- Federal EHR laws evolved from HIPAA’s privacy protections (1996) through HITECH’s meaningful use incentives (2009) to the 21st Century Cures Act’s interoperability mandates (2016).
- For Medicare eligible clinicians today, using certified EHR technology (CEHRT) and meeting the Promoting Interoperability requirements within MIPS is required to avoid negative payment adjustments of up to 9%.
- MIPS ties Medicare payments to quality reporting and EHR interoperability, making certified systems essential for financial performance.
- Tebra’s ONC-certified EHR+ platform helps practices meet all federal requirements while streamlining clinical workflows, billing, and patient engagement.
Eighty-eight percent of office-based physicians now use electronic health records (EHRs) — a dramatic shift from the paper-based era. This transformation didn't happen by accident. A series of federal laws established clear requirements for how healthcare providers must collect, store, and share patient data electronically.
Understanding these EHR laws is essential for staying compliant and avoiding penalties. It also helps you maximize your practice's performance under value-based payment models. Keep reading to learn more about federal EHR laws and how to keep your practice compliant.
What are EHR laws?
EHR laws are the federal regulations that govern the adoption, use, and security of electronic health records. These laws create a framework for protecting patient privacy, improving care coordination, and driving technology adoption through payment programs.
"EHR laws are the federal regulations that govern the adoption, use, and security of electronic health records."
This legal framework is not static but continues to evolve to meet the demands of modern healthcare. It's important to distinguish these laws from the records themselves. An EHR is designed to be shared across healthcare settings, unlike a more limited electronic medical record (EMR).
Key federal EHR legislation
Three major federal laws shape how providers must handle electronic health records: HIPAA established privacy standards, HITECH accelerated EHR adoption through incentives, and the 21st Century Cures Act mandated interoperability.
HIPAA (1996)
The Health Insurance Portability and Accountability Act (HIPAA) set the foundational standards for patient privacy and data security. It applies to providers, health plans, and healthcare clearinghouses. Its key protections are outlined in three main rules.
- The privacy rule: Governs the use and disclosure of protected health information (PHI).
- The security rule: Sets national standards for securing electronic PHI (ePHI).
- The breach notification rule: Requires patient and government notification following a data breach.
HIPAA also grants patients rights to access and amend their health information. And establishes the essential security baseline that all certified EHR technology must meet.
HITECH Act (2009)
The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 was designed to accelerate the adoption of EHRs. It introduced the "meaningful use" program, which offered financial incentives for using certified EHR technology. The act also significantly strengthened HIPAA by adding stricter penalties and breach notification rules.
- Key point: The HITECH Act marked the shift from encouraging EHR use to mandating it through a system of incentives that later became penalties for non-adopters.
21st Century Cures Act (2016)
The 21st Century Cures Act aims to promote nationwide interoperability and give patients greater access to their health data. Its key provisions include:
- Anti-information blocking: Prohibits practices that unreasonably interfere with the access, exchange, or use of electronic health information.
- Standardized APIs: The Cures Act's API Condition of Certification requires certified health IT developers to publish standardized APIs that allow electronic health information to be accessed, exchanged, and used without special effort. Providers are obligated not to information block and to meet patient access measures in Promoting Interoperability/MIPS.
This act shifted the focus from simple EHR adoption to seamless and secure data sharing. It directly impacts the features and certification requirements of modern EHR systems.
Understanding the EHR mandate
The "EHR mandate" refers to the federal requirement for eligible healthcare providers to adopt and use certified EHR technology. Primarily affecting providers who accept Medicare, participation in MIPS and the Promoting Interoperability program requires CEHRT to avoid negative payment adjustments, which effectively necessitates EHR use. Note that the Medicaid Promoting Interoperability program ended in 2021.
To comply, providers must use an EHR system that's tested and certified by the Office of the National Coordinator for Health Information Technology (ONC). While some exemptions exist, most providers must comply to avoid financial penalties in their Medicare reimbursements.
