Why health data still gets stuck despite new rules

Health information blocking has declined overall yet persists as an issue

Health data exchange is improving, but it’s not where it needs to be yet. Since the federal government introduced stricter rules in 2021 to stop information blocking, we’ve seen visible progress across the healthcare ecosystem. Fewer organizations are getting caught in data silos, and more systems are beginning to sync. However, certified health IT developers still hold too much control over the flow of information. They influence how data moves and who has access, which creates needless friction across hospitals, labs, and networks trying to work together.

These developers use tactics that slow progress, raising fees, writing restrictive contracts, and designing platforms that make it hard to connect with other systems. Regulations have narrowed these gaps, but practical and financial barriers remain. The issue now is about the will to change outdated business structures that favor control over collaboration.

For executives, this means strategic attention is needed beyond compliance. It’s about setting aggressive expectations with technology partners and demanding interoperability as a core feature, not an afterthought. Healthcare relies on seamless data flow for speed, accuracy, and trust. Companies that get this right will lead the digital health transformation, while others will lag behind in inefficiency and cost.

According to the Office of the National Coordinator for Health IT (ONC), the percentage of health information organizations (HIOs) reporting at least one incident of potential information blocking dropped from 91% in 2019 to 71% in 2025. The trend is positive, but a lingering 71% still points to a system with friction built into its foundations.

Certified health IT developers are identified as the most common source of potential information blocking

Developers are still the main bottleneck in the health data ecosystem. Health information organizations have repeatedly identified certified health IT developers as the top source of data exchange obstruction. The problem is structural. Many developers still price their services in ways that make open data exchange prohibitively expensive or technically complex. These are not technical limitations, they are competitive behaviors designed to retain control of valuable health data and the networks built around it.

While the frequency of such practices is falling, developers remain more often linked to data-blocking than hospitals, networks, or even other information organizations. Common methods include imposing high service fees, creating technical hurdles that restrict integration, and enforcing contracts that explicitly limit data sharing across systems. Each barrier undermines the purpose of interoperability.

Executives should approach this as both a technical and strategic issue. The leadership opportunity lies in pushing vendors toward open data exchange, favoring certified systems that comply with interoperability standards, and ensuring internal data management teams have leverage to negotiate from strength. The broader market is moving toward open systems. Those that resist will soon find themselves out of step with policy, technology, and customer expectation.

In 2025, 62% of HIOs reported that certified health IT developers were behind blocking behaviors. That figure overshadows hospitals and health systems (49%), national networks (20%), and other HIOs (7%). Even with improvement over time, pricing-related blocking dropped from 81% in 2019 to 59% in 2025, the persistence of artificial barriers (40%) and restrictive contract language (30%) shows this issue is far from solved.

The takeaway for any executive in healthcare or health IT is clear: the era of proprietary restriction is closing. The next competitive edge lies in building trust through open, secure, and efficient data flow, because transparency, not control, will shape the next generation of healthcare systems.

Hospitals and health systems apply strategic affiliations as a method to block information exchange

Hospitals and health systems are still using structural advantages to control how data moves across networks. The issue isn’t just about outdated technology, it’s about how ownership and affiliations create quiet barriers to collaboration. Health Information Organizations (HIOs) report that some hospital groups use their business alignments or corporate structures to restrict the open exchange of data, protecting internal networks and partnerships while slowing progress toward seamless interoperability.

Even though these practices have declined slightly in recent years, they remain a significant obstacle. According to data from the Office of the National Coordinator for Health IT (ONC), 42% of HIOs in 2025 said hospitals and health systems used ownership or affiliation strategies to limit data sharing. That figure was only marginally lower than 45% in 2023, indicating that structural barriers remain deeply embedded.

For executives, the challenge lies in balancing competitiveness with collaboration. Keeping valuable data internal may seem beneficial in the short term, but it stifles innovation and reduces the system-wide value of digital transformation. The future of healthcare data management depends on interconnectivity, data needs to move quickly, securely, and across organizational boundaries. Forward-thinking leaders can set the tone by prioritizing partnerships that enable interoperability and by reviewing data-sharing agreements to remove redundant or outdated restrictions.

Strategic openness doesn’t call for abandoning control over sensitive information; it requires rewriting how trust and access are managed. Decision-makers who take an active stance on breaking down internal and systemic silos will gain operational fluidity, stronger partnerships, and measurable performance advantages in care delivery and analytics.

