What Happened?

Your health records should follow you from one doctor to the next, but a new federal report says the systems meant to make that happen still has major gaps. A new Congressional Research Service (CRS) report found that efforts to make digital health information work across the U.S. health system have spanned decades and still face four barriers: uneven adoption of health technology, information blocking, gaps in the Trusted Exchange Framework and Common Agreement, and governance that lags behind technological change. The report says many obstacles still remain in digital health information interoperability, and it identifies four barriers: uneven adoption of health IT, information blocking, gaps in the Trusted Exchange Framework and Common Agreement (TEFCA), and governance that lags behind technological change.

At least five laws and 18 regulations have shaped the current framework, starting with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and running through the 21st Century Cures Act, which banned information blocking and authorized a voluntary national data-sharing network called the Trusted Exchange Framework and Common Agreement (TEFCA).

Why Does it Matter to Me?

Nearly every hospital has adopted electronic health records, with 100 percent of nonfederal acute care hospitals reporting certified use in 2024, and 91 percent of office-based physicians using a certified system. But only 19 percent of surveyed behavioral health facilities reported participating in a health information exchange (HIE), and health information organizations cited public health agencies' lack of funding and inability to receive or process messages as major barriers to connectivity.

Since April 2021, the Office of the National Coordinator for Health Information Technology (ONC) has received 2,389 portal submissions, of which 2,279 appeared to be possible information blocking claims, with most coming from patients and most concerning health care providers. The report notes that ONC currently lacks authority to issue binding rulings on whether a specific situation counts as information blocking, and that only Congress can grant that authority.

Both Sides, Now

A proposed rule called HTI-5, published Dec. 29, 2025, would remove 34 of the 60 existing health IT certification criteria and revise seven others. Supporters say the change reduces compliance burdens on providers. The CRS report says the proposed rule drew mixed reactions from stakeholders who support burden reduction but worry about losing privacy, security, and artificial intelligence transparency requirements.

Critics of a deregulatory approach point to a U.S. Government Accountability Office (GAO) report finding that early in the COVID-19 pandemic, poor IT interoperability forced hospitals and health officials to enter data manually into multiple systems, hampering timely information sharing. A separate GAO report found that small and rural providers were less likely to have the financial and technological resources needed to participate in or maintain electronic health information exchange capabilities.

What Happens Next?

TEFCA, which went live in December 2023, had grown to 11 designated qualified health information networks and more than 21,000 live organizations, with the Department of Health and Human Services announcing in June that more than 1 billion records had been exchanged. The CRS report identifies trust, not technology, as the central remaining obstacle, citing Epic's January lawsuit against Health Gorilla as an example of the tensions that persist.

As of now, no vote on that authority is scheduled. The CRS report offers Congress options that range from targeted funding and new mandates to allowing the Office of the National Coordinator for Health Information Technology to continue its existing efforts.

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