- The share of health information exchange organizations reporting instances of potential information blocking dropped from more than 90% in 2019 to 71% in 2025, according to new data from the Office of the National Coordinator for Health Information Technology — a meaningful improvement over six years that the ONC attributes partly to the regulatory framework established by the 21st Century Cures Act (2016) and the information blocking rules that went into effect in 2021; however, the improvement masks a persistent hard core of bad actors: the share of exchanges routinely experiencing blocking has remained unchanged over the entire period.
- Health IT developers — not hospitals — are the primary information blockers: more than 60% of health information exchanges said IT developers sometimes or routinely hindered health data flow in 2025, compared with about half of hospitals and health systems; approximately 60% said IT developers used fees and pricing to potentially block data sharing, down from over 80% in 2019; the pattern suggests that proprietary data lock-in remains a business model for a subset of health IT vendors despite federal prohibition.
- The enforcement picture has been weak: the Trump administration has issued notices of nonconformity to potential information blockers, but as of March 2026 the federal government had not levied any penalties or enforcement actions despite the rules having been in effect since 2021 — National Coordinator Dr. Thomas Keane told lawmakers in March that action was coming, with IT developers facing potential loss of ONC health IT certification and fines from the HHS Office of Inspector General.
- The ONC’s analysis carries a policy implication: since most information blocking is concentrated among a small group of repeat offenders (“fewer specific entities may be engaged in potential information blocking, and some share of those entities are consistently doing so routinely”), targeted enforcement against a small number of high-frequency blockers could have an outsized impact on overall data exchange — a precision enforcement strategy rather than broad regulatory pressure.
What Happened?
The ONC released new data showing improvement in health information blocking trends from 2019 to 2025: the share of health information exchanges reporting any potential blocking fell from over 90% to 71%. But the analysis also reveals that routine blocking by a minority of IT developers and hospitals has not declined — the same roughly one-third of exchanges that experienced routine IT developer blocking in 2019 still experienced it in 2025. The federal government has yet to levy any fines or enforcement actions despite rules that have been in effect for five years.
Why It Matters?
Information blocking is not a technical problem — it is a business model problem. Health IT vendors that have built proprietary data ecosystems have financial incentives to make it difficult for patients and providers to move data to competing systems. The 21st Century Cures Act tried to address this by prohibiting blocking and establishing a penalty regime, but five years of non-enforcement have undermined deterrence. The consequence is real: patients whose records are fragmented across systems that don’t communicate face worse care coordination, duplicate testing, and medication errors that more seamless data exchange would prevent. The concentration of blocking among IT vendors — rather than hospitals — points to the EHR and health IT industry as the primary target for enforcement action.
What’s Next?
The ONC and HHS OIG have signaled that enforcement is coming. The first actual penalty levied against an information blocker — whether an IT developer losing its ONC certification or a firm being fined by the OIG — will be the signal that the regulatory framework has teeth. Watch for whether the Trump administration’s stated commitment to information blocking enforcement materializes in specific actions against named vendors before the end of 2026. The TEFCA (Trusted Exchange Framework and Common Agreement) rollout, which the ONC is separately accelerating, provides the interoperability infrastructure that makes blocking harder and less valuable as a competitive strategy.
Source: Healthcare Dive
