EHR Data Export and Information Blocking: When Switching Systems Meets an Access Barrier

Information blocking during EHR switching can involve a data export that a vendor disables, delays or puts behind conditions that obstruct access. If you work in migration, implementation or product engineering, you may see the gap between the capability a vendor promised and the records a customer can actually take elsewhere. That gap has already figured in False Claims Act cases.

The Vendor Cases Connected Export Failures to Federal Payments

Batch Export and the Difficulty of Leaving

In May 2017, the Justice Department announced a $155 million civil resolution with eClinicalWorks and certain employees over software-capability and kickback allegations. The government alleged that the software failed portability requirements intended to let providers transfer patient data to another vendor. It connected those deficiencies and other certification problems to false claims for federal incentive payments.

The government’s complaint described an internal response to customers asking about batch export:

United States ex rel. Delaney v. eClinicalWorks LLC, government complaint, paragraph 62

The alleged internal explanation matters. The customers wanted their records out, and the complaint described an employee questioning whether the company wanted to make that easy. We see a product sold to manage patient information allegedly making that information harder for its own customers to move. Their records. The vendor’s exit barrier.

The corporate integrity agreement required eClinicalWorks to offer customers a transfer to another EHR provider without penalties or service charges. A software technician working for a municipal health agency had started the qui tam case, and the government joined it.

Practice Fusion and the Disabled Export Feature

Practice Fusion’s January 2020 civil settlements totaled approximately $118.6 million and covered certification and kickback allegations. In its account of the civil certification allegations, the Justice Department said several software versions could not let a user create the standardized export summaries required by the 2014 Edition when the products were certified.

The government further alleged that, after certification, Practice Fusion disabled access to the feature altogether. Users instead had to contact the company separately to request an export. In that account, a capability supposed to be available to the user became something the vendor controlled request by request.

The Justice Department alleged that the false certifications caused providers to submit false incentive attestations for Medicare reporting periods from 2014 through 2016 and Medicaid reporting periods from 2014 through 2017. The alleged chain ran from the vendor’s certification representations to the providers’ claims for payment.

What Must an EHR Export?

An EHR certified to the electronic health information export requirement must support exports for a single patient and for a patient population. The scope reaches the electronic health information the product can store when presented for certification, including information held through its other components and storage locations.

The Office of the National Coordinator for Health Information Technology’s export certification guidance ties that scope to the electronic information a patient would have the right to request under HIPAA. The scope follows the records, rather than a fixed clinical-summary template.

That distinction reaches images, too. Images stored in or by the product belong in the export when they fall within the covered information. If the product stores only links to images held in a separate imaging system, the export requirement reaches those links.

Single-Patient Export and Population Export

Single-patient export must let an authorized user create the export whenever the user chooses, without subsequent developer assistance to operate the feature. The implementing organization can restrict that capability to particular users or administrators. Developers cannot use that restriction to defeat the user-driven capability.

Population export can require developer action or support, but it must cover all the electronic health information the product can store. A practice-wide move and a request for one patient’s record involve different technical requirements.

Which Rules Applied When?

The vendor cases above concerned earlier certification requirements. The broader electronic health information export capability had a compliance deadline of December 31, 2023.

The information-blocking regulations applied from April 5, 2021. From October 6, 2022, their scope expanded beyond the initial United States Core Data for Interoperability baseline to the full defined electronic health information. We match a product’s behavior to the requirement in force when it happened.

Why Does an EHR Export Still Need Migration Work?

An EHR export can use a proprietary format that meets the certification requirement and still need substantial interpretation by the receiving system. The requirement calls for electronic, computable output and public format documentation, while leaving the choice of format to the developer.

The Cures Act final rule makes that gap explicit. ONC declined to require a product to import every proprietary format another product might export. A file can leave the old system without arriving ready to use in the new one.

The documentation is part of the capability. The exported files must include a public link explaining their format, and that documentation must stay current. ONC describes documentation of structure and syntax, such as a data dictionary for comma-separated files. Anyone must be able to reach it directly, without preconditions.

An API answers another question. The standardized patient-and-population API criterion requires access to the defined core data set. The electronic health information export criterion reaches the broader information the product can store. An available FHIR endpoint therefore leaves the migration team with a further question: what happened to the information outside that core data set?

Even the file extension can mislead. ONC permits a PDF export if it is interpretable and machine-readable, with data another program can consume using consistent processing logic. A PDF containing information only as images may lack that capability. We look at what the output lets the receiving software do.

What Are Examples of Information Blocking?

Potential information-blocking practices include restricting a complete export during a system switch, imposing burdensome exchange conditions, or implementing technology in ways that substantially increase the difficulty of accessing information. The Cures Act expressly addresses transitions between systems. A barrier can sit in the product, the commercial terms or the response to a request.

Responsibility follows the organization and its conduct. The rules cover health care providers, developers of certified health IT, health information networks and health information exchanges. For developers, networks and exchanges, the test asks what they knew or should have known about interference. For a provider, it asks whether the provider knew the practice was unreasonable and likely to interfere. That makes the internal explanation for a delay or restriction consequential.

The commercial incentive also deserves attention. A 2022 Vassar College senior thesis explains why the cost of leaving matters:

A Panacea or a Problem? Electronic Health Records and the Complicated Politics of Its Stakeholder Network, Vassar College senior thesis, 2022

In a particular case, we connect the commercial terms to the actual request and the decisions behind the response.

What Are the Exceptions to Information Blocking?

The information-blocking exceptions address issues such as privacy, security, fees and the way a request is fulfilled. We work through a vendor’s explanation with you, alongside what the technology and staff could actually do.

Export fees have a particularly direct connection to switching. The fees exception excludes a charge for using the certified electronic health information export capability to switch systems or provide patients their information. It also excludes an export or conversion fee that was not agreed to in writing when the technology was acquired. The fee schedule and original contract can explain a great deal.

Who Enforces Information Blocking?

The Department of Health and Human Services’ Office of Inspector General investigates information-blocking allegations. Developers, networks and exchanges face civil monetary penalties. Providers face program-specific disincentives administered through the responsible agencies, including the Centers for Medicare & Medicaid Services. The Office of the National Coordinator for Health Information Technology separately reviews possible certification violations by certified developers.

The agency’s claims dashboard reported 2,450 possible information-blocking claims through July 31, 2026. Those reports show why access barriers deserve scrutiny. The vendor cases above show the separate connection between export capabilities, certification promises and federal payments.

What the Migration Team Can Show

A migration insider may know which product version ran, what export the customer requested and what the system actually produced. An engineer may know when a feature was disabled. Implementation staff may know why the customer was sent back to the vendor for something the certification description said a user could do.

We connect those observations to the export files, public format documentation, support responses and commercial terms. The receiving system’s experience helps distinguish missing information from information delivered in a format that needs interpretation. The product history and internal decisions explain who knew about the obstacle. The historical vendor cases show why those details can matter alongside the certification representations and federal payments.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. For a later export failure, we examine the certification assurances and the connection to federal payments with you. The export guidance requires developers to ensure full compliance and unrestricted implementation of the population-export capability.

When You Know Why the Export Failed

If you know why a customer’s records could not leave an EHR, speak with our whistleblower experts about the export and the decisions behind it. We bring the certification promises, export failures and federal payments together to build your strongest EHR whistleblower case. We stay beside you through that work and bring in EHR fraud whistleblower lawyers who understand the software and the payment programs.