with the federal Cures Act?

Signed into law in 2016, the federal 21st Century Cures Act (and its “information blocking” rules) requires that patients have rapid access to their health information, including test results. At first glance, Virginia’s 72-hour delay looks like a conflict.

However, the Cures Act includes exceptions that allow providers to withhold information in limited circumstances — particularly when immediate release could cause harm or when technical or operational constraints exist.

Virginia’s statute is written with those exceptions in mind. It states that providers must still comply with federal law while outlining specific scenarios — like results that may indicate malignancy — where delayed release is permitted. 

In practice, the laws are intended to align:

• Federal law provides for timeline access to information and says not to block access without a valid reason

• Virginia law outlines those valid reasons where a delay is appropriate

The distinction is that federal rules emphasize case-by-case judgment, while Virginia establishes a more standardized approach. How that balance is applied in emergency settings depends on hospital policies and real-world implementation.

Signed by Gov. Abigail Spanberger, House Bill 973 requires healthcare entities to delay the release of specific test results in patient portals for up to 72 hours when those results may indicate serious conditions.

The law is explicit in scope. It applies to pathology or radiology reports that have a  “reasonable likelihood” of showing a finding of malignancy, or any testing that could reveal genetic markers.

Unless an exception applies, those results cannot be automatically released to patients through the electronic health record until the 72-hour window has passed.

Why the law matters in the emergency department

For emergency physicians, the inclusion of radiology reports is particularly important…and potentially problematic.

CT, MRI, and ultrasound imaging studies routinely uncover incidental findings, including previously undiagnosed masses or lesions. That means imaging performed for routine complaints can unexpectedly reveal lung nodules, kidney masses, pancreatic lesions and other findings requiring follow-up care.

• A 2022 systematic review published in the Annals of Emergency Medicine found incidental findings in roughly 31% of ED CT studies, while earlier studies reported rates ranging from 33% to 45% depending on the imaging type and patient population. Many of those findings are clinically significant, and a smaller subset may represent previously undiagnosed malignancies.

VACEP leaders advocated for House Bill 973 with legislators during this year’s General Assembly. Members are pictured here with Del. Mark Downey, a Williamsburg pediatrician and freshman delegate. Downey is the first physician in the General Assembly in three years.

This creates a real-world tension: emergency physicians are frequently the first to identify potentially life-altering diagnoses, but they are not always positioned to deliver that news in a controlled or longitudinal care setting.

Delay or no? Here’s what the new law allows.

Virginia’s new statute includes important exceptions. Results may be released before the 72-hour delay if:

• The patient requests and consents to early release

• The electronic health record system cannot separate the result from other data

• The treating clinician determines early disclosure is in the patient’s best interest 

In addition, the law provides liability protection for healthcare entities that comply with the requirements.

Key questions remain for ER docs

While the intent of the law is to ensure patients receive serious diagnoses with appropriate clinical context from a physician, application in emergency settings is less straightforward.

Here’s the question before a health system’s legal and IT teams: Can an informatics change be made to allow the delay of advanced imaging?

Delaying test results: Practical guidance for ER docs

1. Be deliberate in documentation

Clearly document any incidental findings — especially those that could represent malignancy — along with follow-up recommendations and communication with the patient.

2. Strengthen discharge instructions

Given potential delays in portal release, discharge paperwork may become even more critical in ensuring patients understand next steps.

3. Coordinate with radiology and hospital leadership

Work with radiology departments and administrators to understand how “reasonable likelihood of malignancy” will be defined and operationalized.

4. Understand your EHR capabilities

Not all systems can easily segment results. Know when exceptions may apply and how your system handles delayed release.

5. Use clinical judgment when appropriate

The law allows early disclosure when it is in the patient’s best interest. That provision may be particularly relevant in emergency settings.

In conclusion

For emergency physicians, the new law underscores a reality of modern practice: the ED is increasingly a point of entry not just for acute care, but for the discovery of chronic and life-threatening disease.

How this law is implemented — especially in high-volume, high-acuity environments — will determine whether it improves patient care or creates new gaps in communication.