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Achieving an interoperable healthcare system has been a long-term goal in the United States for many years. Having healthcare workers with electronic access to patient data across locations offers many benefits that can improve patient care. In addition, patients with access to their healthcare data are more engaged in their healthcare plan, which can lead to better chronic disease maintenance and outcomes.

Yet, there are significant barriers to achieving shared electronic data. One obstacle has been the blocking of information due to competitive situations and misplaced incentives. A 2021 survey of health information exchanges (HIEs) found the following percentages of HIE respondents reported that EHR vendors and health systems still engage in information blocking:

  • 55% EHR vendors
  • 30% health systems1

One step toward sharing electronic patient data is to have that data available to the patient via a secure patient portal. With a patient portal, laboratories can play their part and enable immediate access to patient test results.

21st Century Cures Act

To facilitate healthcare’s move toward interoperability and the free exchange of health information, in 2016 the Office of the National Coordinator (ONC) introduced the 21st Century Cures Act. Section 4004 of that act addresses information blocking, defining it as:

“A practice by a health care provider, health IT developer, health information exchange, or health information network that, except as required by law or specified by the Secretary as a reasonable and necessary activity, is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information.”

The act also empowers the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) to investigate claims of information blocking and assert penalties up to $1 million per violation.

Cures Act Final Rule

In May of 2020, the Cures Act Final Rule was released to implement the interoperability requirements outlined in the Cures Act. The rule intends to give patients and healthcare providers secure access to health information. Its goals include:

  • To increase innovation and competition for new applications that provide patients with more healthcare choices
  • To adopt standardized application programming interfaces (APIs) to allow secure, easy access to structured electronic health information (EHI) via smartphone applications
  • Require that patients can electronically access their EHI at no cost
  • Supports exchange of EHI through implementation of information blocking provisions

Information Blocking

Information blocking means interfering with the exchange of EHI. Information blocking comes in many forms, such as restricting patient access to their healthcare data, restrictions on authorized access, and excessive fees to export data when switching information systems.

HTI-1 Proposed Rule

In April of 2023, the HHS ONC released a proposed rule called the Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) Proposed Rule. The HTI-1 Proposed Rule updates exceptions in the information blocking regulations to further support information sharing and includes more provisions related to health information technology and certification.

Legislation Timeline
December 2016 21st Century Cures Act
May 2020 Cures Final Act Rule
April 2023 HTI-1 Proposed Rule


Orchard® Patient Portal

The Information Blocking Rule intends to give patients greater and, at times, immediate access to their health information. One way that laboratories can comply and become part of an interoperable healthcare system is to provide patients with immediate electronic access to their lab results via a patient portal. The Orchard Patient Portal can improve patient satisfaction and engagement and become a part of your organization’s tool kit for interoperability.


  1. Everson J, et. al. Information blocking remains prevalent at the start of 21st Century Cures Act: Results from a survey of health information exchange organizations. Journal of the American Medical Informatics Association. 2021;28(4)727–732. https://doi.org/10.1093/jamia/ocaa323.