How Immediate Patient Access—and AI Tools—Are Changing the Patient-Pathology Landscape
By - September 22, 2026
In the years since the Cures Act was passed, a new element has entered the equation: patients’ ready access to AI tools. How is that upending the ways in which patients interact with labs?
In the decade since the 21st Century Cures Act was passed and implemented, something has happened to further alter the landscape around lab test results reporting—and it’s got pathologists and laboratory leaders adjusting how they interact with patients. In a word (or two words), it’s AI—artificial intelligence.
The 21st Century Cures Act was passed by the U.S. Congress in 2016 and signed into law by President Barack Obama on December 13, 2016. The law has many different provisions, ranging from FDA drug approval processes to informed consent for medical research, to the classification of medical software as medical devices. But one section of the Act that has had a huge impact on the healthcare industry has been its provisions around what the Act refers to as “electronic health records information blocking.”
That provision subjects provider organizations to fines for any form of activity that blocks patient access to medical history or treatment. And within that section was a provision that requires that patients receive their medical test results and clinical notes immediately; that provision took effect on April 5, 2021, and was expanded in October 2022 to apply to all electronic health information maintained by any provider, including pathology reports and all clinical notes. But patient care and other healthcare organizations have taken time to adjust to the lab-test results requirement.
And initially, the provision was seen as somewhat controversial inside healthcare. As the authors of study published in 2021 in JAMA Network Open wrote, “Before implementation of the Cures Act, many institutions released only a subset of electronic health record (EHR) information through the patient portal. This information was often suppressed or delayed when it was considered by the health system to be highly sensitive or there was a risk of misinterpretation. The requirement that all electronic health information be immediately available to patients—who may see it before their clinicians—has raised concerns about unintended implications on clinical workflow and patient well-being.” What did the researchers find? “Improved availability of data to patients represents a marked transformation in patients’ opportunity to take ownership of their health care,” they wrote. “However, the benefit associated with immediate release of test results may be overshadowed by unintended consequences to patient well-being and clinical workload.”
A change for the laboratory
But the entire situation on the ground has been shifting in real time since then, laboratory leaders note. Indeed, the emergence of AI tools has upended a lot of the old assumptions about how patients might/should interact with the healthcare system, as, armed with their test results even before they speak to clinicians, patients are turning to AI tools to find out more about their diagnoses, even before they speak with their own personal physicians, or with pathologists.
And it is because of that clinical pathologists say they’re now actively adjusting to the reality of patients having access to information that is undigested and unfiltered by clinical explanations.
Anne Buckley, MD, PhD, an associate professor of Pathology at Duke Health in Durham, North Carolina, and a practicing clinician in neuropathology, says that the transition “had an almost immediate impact. In a matter of days after those reports started going out, I started receiving direct inquiries from patients by phone or email to look at their cases.”
Patients are learning more, she adds, which has accelerated the pace of pathologists’ interactions. “And that’s what I’ve wanted all along,” Dr. Buckley says. “In my case, for my entire practice for the last 19 years, I’ve always invited patients to contact me directly to discuss their reports. They already had my number and work email on my reports. If you don’t have that invitation, it might not have had the same impact.” One example: “We list all the molecular data used in the diagnosis, on the report; so if you were to get a report via MyChart, the patients can see the entire PDF report, with everything on it, including the gross description, all the comments, except what we keep behind the firewall, which could include sensitive patient information. And in neuropathology, per brain tumors, patients want to know how much tissue is left that can be sent out to labs for testing. They can see in the gross description how much tissue we’ve used. They’re very interested and are increasingly educated. And I can tell that I’m receiving inquiries that are AI-generated. Patients used to be able to look things up, but now they can ask incredibly sophisticated questions, asking leading-edge things that have been taken from all over the web, and the algorithm has assembled them.” And all of that is to the good, she posits.
Pathologists and lab leaders note that they are very clear about the challenges of patients using the large language models in AI tools to help them prepare for their interactions with clinicians. "LLMs are theoretically very powerful and they can give great advice, but they can also give truly terrible advice depending on how they're prompted," Adam Rodman, an internist at Beth Israel Deaconess Medical Center in Massachusetts and chair of a steering group on generative AI at Harvard Medical School, told Kate Rudner in September 2025 in an NPR segment on the subject.
The emergence of consumer-accessible AI tools in the last couple of years has fundamentally changed the landscape around the relationships and interactions between patients and clinicians, including pathologists. “It’s not just patients searching the Internet any longer,” says Michael Datto, MD, PhD, medical director and associate vice president, Duke Health Clinical Laboratories. “It’s AI tools, which are surprisingly good, and are going to change the landscape of healthcare. And an informed patient is a huge asset; an informed patient helps us provide better, safer, higher-quality care. So I think it’s wonderful that patients have more access to information than ever before; the immediate-release element gives me pause. But it’s wonderful when a patient brings their own research into their conversation with their provider. It’s just a challenge that they have the information so fast.”
At the level of senior management and governance, the change has had a large impact as well, says Dr. Datto. “The biggest changes have been around provider and patient satisfaction.” In the past, he says, “We didn’t have a big problem with health records being blocked from patients at Duke. It is a problem that patients have to live with uncertainty and anxiety before someone can talk to them. That’s a big deal. You’re sitting for hours or even a day, it’s a lot.” In terms of practical changes, Dr. Datto says, “We honestly haven’t had to change too much about the way in which we operate.” To accommodate the regulatory change, he reports, “We had to make changes in Epic [the electronic health record from the Madison, Wisconsin-based Epic Systems Corporation] in terms of the way things are released to patients, in terms of the IT build, but it was not very onerous and was done a while ago. And from this point, it’s sort of accepted the way it works. At first, clinicians were reaching out to him, uncertain as to how to modify their interactions with their patients based on the fact that the patients were being shown their results before any consultation with them. “They were saying, ‘Hey, the patient has their results.’ That was more than a year ago.”
Drs. Datto and Buckley both note an important element in all of this: not only have the provisions of the Cures Act mandated the release of lab test results, pathology reports, and clinical notes, to patients; the emergence of consumer-accessible artificial intelligence (AI) tools in the last couple of years has fundamentally changed the landscape around the relationships and interactions between patients and clinicians, including pathologists. “It’s not just patients searching the Internet any longer,” Dr. Datto says. “It’s AI tools, which are surprisingly good, and are going to change the landscape of healthcare. And an informed patient is a huge asset; an informed patient helps us provide better, safer, higher-quality care. So I think it’s wonderful that patients have more access to information than ever before; the immediate-release element gives me pause. But it’s wonderful when a patient brings their own research into their conversation with their provider. It’s just a challenge that they have the information so fast.”
And all the changes impact pathologists along multiple dimensions, Dr. Buckley adds. “As a practicing surgical pathologist signing off on surgical pathology reports, using the latest molecular data, which is constantly evolving and making our reports increasingly complex—ten years ago we would have signed out a glioblastoma based on histology in one line; now, we list all of the supporting data, across multiple platforms, including fusion, next-generation sequencing, FISH, and we spend time integrating all of this into one diagnosis; it’s all gotten increasingly complex.” But, she immediately adds, “Even though the AI algorithms are potentially riddled with errors, the use of AI tools by the patients allows them to ask increasingly sophisticated questions, and we’re there to help answer those questions.”
The bottom line? Asked what he would say to fellow laboratory leaders and to practicing pathologists regarding how they might respond to the shifts in practice being brought about by the many changes, Dr. Datto, who is both, says firmly that “The more informed our patients are, the better we equip them to engage in their healthcare, and the better, safer, and higher-quality care we can provide.”
