What Is Information Blocking?

According to the Office of the National Coordinator for Health IT (ONC), information blocking is a practice by an "actor" that is likely to interfere with the access, exchange or use of electronic health information (EHI), except as required by law or specified in an information blocking exception. The 21st Century Cures Act applied the law to health care providers, health information technology (IT) developers of certified health IT, and health information exchanges (HIEs)/health information networks (HINs).

This legislation also established two different "knowledge" standards for actors' practices within the statute's definition of "information blocking." For health IT developers of certified health IT as well as HIEs/HINs, the law applies the standard of whether they know or should know that a practice is likely to interfere with the access, exchange or use of EHI. For health care providers, the law applies the standard of whether they know that the practice is unreasonable and is likely to interfere with the access, exchange or use of EHI.

Exceptions

The ONC has created eight exceptions that outline activities that do not constitute information blocking by actors. These exceptions include:

• Exceptions that involve not fulfilling requests to access, exchange or use EHI
• Preventing Harm Exception
• Privacy Exception
• Security Exception
• Infeasibility Exception
• Health IT Performance Exception
• Exceptions that involve procedures for fulfilling requests to access, exchange or use EHI
• Content and Manner Exception
• Fees Exception
• Licensing Exception

View the ONC Information Blocking Exceptions Fact Sheet for more information about each available exception.

Information Blocking Enforcement Alert

In September 2025, The Office of Inspector General (OIG) and the Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) issued an enforcement alert to signal their intensified enforcement activity, dedicate additional resources, and take decisive action to detect and end information blocking.

Consequences for Information Blockers

Individuals and entities found to have engaged in information blocking may face several types of enforcement actions:

OIG may impose CMPs of up to $1 million per violation against:

• Health IT developers of certified health IT,
• Entities offering certified health IT,
• Health information exchanges (HIEs), and
• Health information networks (HINs).

OIG will prioritize enforcement where practices cause patient harm, significantly impact or impair a provider's ability to deliver patient care, are of long duration, or cause financial loss to Federal health care programs or other Government or private entities. Additional information about OIG's investigative process and OIG enforcement priorities may be found on OIG's information blocking page.

ASTP/ONC Certification Program Ban and/or Termination of Certification

ASTP/ONC can ban a developer of certified health IT that information blocks from the ONC Health IT Certification Program and may also terminate the certification of health IT involved in information blocking. ASTP/ONC intends to investigate and take swift action where warranted. Additional information can be found on ASTP/ONC's information blocking page.

CMS Health Care Provider Disincentives

Under the Cures Act, OIG may investigate and refer providers that engage in information blocking to the Department, which may impose appropriate disincentives. CMS has established specific disincentives that it may apply to the following providers:

• Eligible hospitals and critical access hospitals participating in the Medicare Promoting Interoperability Program;
• Merit-based Incentive Payment System eligible clinicians (including a group practice); and
• A Medicare Shared Savings Program accountable care organization (ACO), ACO participants, and ACO providers/suppliers.

Additional information on the application of disincentives for providers that have committed information blocking include:

• Disincentives Final Rule
• Disincentives Fact Sheet
• Disincentives Common Questions

Information Blocking Compliance FAQs

Interoperability and Information Blocking Regulatory Updates From the HTI-1 Final Rule

The ONC issued its final rule addressing Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) in late 2023, which continues to implement provisions of the 21st Century Cures Act and makes updates to the ONC Health IT Certification Program (Certification Program) with new and updated standards, implementation specifications and certification criteria.

The rule includes "first of its kind" transparency requirements for artificial intelligence and other predictive algorithms that are part of certified health IT. It also adopts the United States Core Data for Interoperability (USCDI) Version 3 as the new baseline standard within the ONC Health IT Certification Program (Certification Program) as of Jan. 1, 2026; revises certain information blocking definitions and exceptions to support information sharing; and implements the 21st Century Cures Act's requirement to adopt a Condition of Certification for developers of certified health IT to report certain metrics as part of their participation in the Certification Program.

Key Dates

• Dec. 31, 2025: Health IT developers must update and provide health IT systems to customers that conform to new standards.
• Jan. 1, 2026-2029: Health IT developers collect data for Insight Conditions Measures.

Visit the ONC website to learn more details from the HTI-1 Final Rule, including definitions and timeline.

ONC Releases HTI-2 Proposed Rule

The ONC released the Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule on July 10, 2023, building on the HTI-1 final rule released in 2023 and additional information blocking rules released by the Centers for Medicare and Medicaid Services and ONC in 2021.

Key provisions from the proposed rule include:

• New certification criteria for electronic health records (EHRs) designed to improve interoperability for health IT systems used by public health systems and payers.
• Updates to technology and standards for certified EHRs ranging from the capability to exchange clinical images (e.g., X-Rays) to the addition of multi-factor authentication support.
• Expansion of the USCDI data set.
• Updates to the Privacy, Infeasibility, and Requestor Preference Information Blocking Exceptions, and the creation of a new Protecting Care Access Exception.
• Alignment with EHR requirements and CMS Electronic Prior Authorization requirements.
• Revisions to electronic prescribing certification criterion to include real-time prescription benefit tools.

Access more information on the HTI-2 proposed rule on the ONC website.

Additional Resources and Tools

The ACC recommends the following resources from the American Medical Association (AMA), ONC and Centers for Medicare and Medicaid Services (CMS):

• Information Blocking: How Do I Comply and Where Do I Start? (AMA)
• Information Blocking FAQs (ONC)
• 21st Century Cures Act Interoperability Final Rule Overview (ONC)
• Who Qualifies as an Information Blocking Actor? (ONC)
• Qualified Information Blocking Exceptions (ONC)
• Interoperability and Patient Access Final Rule Fact Sheet (CMS)
• Health Care Provider Definition and Cross-Reference Table
• Information Blocking Exceptions
• United States Core Data for Interoperability