Information Blocking

Information Blocking
Digital Contact Information into NPPES
Releasing Eight Clinical Note Types

What is Information Blocking?

In the 21st Century Cures Act, The Office of the National Coordinator (ONC) for Health Information Technology (HIT) released requirements regarding the prevention of “information blocking.”  Information blocking refers to anything that restricts sharing and accessing electronic health information (EHI) among physicians and patients. Physicians have until April 5, 2021 to comply with certain provisions related to information blocking. The initial deadline was in November 2020, but due to COVID-19, an extension was granted.

The benefits of these information blocking provisions:

  • Enhances care coordination among physicians.
  • Facilitates secure sharing of patient information.
  • Reduces administrative burden.
  • Provides patients with convenient access and transparency to their health information and increases patient engagement.

Note: Physicians with paper records are exempt from the information blocking requirements since this only involves electronic patient health information.

Requirement: Upload Digital Contact Information into NPPES
Physicians must have their digital contact information (direct address and/or an Application Programming Interface endpoint) from electronic health records listed in National Plan and Provider Enumeration System (NPPES)The direct address is not the same thing as an email address but looks very similar to one (ex. To learn more about a direct address, refer to the Direct Address Q&A.

How to Meet this Requirement

  1. Find direct address or API endpoint by contacting the EHR vendor, HIE, or another certified entity with direct messaging capability, such as a Health Information Service Providers (HISPs).
  2. Login to NPPES with User ID and Password to upload this information.
  3. Enter direct address or API endpoint in a field for the digital contact information in a section related to Health Information Exchange.


There are no penalties at this time for noncompliance. However, this requirement needs to be completed immediately, as CMS will publicly report a list of physicians who have not complied at the end of the first quarter.

Requirement: Starting April 5th, patients and physicians need to be given immediate electronic access to significant portions of the patient’s electronic health information upon request.

Patients should be able to access the eight types of clinical notes in their patient portal.

Note: In the future, it is anticipated that ONC will require “open notes”. This means that providers would be required to automatically release all clinical notes when requested, and not just these eight note types. As ONC continues to move towards EHI transparency, physicians should prepare for “open notes” if they are not already releasing them.

How to Meet this Requirement

The physician is responsible for asking the EHR vendor on their preparations for complying with the information blocking rules. To ensure that the requirement is met, patients should be able to access this health information electronically without charge and without delay.

To comply, physicians and practices should:

  •       Check with their EHR vendor about their capabilities to allow the release of the eight clinical note types in the patient portal to ensure that patients can access them.
  •       Ensure EHR vendor has a plan in place to distinguish these 8 clinical note types and other EHI in the EHR for purposes of responding to EHI requests.
  •       Ask how EHR vendor will help determine and document the use of exceptions (see “Exceptions” section below).
  •       Evaluate whether existing practice policies about accessing EHI reflect the ONC Final Rule requirements and ensure that the practice staff understands how to approach EHI requests.


Physician penalties for noncompliance will be decided in future rulemaking. ONC has the functionality on its website to report information blocking.


As soon as the physician’s office receives an electronic copy of results and reports, these notes must be available to patients. However, there are eight exceptions that offer healthcare providers certainty that when their practices meet the conditions of one or more exceptions, such practices will not be considered information blocking. For example, a physician who withholds a medical record to protect a patient from harm would not be considered information blocking.

Refer to this resource for Information Blocking Exceptions set by the Office of the National Coordinator for Health Information Technology (HIT).

Additional Resources