Although information blocking practices are increasingly limited to a smaller group of actors

The ONC’s data shows that information blocking is narrowing in scope, but its effects are as strong as ever. Most Health Information Organizations (HIOs) report that blocking now comes from a smaller number of developers and hospitals, yet these actors have an outsized influence. Their practices continue to slow national progress on interoperability by disrupting connections among hundreds of networks. This is no longer a widespread behavioral issue; it’s a problem of concentrated resistance from a minority of players with entrenched interests.

From a data governance perspective, this trend is critical. It means regulators and health executives can now direct their focus more precisely. Broader industry penalties or universal compliance programs are less effective when the challenge is tied to a small group of repeat offenders. Strategic policy pressure, market-driven incentives, and more transparency in interoperability metrics can help isolate and correct these remaining sources of friction.

In 2019, 55% of HIOs said that some or most developers engaged in blocking behavior. By 2025, that number fell to 27%. For hospitals and health systems, the figures remained relatively consistent, 24% in 2019 and 28% in 2025. This data shows progress but also signals an uneven landscape where improvement in one area can be undermined by stagnation in another.

Business leaders should see this concentrated problem as an opportunity. Targeted oversight and partnership adjustments can deliver major interoperability gains without industry-wide disruption. Those who can identify and correct these small but powerful points of resistance will be the ones to unlock faster, more efficient, and transparent data flows across the healthcare ecosystem. This, in turn, lays the groundwork for large-scale digital growth and greater patient-focused innovation.

Even limited instances of information blocking significantly impair overall health data exchange

The health data network depends on consistency and trust. Even when only a few organizations engage in information blocking, their actions compromise the reliability and efficiency of the entire system. Health Information Organizations (HIOs) continue to report that small clusters of resistant actors create large-scale inefficiencies, introducing delays and data gaps that affect analytics, care coordination, and system-wide decision-making. The result is slower progress across areas designed to benefit from automation and connected care.

The data from the Office of the National Coordinator for Health IT (ONC) underscores this reality. Around one in five HIOs reported that data-blocking behaviors had a major impact on how information moves between entities. These effects are not isolated, they ripple across networks, influencing how quickly and accurately healthcare data can be used for patient outcomes, research, and regulatory compliance. As a result, even limited interference has measurable operational and economic costs for the wider healthcare ecosystem.

Executives should approach this as a top-level performance issue, not a compliance checkbox. Removing information-blocking behaviors, even among a few organizations, can deliver significant efficiency gains, enhancing communication between care providers and reducing redundant efforts in data management. The leadership opportunity lies in setting higher expectations for data transparency and taking decisive action to integrate systems, manage vendor accountability, and strengthen cross-organization collaboration.

A healthcare system operates best when data moves without obstruction. Every dataset, interface, and protocol contributes to the precision and speed of clinical and business decisions. Reducing residual information-blocking practices can therefore unlock operational momentum and raise the value of existing digital infrastructure. By ensuring exchange systems are fast, accurate, and open, executives can secure a long-term foundation for scalable innovation and improved patient outcomes.

Main highlights

• Health data exchange is improving but still constrained by developer practices: Information blocking has declined, yet developers remain central to ongoing barriers. Leaders should push for greater accountability in vendor contracts and enforce interoperability as a non-negotiable performance standard.
• Certified health IT developers remain the primary bottleneck: Developers’ pricing models, technical barriers, and restrictive contracts continue to hinder open data flow. Executives should demand transparency on integration costs and align with partners committed to open standards.
• Hospital affiliations and ownership structures still restrict data sharing: Some hospitals use internal corporate structures to limit interoperability. Leadership teams should review partnership terms and restructure governance models that restrict exchange to improve collaboration and data efficiency.
• Information blocking is now concentrated among a few major actors: The problem is shrinking but increasingly centralized among select developers and hospital systems. Decision-makers should target oversight on these groups to achieve disproportionate gains in connectivity and compliance.
• Even limited blocking significantly disrupts data flow and system efficiency: A small number of obstructive behaviors continue to cause major operational ripple effects. Executives should prioritize eliminating these disruptions to accelerate digital transformation and strengthen system-wide performance.