ONC is ending 2025 with a tight set of four (4) new Information Blocking FAQs issued on December 19, 2025 that squarely target how Actors (i.e., HIE/HINs, Developers of Certified Health IT and Health Care Providers) behave in the real world: automation, contract leverage, and the Manner and Fees exceptions. These December FAQs do not stand alone. They join a small handful of other new 2025 Information Blocking FAQs that are worth bookmarking:
Fees Exception: “Can an actor meet the Fees Exception if it conditions the access, exchange, or use of EHI on the establishment of a revenue sharing agreement?”
No. For an actor’s practice of charging fees for access, exchange, or use of EHI to not be considered information blocking under the Fees Exception, the fees an actor charges must not be based on the revenue that the requestor derives or may derive from the access, exchange, or use of the EHI (45 CFR 171.302(a)(2)(ii)). The conditioning of access, exchange, or use of EHI on the establishment of “revenue sharing” or “royalty agreements” with third parties seeking access, exchange, or use of EHI provided by an actor to a requestor that go beyond recovering costs reasonably incurred by the actor to enable the access, exchange, or use of EHI could implicate the information blocking provision (85 FR 25882, 85 FR 25879).
ID: IB.FAQ57.2025DEC | Date Added: 12/19/2025
Takeaway: ONC draws a bright line between cost recovery and revenue-based tolls for access.
Manner Exception: “What role does a ‘requestor’ play under the alternative manner condition of the Manner Exception?”
When an actor believes they can fulfill a request for access, exchange, or use of electronic health information (EHI), they may seek to satisfy the Manner Exception (45 CFR 171.301) to be sure they are not committing information blocking. The Manner Exception states in principle that an actor “must fulfill a request for EHI in any manner requested, unless the actor is technically unable to fulfill the request or cannot reach agreeable terms with the requestor to fulfill the request in the manner requested” (45 CFR 171.301(a)(1), 85 FR 25877). If an actor does not fulfill a request for EHI in any manner requested because the actor is technically unable to fulfill the request or cannot reach agreeable terms with the requestor, the Manner Exception then specifies that an actor must fulfill the request in an alternative manner (45 CFR 171.301(b)).
Under this alternative manner condition of the Manner Exception, the actor must fulfill the request for EHI without unnecessary delay in an alternative manner (45 CFR 171.301(b), 85 FR 25878). The actor must offer alternative manners in a strict priority order, starting with 45 CFR 171.301(b)(1)(i) and only proceeding to the next consecutive paragraph if the actor is technically unable to fulfill the request in the manner identified in the paragraph.
Importantly, a requestor must specify the technology or standards, respectively, of the alternative manners under paragraphs (b)(1)(i) and (ii) or agree to an alternative machine-readable format under paragraph (b)(1(iii). Simply put, if the requestor does not specify technology certified to a standard or standards adopted in part 170 ((b)(1)(i)), or content and transport standards published by certain publishers ((b)(1)(ii)), or agree to an alternative machine-readable format ((b)(1)(iii)), then the actor cannot meet the alternative manner condition of the Manner Exception. An actor is not permitted to presume or dictate the manner in which access, exchange, or use of EHI is fulfilled under the alternative manner condition of the Manner Exception.
If an actor is unable to meet the Manner Exception, the actor may want to consider whether the actor can meet the conditions of another exception. For example, the actor may be able to rely on the Infeasibility Exception. One factor of the infeasible under the circumstances condition of the Infeasibility Exception is “[w]hy the actor was unable to provide access, exchange, or use of electronic health information consistent with the [Manner Exception].” (45 CFR 171.204(a)(5)(i)(F), 85 FR 25867)
ID: IB.FAQ56.2025DEC | Date Added: 12/19/2025
My takeaway: If you are trying to land in the alternative manner condition, the requestor’s role is not optional. ONC is explicit that the Actor cannot simply presume or dictate the alternative manner.
Manner Exception: “Does an actor have to provide all the EHI requested by a requestor to satisfy the Manner Exception?”
Generally, yes, but it may depend on the circumstances.
The scope of EHI* for which the actor must fulfill a request for access, exchange, or use in order to satisfy the Manner Exception is determined by the scope of the request and thus by the requestor. This is true regardless of whether the actor seeks to fulfill the request consistent with the manner requested condition (see 45 CFR 171.301(a)), the alternative manner condition (45 CFR 171.301(b)), or a combination of the conditions.
If the requestor’s request is for access, exchange, or use of a subset of EHI that the actor can fulfill in the manner requested (45 CFR 171.301(a)), then the actor can satisfy the Manner Exception by providing access, exchange, or use of that subset of EHI in that requestor-specified manner so long as the actor’s practice in doing so is otherwise consistent with the Manner Exception (45 CFR 171.301).
