How to Prevent Information Blocking (the Easy Way)

Patient care is at its best when it involves seamless coordination among multiple providers with different expertise. However, there can be challenges with sending and receiving patient information with another practice, especially if their technology isn’t equipped to facilitate smooth collaboration. To keep provider communication flowing, encourage data sharing from one practice to the next, and keep patients more informed about their care, the federal government created regulations around information blocking and other EHR mandates.

These regulations have generated many positives for providers and patients — but they can be challenging to navigate. It’s important to fully understand what information blocking in healthcare is, the specific regulations to prevent it, and how your practice can maintain compliance. 

• What Is Information Blocking?
• The History of Information Blocking
• Information Blocking Exceptions  
• Information Blocking Disincentives and Penalties
• Submitting Information Blocking Claims
• How to Ensure Your Practice Complies with Information Blocking
• The Future of Information Blocking Prevention 

What Is Information Blocking?

Information blocking occurs when an "actor" – such as a specialty practice – interferes with access, exchange, or use of electronic health information. The 21st Century Cures Act prohibits healthcare providers, health IT developers of certified health IT, or health information exchanges/networks from information blocking, unless the circumstances are required by law or covered by an exception.

Preventing information blocking isn’t a “nice-to-have” feature, but a federal requirement that impacts healthcare providers and healthcare IT companies. Both have a responsibility to ensure it’s easy to share information with patients and other healthcare providers.

Along with being a regulatory standard your practice must follow, preventing information blocking benefits your practice, when prevention measures are integrated the right way. Investing in a patient portal so information is accessible to patients, for example, can improve patient pay yields by up to 8%. 

Who Does Information Blocking Apply To?

All healthcare providers must be compliant with the 21st Century Cures Act and its information blocking regulations. The act defines four responsible parties for preventing information blocking:

• Medical practices
• Health information companies that provide EHRs, PM software, or any other health IT technology
• Health information sharing networks
• Those who offer but don’t develop health information technology — a group who the Office of the National Coordinator for Health Information Technology (ONC) refers to as “Offerors of Certified Health IT.”

As a medical practice, you can accommodate most of the act’s requirements by working with an EHR vendor that is Cures Act-compliant. But there's more work to be done. 

Your practice should keep patient information private, unless it is requested by the patient or by another healthcare provider. If a patient starts seeing a dermatologist, for example, that dermatologist may request protected healthcare information from the patient’s primary care doctor. That doctor must quickly share the patient’s data for purposes of care coordination. 

A practice may be found at fault for information blocking if they take an unreasonable amount of time to transfer requested documents or knowingly make it difficult for authorized parties to “access, change, or use electronic health information.” The requesting healthcare provider doesn’t have to provide written consent from the patient, just demonstrate that they are providing treatment. 

The History of Information Blocking

Before the Cures Act, practices could choose not to send information to other providers. This led to uncoordinated care and worse outcomes for patients. 

An ophthalmology practice, for example, could request patient information from a primary care provider that would inform treatment, but there weren’t legal regulations around when or how the primary care provider would share that patient’s files.

To ensure care was cohesive and high quality, the U.S. government banned information blocking as part of the larger 21st Century Cures Act.

Information Blocking Exceptions 

Under the 21st Century Cures Act, most instances of information blocking should be avoided, though there are some exceptions. If, for example, a health IT company is performing maintenance and cannot share a patient’s medical information during the maintenance, that is not considered information blocking. Information blocking exceptions include:

• Preventing Harm: If there is concern harm may be caused to a patient, your practice may decline sharing information.
• Privacy: If it’s believed the healthcare provider won’t protect private patient information, the data doesn’t have to be shared. This exception also exempts your practice from sharing if the other practice’s EHR does not comply with HIPAA.
• Security: If data may be insecure with the other practice, your practice shouldn’t share it.
• Infeasibility: If the information sharing request is infeasible, your practice may be exempt.
• Health IT Performance: If health information is temporarily offline due to health IT updates or maintenance, it’s not considered information blocking.
• Content and Manner: Your practice is given some leeway in the content shared and manner in which it is provided for a request, without being considered information blocking. 
• Fees: Charging fees in response to requests for information exchange is not considered information blocking.
• License: A vendor can license interoperability elements to protect information, specifically around how they store information.
• TEFCA: If both the requestor and requestee are part of the Trusted Exchange Framework and Common Agreement (TEFCA) network, they can exchange information through that network and it will not be considered information blocking.

There are nuances to these exceptions, and it’s important to choose an EHR provider with a customer support team that can help you navigate these exemptions.

When Panacea Eye Center switched EHR providers, they were glad to have the support of Cures Act-compliant software and a responsive team that could answer any questions about the act’s nuances and exceptions. 

“I can always get in touch with someone. Everyone’s always friendly and answers all questions from my staff and me,” says Dr. Sarah Khodadadeh of Panacea Eye Center. “Everyone’s always following up asking if we need anything.”

Information Blocking Disincentives and Penalties 

What happens if you’re found to be information blocking? The penalty depends on what type of offender you are. Health IT developers, offerors, and healthcare information networks are subject to civil monetary penalties of up to $1 million dollars per violation. 

