# A Simple 21st Century Cures Act Information Blocking Timeline

October 14, 2021

Particle Health Team

Remember these key dates for info sharing compliance.

## Information Sharing Timeline

### **December 13, 2016 - 21st Century Cures Act Signed Into Law**

The aim of the Cures Act is summed up in one of its subtitles, “Empowering Patients and Improving Patient Access to Their Electronic Health Information” (Section 4006). When Congress passes a law with plain English in it, you know it’s important!

Among other things, the Cures Act championed the bipartisan patient access philosophy. Patient access encompasses information sharing and pushes all players in the healthcare ecosystem to share health data.

### **March 9, 2020 - Cures Act Final Rules Released**

The [Cures Act Final Rule,](https://www.healthit.gov/curesrule/) which sets out _how_ providers will implement the Cures Act, is published. Some people call this the Information Sharing Rule, or ( [incorrectly](https://twitter.com/ONC_HealthIT/status/1442844894045814785)) the Open Notes Rule. Due to COVID-19 disruption, over a year of delays pass by before the Final Rule takes effect.

### **April 5, 2021 - Cures Act Final Rule Is Active; Information Blocking Banned (In Theory) 🎉**

The Cures Act Final Rule, and some of its major conditions, take effect. From now on, your basic electronic health information must be accessible on request. For example:

1. Major categories of electronic health information must be made available.
   - Healthcare organizations must now respond to requests for data that use the well-understood [USCDI v1 data elements](https://www.healthit.gov/isa/united-states-core-data-interoperability-uscdi#uscdi-v1). Complex use cases that are not defined by the [USCDI standard](/content/blog/understanding-uscdi/index.html) are still optional.
2. Anti-information blocking provisions are now binding.
   - Penalties are possible, but enforcement is not yet active.
3. [Condition of Certification (CoC) compliance requirements](https://www.healthit.gov/condition-ccg/attestations) begin.
   - Developers need to meet compliance requirements from the Office of the National Coordinator for Health IT (ONC). However, there’s no need to certify this to ONC just yet.
4. Health IT developers now prohibited from restricting certain communications.
   - Don’t even think about putting up new artificial barriers to access!

Some parts of the rule are still rolling out (more on that below).

### **December 15, 2021 - Developers Must Submit Real World Testing Plans**

By December 2021, it’s time for developers to show the world how far they’ve come on interoperability.

Before this date, “developers of certified health IT” need to submit [real world testing plans](https://www.healthit.gov/condition-ccg/real-world-testing) to the Certified Health IT Product List. This requires a plan certified by [ONC-ACBs](https://www.healthit.gov/topic/certification-ehrs/onc-authorized-certification-bodies-onc-acbs)(Authorized Certification Bodies).

### **January 18, 2022 - TEFCA Framework Released**

ONC releases the final [Trusted Exchange Framework](https://www.healthit.gov/sites/default/files/page/2022-01/Trusted_Exchange_Framework_0122.pdf) and [Common Agreement](https://www.healthit.gov/sites/default/files/page/2022-01/Common_Agreement_for_Nationwide_Health_Information_Interoperability_Version_1.pdf) (TEFCA), a non-binding policy framework that standardizes the process for [Health Information Networks](/content/blog/what-is-an-hie/index.html) to share data. TEFCA will also make it easier for other networks to connect with each other by transforming into a new type of entity, Qualified Health Information Networks (QHINs). Cures Act Section 4003 directed ONC to oversee this public-private partnership.

### **April 1, 2022 - Attestations to Conditions of Certification (CoC) Begin**

If you’ve started complying with information sharing rules, now is the time to prove it.

There’s more work to be done for development teams that want to meet the important _Conditions and Maintenance of Health Certification for Health IT_.

To be a part of Cures Act-compliant networks, developers must submit an attestation to their ONC-ACB that conditions like API availability and info blocking best practices are followed.

### **October 6, 2022 - ALL Electronic Health Information Must Be Made Available**

After this date, any electronic health information on a patient must be made shareable - not just USCDI v1 elements.

### **December 31, 2022 - New HL7 FHIR API Update Capability Must Be Active**

If you thought [FHIR](/content/blog/what-is-fhir/index.html) was for someone else to figure out, think again. The Conditions of Certification will require FHIR compliance in health apps from this day forth.

### **March 15, 2023 - Submit Initial Real World Testing Results**

It actually takes over a year before last year’s results are made publicly available.

### **December 31, 2023 - EHI Export Capability Must Be Activated**

Ever ported your phone number from one carrier to another? [EHI export capability](https://www.healthit.gov/test-method/electronic-health-information-export) means that the health data ecosystem will support that equivalent for your personal health data. If you’re a healthcare provider, the same goes for your EHR.