Confusion Remains about ONC Information Blocking Rules, Even After Start Date

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Posted on April 8, 2021 by Kat Jercich

Nearly half of respondents to a recent survey said they were not familiar with the term “information blocking,” although 70% said they were aware of rules taking effect on April 5.

A poll taken this past month found that many healthcare industry stakeholders were still confused about federal information blocking rules – even though they were finalized more than a year ago and their new April 5 start date has been long publicized.

Now that the info blocking rules drafted by the Office of the National Coordinator for Health IT are in effect, the poll suggests that many healthcare organizations may still not meet or even understand basic interoperability requirements.

The survey – sent this past month to 4,000 clinical, technology and administrative leaders from provider, payer, IT and other organizations by the clinical and imaging data network Life Image – found that nearly half of the respondents were not familiar with the term “information blocking,” among other troubling data points.

“Our recent survey validates what Life Image has been witnessing across the healthcare ecosystem in terms of interoperability readiness,” said Life Image CEO and president Matthew A. Michela, in a statement.

“While the COVID-19 pandemic created massive challenges and delayed many interoperability initiatives, it also underscored the paramount importance of the final ONC rules for advancing patient care and driving innovation.”

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The information blocking provisions of the 21st Century Cures Act went into effect on Monday, with healthcare providers, developers of certified health IT and health information networks now required to follow a series of new requirements, with eight specified exceptions, for how their data must be shared. (This despite the fact that an enforcement mechanism has not been developed to ensure compliance.)

“Through the Cures Act, Congress defined ‘information blocking’ and established penalties for those who engage in practices that interfere with the access, exchange or use of ‘electronic health information’ (EHI),” wrote National Coordinator for Health IT Micky Tripathi and Deputy Coordinator Steven Posnack in an ONC blog post Monday.

“The law excludes practices required by applicable law(s) or if they meet an ‘exception’ established by the HHS Secretary,” Tripathi and Posnack continued.

Tripathi and Posnack explained that for the next 18 months, the information that can’t be “blocked” is limited to the data elements represented in the United States Core Data for Interoperability.

“This initial 18-month period and limited scope gives the regulated community time to grow more experienced with the information blocking regulation, including when and how to meet an ‘exception,’ before the full scope of the regulation’s EHI definition comes into effect,” they wrote.

Still, although 70% of participants in the Life Image survey said they were aware of the rules going into effect, up to half reported noncompliant practices – including charging patients fees to obtain records or sharing records via paper or CDs.

Nearly half of respondents said they had either not made any changes or did not know how to ensure their facility met requirements.

Two-thirds of the healthcare organization said they still used paper for healthcare data, and 32% used CDs.

And 39% did not know they risked civil monetary penalties for information blocking practices, and 15% currently charge $25 or more for patients to obtain records.

Nearly half – 48% – said they were not aware of practices that would be considered “information blocking.”

“ONC will continue to release education materials and communicate with stakeholders about the information blocking regulations,” wrote Tripathi and Posnack this week.

“We remain closely partnered with the HHS Office of Inspector General with respect to information blocking investigations and civil monetary penalties (for which a final rule is still pending) as well as HHS broadly when it comes to disincentives for health care providers,” they continued.

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The road to implementation of information blocking rules has been a winding one, with more than a year since the ONC issued the final regulations. (The COVID-19 pandemic certainly didn’t help: the deadline for compliance was pushed back multiple times.)

Still, confusion clearly endures. ONC has tried to make the process smoother, releasing new tools to help developers comply. Legal and policy experts have also chimed in.


“As ONC starts enforcement, organizations must prioritize deepening their knowledge of these mandates and implementing changes to adapt to the evolving landscape, or run the risk of incurring significant penalties,” said David Schoolcraft, partner and chair of the digital health group at the Ogden Murphy Wallace law firm, in a statement about the Life Image survey.