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Multi-institutional Experience with Patient Image Access Through Electronic Health Record Patient Portals

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The objective is to determine patients’ utilization rate of radiology image viewing through an online patient portal and to understand its impact on radiologists. IRB approval was waived. In this two-part, multi-institutional study, patients’ image viewing rate was retrospectively assessed, and radiologists were anonymously surveyed for the impact of patient imaging access on their workflow. Patient access to web-based image viewing via electronic patient portals was enabled at 3 institutions (all had open radiology reports) within the past 5 years. The number of exams viewed online was compared against the total number of viewable imaging studies. An anonymized survey was distributed to radiologists at the 3 institutions, and responses were collected over 2 months. Patients viewed 14.2% of available exams – monthly open rate varied from 7.3 to 41.0%. A total of 254 radiologists responded to the survey (response rate 32.8%); 204 were aware that patients could view images. The majority (155/204; 76.0%) felt no impact on their role as radiologists; 11.8% felt negative and 9.3% positive. The majority (63.8%) were never approached by patients. Of the 86 who were contacted, 46.5% were contacted once or twice, 46.5% 3–4 times a year, and 4.7% 3–4 times a month. Free text comments included support for healthcare transparency (71), concern for patient confusion and anxiety (45), and need for attention to radiology reports and image annotations (15). A small proportion of patients viewed their radiology images. Overall, patients’ image viewing had minimal impact on radiologists. Radiologists were seldom contacted by patients. While many radiologists feel supportive, some are concerned about causing patient confusion and suggest minor workflow modifications.

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De-identified data can be made available on request, subject to IRB data sharing approval.


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Authors and Affiliations



HHC and MDK contributed to the study design, data collection, and analysis and writing parts of the manuscript. ALK and CJR contributed to the data collection and analysis and writing parts of the manuscript. JVC contributed to the data analysis and writing parts of the manuscript.

Corresponding author

Correspondence to Hailey H. Choi.

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IRB approval was waived. Consent to participate and consent for publication were waived.

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The authors declare no competing interests.


The authors declare that they had full access to all of the data in this study and the authors take complete responsibility for the integrity of the data and the accuracy of the data analysis.

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Choi, H.H., Kotsenas, A.L., Chen, J.V. et al. Multi-institutional Experience with Patient Image Access Through Electronic Health Record Patient Portals. J Digit Imaging 35, 320–326 (2022).

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