Results are back, without results: why the app never shows them

In a survey of 8,139 patient portal users, 95.7% preferred to receive their results immediately, even before a clinician had reviewed them. Yet 16.5% of people with abnormal results reported more worry, compared with 5.0% of people with normal results (odds ratio 2.71).^[1] A later study found that patients repeatedly refreshed the portal while waiting for 25.9% of results, and for 39.3% of high-sensitivity results, and that refreshing predicted messages to clinicians.^[2]

Preferences also depend on what is at stake. Most patients accept online release of low-stakes results, but a majority prefer to hear serious results, such as a cancer diagnosis, in person.^[3]

An emergency visit is different from a portal at home. Results arrive within hours, often while the patient is alone on a stretcher, and many are preliminary or part of a picture that only makes sense together. The clinician is minutes away and will explain them, in context, as part of a plan.

The closest published analogue to a test tracker, a digital care updates pilot, showed progress bars for lab, imaging, consults and disposition with no results and no health information, and deliberately waited 30 minutes before showing "complete" so clinicians could talk first. Satisfaction with lab turnaround was 86% with updates versus 55% without in the unmatched analysis.^[4]

"Back" uses a neutral information tone and a tray icon, never a green check or a celebration, because a result being back is not good news or bad news: it is a result. When the last one arrives, the screen says so in the same neutral tone and the timeline moves to the next step: seeing the care team again, with a usual time for this hour.

• No values, flags or interpretation anywhere: not on screen, not in notifications, and not in the words "normal", "fine" or "stable".
• Sensitive tests appear as "Additional test".
• Held results stay at "In the lab" or "Being read" until the clinician releases them.
• Notifications only at meaningful moments (first result in, all results in, next step) and always generic on the lock screen.

Not showing results also keeps EDFlow clearly on the right side of Health Canada's line between communication software and a medical device, and lets it coexist with the hospital's patient portal, which releases results under the hospital's own rules.^[5]