What is meaningful use?
"Meaningful use" was a set of standards that required providers to use their EHRs in specific ways to improve patient care. The program evolved through three stages — shifting focus from data capture, to information exchange, and finally to improved patient outcomes.
Key objectives included:
- Using Computerized Provider Order Entry (CPOE) for medications
- Implementing clinical decision support tools
- Generating and transmitting prescriptions electronically (e-Prescribing)
- Exchanging health information with other providers
- Providing patients with timely electronic access to their health records
The term "meaningful use" has since been replaced by the "Promoting Interoperability" program, but its core principles remain central to EHR compliance.
MIPS and quality reporting
Today, EHR compliance is primarily measured through the Merit-based Incentive Payment System (MIPS). This value-based payment program for Medicare providers determines whether you receive a positive, negative, or neutral payment adjustment. Your score is based on performance in four categories.
- Quality: Reporting on specific clinical quality measures.
- Promoting interoperability: The evolution of meaningful use, focused on patient engagement and information exchange.
- Improvement activities: Activities that improve clinical practice.
- Cost: The cost of care provided.
Key point: The Promoting Interoperability category makes up 25% of the total MIPS score, making a certified EHR system essential for maximizing financial performance.
EHR compliance requirements for providers
To stay compliant with federal EHR laws, healthcare providers who use EHRs must meet several key requirements. These rules ensure that technology is used securely and effectively to improve patient care. A certified EHR platform is essential for meeting these obligations.
| Requirement | Why it matters |
| Use ONC-certified EHR technology | Ensures your system meets federal standards for security and interoperability. |
| Demonstrate promoting interoperability | Required for MIPS reporting and avoiding Medicare payment penalties. |
| Protect patient data | Fulfills core HIPAA Security Rule obligations to safeguard electronic patient information. |
| Provide patient access | Meets 21st Century Cures Act mandates for patient data access via portals or APIs. |
| Avoid information blocking | Prevents penalties by ensuring you don't unreasonably interfere with data exchange. |
| Maintain audit trails | Creates a legal record of data access and helps with security incident investigations. |
Penalties for non-compliance
Failing to comply with EHR regulations can result in significant financial penalties from multiple sources. These penalties underscore the importance of maintaining a robust compliance strategy.
- MIPS payment adjustments: Providers who do not successfully report for MIPS can face negative payment adjustments of up to 9% on their Medicare Part B reimbursements.
- HIPAA violation fines: As of August 2024, HIPAA civil monetary penalties are inflation-adjusted and range from $141 up to $71,162 per violation, with annual caps up to $2,134,831 for willful neglect that’s not corrected.
- Information blocking penalties: Healthcare providers found guilty of information blocking can face disincentives, and other entities can be fined up to $1 million per violation.
The best ways to avoid these penalties are to use a certified EHR, participate in quality reporting, and maintain strong internal privacy policies.
How Tebra supports EHR compliance
Navigating the complex web of EHR regulations can be challenging. An integrated, certified platform like Tebra simplifies compliance by providing all of the necessary tools in one place. Tebra's all-in-one EHR+ platform supports your practice with key features, including:
- ONC certification: Tebra is an ONC-certified platform that meets all federal technology requirements.
- MIPS/quality reporting dashboards: Easily track and report measures for the MIPS Promoting Interoperability and Quality categories.
- Automated patient access: A built-in patient portal and secure APIs fulfill Cures Act requirements for patient data access.
- HIPAA-compliant security: Robust security features help you meet the technical safeguard requirements of the HIPAA Security Rule.
"An integrated, certified platform like Tebra simplifies compliance by providing all of the necessary tools in one place. "
By using a single platform, you can reduce compliance complexity and focus on providing excellent care. Take your practice to the next level with an ONC-certified, all-in-one EHR+ platform. Book a free demo now.
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- Current Version – Feb 09, 2026Written by: Erica FalknerChanges: This article was updated to reflect the most recent and up-to-date information.
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