Given all that the 21st Century Cures Act encompasses, assessing the 2016 law’s impact on health care isn’t easy to sum up. Yet, for the physician leading the Texas Medical Association’s committee most engaged with it, it only takes 17 words to frame the conversation.
“It is a huge bill, and there are a ton of positives that have come from it,” said Philip Bernard, MD, who took over leadership of TMA’s Committee on Health Information Technology (HIT) and Augmented Intelligence (AI) on June 1.
For physicians practicing nearly a decade after the Cures Act was enacted, arguably most impactful are its ramifications on patient access to data and how health care professionals share information – particularly via electronic health records (EHRs).
It aimed to improve EHRs by making it easier to share patient data among health care professionals. The Cures Act defines interoperability, in part, as health information technology that “enables the exchange of electronic health information with, and use of electronic health information from, other health information technology without special effort on the part of the user” and “does not constitute information blocking.” That capability is a primary focus of the law – and is increasingly changing how some physicians receive and process the information factoring into their clinical decisions.
Additionally, the Cures Act encourages potentially transformative research under the U.S. Food and Drug Administration’s purview, such as the Breakthrough Devices Program, aimed at speeding development and approval of medical devices, and the Regenerative Medicine Advanced Therapy designation, fast-tracking innovation in cell therapy treatments.
Dr. Bernard, the chief medical information officer at Children’s Health in Dallas, grants that it’s boosted and sped up medication development, and by contributing to a climate of technological advancement, has enabled AI to become a “workforce multiplier.”
Promoting interoperability
TMA’s 2025 biennial HIT survey revealed that 91% of responding physicians use EHRs, indicating that Texas doctors are familiar with at least one facet of health care technology touched by the law. (See “Tech Trends in Texas,” page 14.)
“TMA has stressed the importance of electronic medical records and the quality of the information in them, particularly for patient safety purposes,” said Joseph H. Schneider, MD, who has been part of TMA’s HIT and AI Committee since 2005 when it started as an ad hoc committee, and served as its first chair when it became a standing committee in 2019.
Dr. Schneider likens the push for physicians to adopt EHRs to “incentivizing steam-powered cars in the early 20th century,” he noted. “A relative of mine is a usability expert who works with a large tech firm. When I show her how EHRs work, she’s blown away at how primitive they are.”
The Dallas pediatrician points to TMA’s HIT survey data, showing that physicians still find EHR usage interferes with attentiveness to their patients, diagnostic thought process, and even with the formation of a diagnosis itself. But between 2016 and 2025, fewer physicians have reported those concerns – most notably, the percentage of physicians with diagnosis formation issues dropped from 56% to 36%.
The Cures Act created a standardization of data used in health information exchange, called the United States Core Data for Interoperability (USCDI). It provides guidelines for data classes and data elements used in EHRs; all certified EHRs must comply with those standards. (See “Unpacking the 21st Century Cures Act,” page 24.)
TMA has couched concerns with multiple USCDI versions in comment letters to the Assistant Secretary for Technology Policy within the U.S. Department of Health and Human Services. Most recently, that includes an April letter sent, following TMA’s review of data elements in a draft of a forthcoming version of USCDI, to ensure systems are exchanging information with a standard vocabulary and one that is meaningful for patient care (tma.tips/USCDILetter).
The law also brought about the Trusted Exchange Framework and Common Agreement (TEFCA), a nationwide framework for sharing data across health information exchanges, intended to, per HealthIT.gov, “remove barriers for sharing health records electronically among health care providers, patients, public health agencies, and payers.”
An analogy for TEFCA that Dr. Schneider likes to use is railroads. When they were first built across the U.S., many different track widths were used. Eventually, track width was standardized so trains could move easily across other companies’ tracks.
“TEFCA allows us to exchange data much more easily across different EHRs,” said Dr. Bernard, a pediatric critical care specialist. “I’m excited about TEFCA really trying to improve the operability across disparate systems.”
The emphasis on EHR adoption and interoperability predates the Cures Act, including 2009’s Health Information Technology for Economic and Clinical Health Act (HITECH) and builds on the Centers for Medicare and Medicaid Services’ (CMS’) efforts starting in 2011 to promote what it has dubbed over the years as “meaningful use” and “promoting interoperability” provisions with Medicare’s pay-for-performance programs.
“With the HITECH Act, there were lofty intentions around interoperability, but maybe a misunderstanding of how proprietary systems don’t communicate,” said Shannon Vogel, TMA’s associate vice president of health information technology. “There was some disappointment around interoperability, even though a lot of money was spent on trying to get data moving. It just took more law, namely the Cures Act, to get there.”
Some physicians are noticing advances in EHRs that are making it easier, albeit incrementally, to share information.
“There’s no doubt that there’s more interaction and interoperability between electronic health records than there was five years ago,” said David Gerber, MD, a Dallas oncologist growing increasingly familiar with Epic, the EHR system most used by Texas physicians according to the annual HIT survey. “We are now able to routinely link records from other institutions, which helps in many ways.”
Interoperability helps get information in initial referrals more directly and expediently, he says.
“There’s been – over time – an improvement in technology where maybe five years ago, I could see blood test results because they’re relatively straightforward and measure numbers,” he observed. “And then a little bit after that, it was easier to see radiology reports, where I could actually see those paragraphs that the radiologist put into the record. And then after that, it became possible, in many cases, for us to see the images.
“So, if one of our patients gets sick and goes to an emergency room in another city, sometimes we can actually see what a scan showed,” he added. “And that’s a tremendous advantage for patients and for health care practitioners.”
