At a time when data blocking among healthcare actors represents a significant challenge in the industry, Audacious Inquiry looks forward to the new ONC rules which should foster greater access to data and improved interoperability.


What is the Info Blocking Rule?

On March 9th, 2020, ONC and the Department of Health and Human Services (HHS) released a set of rules addressing how healthcare providers, payers, and health IT companies must share data to enable improvements in information sharing and patient access to their health data. One of the rules, required by the 21st Century Cures Act, addresses information blocking, a problematic practice by some healthcare “actors” — providers, health IT developers, health information exchanges, and health information networks — that is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information. CMS also released a rule that requires hospitals to send real time notifications to community providers when a shared patient is seen at the hospital.

The new info blocking rule defines and prohibits the practice of information blocking, although it does outline eight exceptions. The upheaval in healthcare caused by the COVID-19 pandemic has resulted in the implementation of the rule being delayed. Last week, ONC released the interim final rule and pushed back the information blocking deadline until April 5, 2021. When it does go into effect, it will be a significant step in what is a long, ongoing journey toward seamless data sharing across the healthcare industry. We strongly support the rule and believe the delay is understandable given the significance of the changes and the time the healthcare industry needs time to implement the significant new requirements (while also continuing to respond to the ongoing COVID-19 pandemic).

Ultimately, the rule aims to shift the paradigm for healthcare entities that handle data from “we may share data” to “we must share data unless we have a very good reason not to.”

Supporting the Pursuit of Seamless Care Coordination

At Audacious Inquiry, we support this shift in thinking. Our goal is to make healthcare data sharing across health systems and public health entities more seamless to enable better care coordination. Patients, health plans, and providers need to have access to health data so they can use it to attain better healthcare outcomes, improve patient and member experience, and drive down total cost of care. But that is not a problem technology alone can solve —  policies, incentives, and business practices need to lead, or at least be a close follow. Audacious Inquiry has over 60 million patients subscribed across our customers, 2,500 subscribing organizations, 1000 data senders, and sends out over 30 million notifications a month.

The history of our healthcare system is rife with data sharing difficulties and all of the downstream problems that stem for those challenges; really basic challenges like a safe transition from a hospital stay back to the home. But, while there has been important improvement over the past decade, we can still point to far too many healthcare encounters and transitions of care that don’t benefit from fluid information sharing. The only way to achieve improved interoperability, where healthcare entities and systems are in constant communication, is to navigate this highly-regulated terrain with experience, relationships and most importantly, trust — all in addition to the continued Pursuit of ever better technology solutions.

Requirements and Advantages of the CMS Conditions of Participation

Fortunately, we’re on the cusp of a data sharing revolution in healthcare — the standards and technology largely exists and the incentive structures are broadening to make sharing data seamless between organizations, and now we are beginning to see policies that make that a reality.

These rules are moving us in the right direction, and when paired with the CMS e-notification rule announced in March as well, they will spur real progress. Starting April 30, 2021, a new CMS Condition of Participation (CoP) requires Medicare and Medicaid participating hospitals (including psychiatric hospitals and critical access hospitals (CAHs)) to send notifications to certain providers of a patient’s admission, discharge, or transfer. Specifically, hospitals must send notifications of a patient’s inpatient, emergency department, and observation admission/registration, as well as transfer and discharge (notifications for transfers within an inpatient admission are not required but must occur from outpatient to inpatient).

The new CMS Condition of Participation electronic notification requirement for hospitals and ONC’s information blocking requirements will significantly advance efforts to ensure health data flows when and where it is needed. Knocking down barriers to accessing, exchanging, and using data for patients, providers, and others with an authorized purpose for the data is a critical part of driving real change in the status quo.

These changes will take time to implement and even longer to have real-world impact. There will be complex challenges as this all unfolds, but these new rules are a promising step forward. At Audacious Inquiry, we’re committed to navigating them with our partners. At a time when data blocking among healthcare actors represents a significant challenge in the industry, Audacious Inquiry looks forward to the new ONC rules which should foster greater access to data and improved interoperability.

If you have any questions we can be of assistance with, please feel free to reach out to our team of experts at Audacious Inquiry:



Scott Afzal | President
Scott Afzal is the President of Audacious Inquiry and a Strategic Advisor for CRISP, a health information exchange serving Maryland, DC, and West Virginia. Across both roles, Scott establishes organizational growth strategies, delivery system reform initiatives, and technology solutions to support value-based payment models and connected communities. Through Audacious Inquiry, Mr. Afzal advises other states, health systems, and health information organizations on health information exchange (HIE) implementation approaches and sustainability strategy. Previously at CRISP, Mr. Afzal served as the Program Director for the organization’s first 10 years; he managed the roll-out of CRISP’s HIE network while leading the development of new service offerings. Scott is a noted speaker on HIE, having presented at regional and national health IT conferences. Prior to joining Audacious Inquiry, he served as a consultant with Accenture, Inc. out of their New York City office. Mr. Afzal holds a Bachelor of Science in Business Administration (BSBA) from Bucknell University.