In the complex ecosystem of modern healthcare, the ability to seamlessly transfer patient data between providers, laboratories, and insurers—a process known as interoperability—is considered the bedrock of effective, patient-centered care. Yet, for years, the industry has struggled with "information blocking," a practice where health IT developers, providers, or health information exchanges (HIEs) intentionally interfere with the access, exchange, or use of electronic health information.
A new report released by the Office of the National Coordinator for Health Information Technology (ONC) offers a nuanced look at this landscape. While the overall prevalence of information blocking has declined significantly since 2019, the data reveals a persistent, stubborn core of "bad actors" who continue to disrupt the flow of vital medical data. As the federal government shifts from a stance of educational oversight to active enforcement, the healthcare industry stands at a critical juncture in the fight for digital transparency.
The Legislative Foundation: A Chronology of Accountability
The battle against information blocking did not begin with regulatory penalties; it began with a fundamental shift in legislative philosophy.
- 2016: The 21st Century Cures Act: Congress passed this landmark legislation with a bipartisan mandate: to foster innovation and ensure that patients and providers had unfettered access to health data. The Act officially prohibited information blocking, setting the stage for a new era of interoperability.
- 2021: Regulations Go Live: Following years of development, the final rules prohibiting information blocking officially took effect. This provided the legal framework necessary to define what constitutes "blocking" and what constitutes legitimate business practices.
- 2023-2024: The Push for Penalties: The Department of Health and Human Services (HHS) finalized rules detailing the penalties for both health IT developers and healthcare providers. These rules were designed to bridge the gap between policy and practice, ensuring that non-compliance carried real-world financial and professional consequences.
- 2025: The Year of Enforcement: The current administration has signaled a pivot toward aggressive enforcement. By issuing the first notices of nonconformity, the ONC has moved beyond warnings, signaling to the industry that the "grace period" for compliance is effectively over.
Supporting Data: The Declining Tide of Obstruction
The latest ONC data paints a picture of a system in transition. In 2019, before federal enforcement mechanisms were fully matured, more than 90% of health information exchange organizations reported experiencing at least one instance of potential information blocking. By 2025, that figure had plummeted to 71%.
This reduction suggests that the mere threat of federal oversight has encouraged many organizations to modernize their data-sharing practices. However, the qualitative nature of the remaining 71% is cause for concern. Among the HIEs that reported experiencing potential blocking, a significant subset noted that the behavior remains "routine."
Specifically, the report highlights the following trends:
- IT Developers as Primary Obstacles: More than 60% of HIEs identified developers of certified health IT as entities that sometimes or routinely hindered data flow in 2025.
- Financial Barriers: Fees and restrictive pricing models remain a major point of contention. While the number of exchanges reporting that IT developers use fees to block data dropped from 80% in 2019 to 60% in 2025, it remains a common tactic for limiting interoperability.
- The "Refusal" Problem: Approximately one in three HIEs reported that health systems and IT companies outright refused to share information, a practice that directly contradicts the patient-first mandate of the Cures Act.
Despite these hurdles, the analysis confirms that information blocking is no longer a widespread, systemic epidemic. Only 27% of exchanges reported that "most or all" IT developers engaged in blocking—a sharp decline from the 55% reported in 2019.
Official Responses and the Enforcement Gap
Despite the robust legislative framework, the federal government has historically been slow to pull the trigger on actual penalties. In March, Dr. Thomas Keane, the National Coordinator for Health Information Technology, testified before lawmakers, acknowledging that no formal penalties or enforcement actions had been levied to date.
This admission fueled frustration among some stakeholders who felt that the lack of teeth in the policy emboldened bad actors. However, Dr. Keane’s recent statements suggest a change in strategy. "The goal is not to punish the industry, but to ensure that patients are at the center of their own care journey," officials have noted.
The strategy is now two-pronged:
- Notices of Nonconformity: The ONC is currently issuing these notices to developers, acting as a "yellow card" in the world of digital health.
- Certification Revocation: For IT developers, the ultimate consequence is the loss of health IT certification. Without this certification, products are effectively ineligible for many federal contracts and may face significant reputational damage in the private market.
- Inspector General Oversight: The HHS Office of Inspector General (OIG) remains poised to levy heavy financial fines against firms that persist in blocking behaviors.
Implications for the Future of Healthcare
The persistence of a "small group of bad actors" in an otherwise improving landscape has profound implications for the future of digital health policy. The authors of the ONC report emphasize that the remaining instances of blocking are not merely clerical errors; they are often strategic choices made to protect market share or leverage pricing.
The "Deterrence" Strategy
Policymakers are now focused on the concept of deterrence. If the federal government can successfully penalize a few high-profile instances of information blocking, the ripple effect could be substantial. By making an example of organizations that refuse to open their data silos, the government hopes to convince the remaining "routine" blockers that the cost of non-compliance—both financial and reputational—far outweighs the short-term gains of data hoarding.
Impact on Patient Care
For patients, the implications are direct. Interoperability is not just an IT concern; it is a clinical necessity. When a patient moves from a primary care physician to a specialist, or from a local clinic to a major hospital system, the absence of a complete, accurate electronic record can lead to redundant testing, medication errors, and delays in diagnosis. Every instance of information blocking is, in essence, a delay in a patient’s potential recovery.
The Shift Toward Health Data Utilities
The report also highlights the growing importance of non-profit health data utilities and regional HIEs. These organizations are the front lines of the interoperability fight. As they continue to report their findings to the ONC, they provide the federal government with the "ground truth" necessary to refine regulations. The shift in data suggests that while the large-scale, industry-wide hurdles are being cleared, the next phase of the battle will be granular—targeting specific vendors and systems that have yet to fully embrace the spirit of the Cures Act.
Conclusion: A Turning Point
The journey toward a fully interoperable healthcare system is far from complete, but the trajectory is clear. The decline in information blocking from 2019 to 2025 proves that regulatory pressure, combined with a clearer definition of prohibited conduct, works.
As we look toward the remainder of the decade, the focus will undoubtedly shift from broad compliance to targeted enforcement. For the health IT industry, the message is clear: the era of hiding behind proprietary walls is ending. The organizations that thrive in the coming years will be those that view data not as a competitive asset to be guarded, but as a shared resource to be leveraged for the betterment of patient outcomes.
The ONC’s findings serve as both a success story and a call to action. While the industry should celebrate the progress made, the remaining 33% of HIEs still experiencing routine blocking serves as a stark reminder that the fight for transparency is far from over. The coming months will likely see the first of many enforcement actions, marking a definitive end to the "wait and see" approach of the past and the beginning of a strictly enforced, transparent future for American healthcare.