Dr. Gerber notes, on the EHR platform he uses, he’s able to click on a patient record and get test results and visits from a broad array of health care entities. That capacity has increased over time, he says, positing that the “organic change” of technology marching forward has coupled with the federal legislation to bolster digital transfers of medical information.
“I love the goals of the Cures Act,” said Thomas J. Kim, MD, an Austin psychiatrist and internist, consultant to TMA’s HIT and AI committee, and chief medical innovation officer for several entities throughout his career. He’s encouraged by innovations around EHRs that allow physicians to access and even parse patient data to deepen their clinical knowledge, though he says it’s an “iterative process” set to progress over time – potentially utilizing AI.
He adds it’s now possible to gather “a previously inaccessible ‘data pot,’ in a common-sense way, without enormous amounts of burden … and then subsequently, people have figured out ways to hook [that information] into your EHR, so it’s right there in your workflow, rather than stepping out and going to a website.”
Despite optimism around how AI might figure into medicine’s future, Dr. Bernard stresses that physicians remain integral to clinical decision-making.
“It can be time consuming and challenging to navigate through all of those components, to pull out what are the critical pieces” contained within an EHR, he added. “A phone call between two clinicians can succinctly and accurately convey key pieces. So, I hope that never goes away.”
But he does retain concerns – particularly the way the legislation has changed the disclosure of patient data and how physicians must function within its parameters.
Guarding against information blocking
Dr. Gerber’s regard for human interaction also extends to a facet of the Cures Act he feels strongly enough to have written articles about as well as delivering legislative testimony on TMA’s behalf.
Federal law around information blocking requires that electronic health information that a physician has, such as lab results, be made available to the patient without delay, if the patients has logged into a patient portal to access, or has authorized an app to receive (via an application programming interface), the electronic health information.
Since the information blocking only applies to electronic health information, physicians who use paper medical records rather than EHRs aren’t subject to information blocking regulations. Physicians who are found to be in violation of those regulations will incur penalties, per a final rule jointly released by the Office of the National Coordinator for Health Information Technology (ONC) and CMS on June 24, 2024. Those penalties can include Merit-Based Incentive Payment System-eligible clinicians having their performance scores adversely affected, and a physician practice that’s part of an accountable care organization being ineligible to participate for at least a year. (See “Unpacking the 21st Century Cures Act,” page 24.)
Yet, since implementing the information blocking prohibition on April 5, 2021, reports of the practice are relatively uncommon. The Cures Act required the ONC to set up a process where people could report possible information blocking. In the nearly four years since then, through March 31, 2025, the ONC’s Report Information Blocking Portal received slightly more than 1,200 possible claims of information blocking nationwide – which Ms. Vogel says is a relatively small number of cases (tma.tips/BlockingClaims).
While Dr. Gerber sees the Cures Act’s guidance against information blocking as generally positive for patients who now have more access to their data, the potential for sensitive data to be released quickly and without a physician’s in-person framing gives him pause.
“The pendulum just swung too fast, too far,” he said.
An exception in the regulation allows for a delay in releasing sensitive data electronically if the delay is required by state law. During the 2025 Texas Legislature session, TMA helped the passage of Senate Bill 922, which allows for delay. Starting Sept. 1, Texas physicians will be given three days after the tests are finalized to review and communicate results to patients before they are made available via EHRs.
Giving physicians a pause gives them time to deliver what could be potentially devastating news in a supportive manner in a conversation with the patient, rather than impersonally through a patient portal.
Dr. Gerber testified in support of such a state solution in a March hearing, noting that despite being trained to share such information “in a timely, informative, and supportive manner,” federal law requires him to do so automatically and without delay, which he said, “results in confused and potentially traumatized patients.”
Harvey Castro, MD, an AI consultant to TMA’s HIT and AI committee, points out that the “phone tag” that can occur when physicians try to contact patients can frustrate both parties.
“It’s a good thing to give that information to the patients,” he said. “I’m making assumptions that patients have a certain amount of background, education to a certain level, and that that information is good to have, because the worst feeling is [that] you’re basically paying for [lab tests], and then not knowing what you paid for.
“If I’m paying for it, I want to know what happened,” the Dallas emergency physician added. “I don’t want to wait another week or two.”
While the law does speed the process of getting patients’ health information to them, Dr. Castro also cautions them against going to “Dr. Google” or “Dr. ChatGPT” to research what test results mean without the input of physicians who know their medical histories and can provide helpful context.
Though the Cures Act was established before AI became a pronounced topic in health care, the ONC drew from it for a March 2024 final rule that calls for algorithm transparency requirements for AI used in certified health information technology (tma.tips/HTI-1FinalRule).
The ONC, which was reorganized in July 2024 as the Assistant Secretary for Technology Policy and ONC, asserted upon issuing the final rule that the policy “will promote responsible AI and make it possible for clinical users to access a consistent, baseline set of information about the algorithms they use to support their decision making and to assess such algorithms for fairness, appropriateness, validity, effectiveness, and safety.”
Dr. Castro, considering AI in his own practice, emphasizes the importance of patient education to help put clinical information into context and prepare patients for what lab results and diagnostic tests might reveal, especially highlighting that education at discharge is crucial.
Technologies like AI and EHRs become sharper scalpels for physicians who invest the time and energy into learning them.
Dr. Bernard observes that any technology that a practice adopts should ultimately answer the question: “How do we get the physician to be as efficient as possible?”