By contrast, if the actor cannot reach an agreement with the requestor or is not technically capable of providing all of the requested EHI in a particular requestor-specified manner, then to satisfy the Manner Exception for the request the actor would need to use one or more additional alternative manners specified by the requestor (45 CFR 171.301(b)(1)(i) and (ii)) or agreed to by the requestor (45 CFR 171.301(b)(1)(iii)), working through manners in the priority order identified in the alternative manner condition, until the actor has made all requested EHI available to the requestor.
An actor might have the technical capability to satisfy the Manner Exception for only some of the EHI requested in the manner(s) the requestor specifies. In such instances, the actor may want to consider whether another exception may apply for the remaining EHI not fulfilled through the Manner Exception.
* EHI is defined for purposes of the information blocking regulations in 45 CFR 171.102. On and after October 6, 2022, the scope of EHI for purposes of the information blocking definition (45 CFR 171.103) is EHI as defined in 45 CFR 171.102 (89 FR 1199, 85 FR 70069).
D: IB.FAQ55.2025DEC | Date Added: 12/19/2025
My takeaway: The request defines the scope, and partial fulfillment may still require working through the priority-ordered alternatives until all requested EHI is made available.
Interference: “Could an actor’s practice that interferes with an automation technology’ ability to access, exchange, or use EHI implicate the information blocking regulations?”
Yes. An actor’s practice that interferes with, prevents, or materially discourages the access, exchange, or use of EHI by automation technologies (e.g., robotic process automation (RPA), agentic artificial intelligence) could implicate the information blocking regulations. The information blocking definition (42 CFR 171.103) is not specific to any particular means, manners, or mechanisms by which access, exchange, or use of EHI is sought and could be accomplished. Thus, an actor’s practice that is likely to interfere with, prevent, or materially discourage access, exchange, or use of EHI by automation technologies could implicate the information blocking provision.
ID: IB.FAQ54.2025DEC | Date Added: 12/19/2025
My takeaway: ASTP/ONC says the definition is not “human-only.” Practices that materially discourage automated access (ONC gives examples like RPA and agentic AI) can implicate the rule.
The December 19, 2025 FAQs were the year’s clearest signal, but they were not the first: they build on the 2025 breadcrumb trail that started in June with ONC’s guidance on third party claim submissions and continued in July with the QHIN choice interference FAQ.
Interference: “Would it be considered an interference under the information blocking regulations if a health IT developer of certified health IT limited a customer’s or a user’s choice of QHINs for the purposes of participating in TEFCA?”
Yes, it would likely be considered an interference with the access, exchange, or use of EHI if an actor restricts or impedes a customer or user from obtaining or using the QHIN connectivity services of their choice because such services provide for the access, exchange, and use of EHI.
The information blocking law (42 U.S.C. § 300jj-52) may be implicated when an actor engages in exclusionary, discriminatory, or other practices that impede the dissemination or use of interoperable technologies and services, and that interfere with the access, exchange, or use of EHI (85 FR 25813-25814). Examples of practices by a developer of certified health IT that would likely be an interference include practices that restrict or impede a customer’s or a user’s access, exchange, or use of EHI through QHIN connectivity services by: establishing contractual terms that limit or have the effect of reducing the choices of a customer or user to use any QHIN; imposing unreasonable fees for access to certain QHINs; and taking unnecessary time for configuration changes or other technical steps needed to use a QHIN’s connectivity services. Each of these examples would be especially concerning when the QHIN may be a competitor of the actor because it may indicate that different fee structures or terms do not reflect genuine differences in the cost or the effort required to provide access, exchange, or use of EHI (85 FR 25814, 85 FR 25881-25882; 45 CFR 170.302(a)(2)).
ID: IB.FAQ53.1.2025JUL | Date Added: 07/07/2025
My takeaway: ONC signals low tolerance for “choice restriction” tactics, especially where a QHIN is a competitor.
Reporting Claims of Information Blocking: “Can I have a third party submit an information blocking claim on my behalf?”
Yes. Anyone, individually or as a group, can have a third party of their choosing submit a claim of possible information blocking to HHS on their behalf.
ID: IB.FAQ52.1.2025JUN Date Added: 07/07/2025
My takeaway: ONC makes it easy to use counsel, consultants, or other representatives to submit a claim.
Why does this 2025 set of FAQs matter?
This 2025 set of FAQs matters because ONC is putting the market on notice about what it is watching next. Read together, the June and July additions and the December 19 capstone all point in the same direction:
If you are using contracts, pricing, or process to slow-walk access, ONC is treating that friction as a compliance issue, not just “how business gets done.”
The automation FAQ makes that signaling explicit. By calling our RPA and agentic AI, ONC is saying it will judge access by real-world performance, not paperwork. Going into 2026, the question will be less “Do you technically offer access?” and more “Does access actually work at scale, including for automated workflows that are quickly becoming standard?”