Healthcare providers face disincentives. These were set forth in 2022 by the U.S. Department of Health and Human Services (HHS) and confirmed earlier this year. Disincentives include:

• Potential penalties of up to 100% for services covered by Medicare or Medicaid if a violating party doesn’t use an EHR.
• If a provider is an Accountable Care Organization (ACO), ACO participant, or ACO provider, they may not be able to participate in the Medicare savings program for at least one year.
• MIPS-eligible clinicians may see scores as low as zero.

For many practices who serve patients covered by Medicare, MIPS penalties and reimbursements can have a significant impact on business performance. Before the Dermatology Associates of West Texas switched EHR providers, they had been struggling to earn any MIPS bonuses. After switching, the new system was more effective at following regulations, including those around information blocking, which led to the practice getting a MIPS reimbursement for the first time. 

“We were always scoring just neutral enough to avoid negative adjustments. Now, we are receiving that incentive money and we want to keep that going,” said Kitty Arp, office manager.

Submitting Information Blocking Claims

Let’s say you run a plastic surgery practice and need to get patient information from the dermatologist and a patient’s primary care provider. The dermatologist provides the information quickly, but it’s been months since your request and the primary care provider hasn’t sent any information. In this scenario, you can submit an information blocking claim. 

How Do I Submit a Claim?

The first step to submit a claim is to access the ONC’s information blocking portal. The form in the portal will prompt you to share a description of the event and attach evidence of information blocking. It’s possible to fill the form out anonymously or with your name and practice details.

Note: The ONC encourages those making claims to not send any personal information or actual medical records. 

What Happens When a Claim Is Submitted?

Once a claim is submitted, ONC determines if the claim is against one of the four parties that information blocking applies to:

• Healthcare providers
• Healthcare IT developers
• Healthcare IT offerors
• Healthcare information networks

From there, the ONC can investigate and determine if a healthcare practice is subject to appropriate disincentives or if one or more of the other three groups owe civil monetary penalties.

How to Ensure Your Practice Complies with Information Blocking

There are easy ways to ensure your practice complies with information blocking regulations. Here are three of the most effective:

Train Staff on Technology and File-Sharing

Your staff are the backbone of your practice, and they should be properly trained on any healthcare technologies – such as a Cures Act-compliant EHR – that can help stop information blocking. Ideally, this training should cover how to use healthcare software and share files with patients or requesting practices. 

Depending on which EHR provider you choose, they may even provide training for your staff. 

Dr. James Murphy of Scarsdale Ophthalmology Associates reflects on the training provided by his EHR provider, “If Nextech is being implemented at a practice, you can have the availability of live support staff there. They have a great way to customize that onboarding experience.”

Review Policy Updates

Regulations around information blocking are evolving. The most recent policies around official disincentives, for example, were finalized earlier in 2024. And the HHS has stated they may further develop these disincentives, indicating there’s a need to stay updated on policy changes.

There are two ways to stay in the loop on information blocking: 

1. Have a staff member who regularly reads up on policy updates as part of their role. 
2. Partner with an EHR provider that consistently monitors updates on and provides necessary training.

Invest in the Right Health IT Solutions

When evaluating technology platforms, it’s important to ensure any EHR or practice management software you consider is compliant with federal regulations such as the Cures Act and HIPAA. But there’s more to look for than just compliance.

Alongside regulatory compliance, look for health information technology and software that:

• Is designed for your specialty, such as an ophthalmology EHR, 
• Includes staff training,
• Is committed to updating their system as new features and technologies become available. 

Dr. Kerry Solomon reflects on how his practice knew their new EHR provider was right for them. “The same day we went live with Nextech, we were able to maintain our same patient load — never seeing a lapse in patient volume and never having to sacrifice patient care,” Solomon said.

The Future of Information Blocking Prevention 

Health information technology is constantly evolving, and there have been significant recent advances in areas such as artificial intelligence and data sharing capabilities. As a result, your practice should feel confident that there is a modern technology solution on the market that can complement your strategy for simplifying the entire process of securely sharing and providing access to information.

For example, AI can be used to develop new patient education tools, and interoperability solutions are becoming more efficient with each passing year. Your practice also could partner with an EHR company that hosts software on cloud-based servers, which offer enhanced security and make data sharing easier.

What Are the Barriers to Healthcare Information Systems?

The main barriers to accessible health information systems are human errors when trying to input or share a patient’s medical information; technical barriers, such as not having a Cures Act-compliant EHR; and organizational barriers, including a lack of a systematic process for storing patient information. 

Next Steps

To make it easy to be Cures Act compliant, start by reflecting on the three ways to stay compliant (train staff, review policy updates, invest in the right health IT) and identify any areas where you could improve.

Nextech's specialty-specific technology platform with EHR, patient portal, and practice management software are HIPAA- and Cures Act-compliant and are supported by our in-house team of compliance and regulatory experts and thorough training for your staff. Request a demo today.

About the Author 

Courtney Tesvich is a registered nurse with more than 20 years in the healthcare field, 15 of which have been focused on quality improvements and regulatory compliance. She also holds an MBA and a master’s in jurisprudence in Health Law and Corporate Compliance. As VP of Regulatory and Compliance at Nextech, Courtney is responsible for ensuring that Nextech’s products meet government certification requirements and client needs related to the regulatory environment, as well as monitoring overall corporate compliance.