The US HTI-5 final rule removes 14 health IT certification criteria, revises seven and leaves 39 unchanged. The changes do not all take effect together, and the final certification package does not settle the separate information-blocking proposals. For teams reading the announcement, the criterion and its timetable matter as much as the headline count. ONC’s final-rule overview
The rule concerns the Office of the National Coordinator for Health Information Technology’s certification programme. A change to that programme is not, by itself, a finding that a particular electronic health record is suitable for a local deployment.
The final count describes three different actions
The 60 criteria divide into 14 removals, seven revisions and 39 unchanged criteria. A removal and a revision are different actions: revising a criterion does not mean that all of its requirements disappear.
ONC’s overview also identifies changes to certification conditions, real-world testing and reporting. These sit alongside the criterion-level changes; the headline count is not a complete inventory of every programme amendment.
For example, ONC describes scaled-back real-world testing requirements and retained reporting of FHIR bulk-data access. FHIR is a standard used to exchange healthcare information; an announcement about a foundation for future FHIR-based APIs is different from evidence that a particular connection works today. Programme conditions and future API direction
There are several dates to keep beside the changes
The Federal Register’s official record gives 28 December 2026 as the final rule’s effective date, with specified amendatory instructions effective on 1 January 2027. Publication on 28 October is therefore not the date when every change starts. Official document metadata and dates (JSON)
ONC’s criterion table adds the detail needed to interpret individual changes:
| Example in ONC’s final-rule table | Action | Listed timing |
|---|---|---|
| Clinical decision support, §170.315(a)(9) | Remove | Effective date of the final rule |
| Decision support interventions, §170.315(b)(11) | Revise | Effective date of the final rule |
| Family health history, §170.315(a)(12) | Remove | 1 January 2027 |
| Transitions of care, §170.315(b)(1) | Revise | 1 January 2030 |
These examples are selected to show the different actions and dates, not to reproduce the entire table. Teams needing another criterion should use its own row in the official source. Full criterion and timing table
Even similarly named decision-support entries receive different treatment. Collapsing both into “decision support removed” would conceal a revision that the agency lists separately.
Unfinished proposals are not final requirements
HHS says comments on the proposed information-blocking provisions remain under consideration. Its announcement also describes intended future work on information exchange, standards and APIs. Those statements cannot be converted into already-final requirements for an AI agent or a new data-access workflow. HHS announcement and remaining proposals
The announcement projects more than $1.5 billion in regulatory savings. That is HHS’s estimate, rather than a measured reduction in costs, clinician workload or patient harm following implementation.
For an adjacent but distinct US workflow, our prior-authorization API explainer separates finding requirements, exchanging documentation and receiving a decision. HTI-5 does not erase those distinctions simply because both subjects involve certified software and APIs.
The useful reading of this rule is therefore specific: identify the final action, keep the relevant date with it and separate future proposals from the published certification changes. Whether an actual product meets applicable requirements or a deployment is safe needs its own evidence and assessment.