Information Blocking Actors (45 CFR 171.102)

45 CFR 171.102 defines three classes of actors subject to information blocking obligations.

Health care providers: broadly defined to include hospitals, ambulatory surgical centers, skilled nursing facilities, home health agencies, physicians, practitioners, and other clinicians — beyond the narrow Medicare provider definition. Coverage extends to entities that may not bill Medicare at all.

Health IT developers of certified health IT: any developer (or other person/entity) that has health IT certified under the ONC Health IT Certification Program, even with respect to non-certified products.

Health information networks (HINs) / health information exchanges (HIEs): entities that meet the regulatory definition based on whether they govern, manage, or enable EHI exchange among more than two unaffiliated entities not under common control.

The knowledge standard differs by actor. Providers face information blocking liability when they know a practice is unreasonable and likely to interfere with EHI access, exchange, or use. Developers and HINs/HIEs face liability under a "knows or should know" standard.

Provider scope continues to expand in interpretation: a small medical group, a solo dental practice, and a community pharmacy are all candidate actors when they create, receive, maintain, or transmit EHI.