The English origins of the pudding proverb date back to the early 14th century. The tasting of an item was meant in the general sense to test or try something—to know how good a food item was, you had to taste it. The first version specifically using pudding was in 1605 from William Camden’s Remaines of a Greater Worke, Concerning Britaine. His version was,“All the proofe of a pudding, is in the eating.” Of course, back then pudding was not a sweet dessert but likely a savory sausage of meat and seasonings. If not cooked properly, it could have been fatal.

On Feb. 29, 2016, the Department of Health and Human Services (HHS) announced that multiple major health information technology (IT) developers, providing more than 90 percent of U.S. electronic health records (EHRs), have pledged to improve interoperability of their EHR systems. Many other stakeholders, such as hospital systems and professional organizations, have also signed the pledge. HHS Secretary Sylvia Mathews Burwell announced this wonderful pledge during the Healthcare Information and Management Systems Society convention in Las Vegas.

Great, wonderful, exciting…
The three main points of the pledge are:

1. Consumer Access: To help consumers easily and securely access their electronic health information, direct it to any desired location, learn how their information can be shared and used, and be assured that this information will be effectively and safely used to benefit their health and that of their community.
2. No Information Blocking: To help providers share individuals’ health information for care with other providers and their patients whenever permitted by law, and not block electronic health information (defined as knowingly and unreasonably interfering with information sharing).
3. Standards: To implement federally recognized national interoperability standards, policies, guidance, and practices for electronic health information, and adopt best practices including those related to privacy and security.¹

Awesome!

However, before we taste this flavorful treat, let me simply state that the proof is in the pudding. Why my dose of healthy skepticism? How about vendor resistance, high fees for data exchange, lack of vendor incentives, and multiple EHR technical variations and challenges, to name just a few reasons?

Let’s look at some of the potential challenges in improving health IT interoperability. What about vendor resistance? If the data are locked into their system, they can charge high exchange fees. If their business model is based on information management and data exchange, why would they give away potential profit? Aside from governmental pressure and consumer demand, what is their incentive? How will it benefit their shareholders?

Additionally, let’s not minimize the technical and structural challenges in developing health IT interoperability. These potential obstacles are significant, especially considering the hundreds of different EHRs. Some of these challenges include insufficient interoperability standards, variation in state privacy rules and laws, problems with accurately matching patient medical records, significant costs, lack of trust between vendors, and data security concerns.

Hmm, maybe this sausage doesn’t smell so good…

The three main components of the health IT interoperability pledge are to help patients access their personal health information, to help providers deliver better care through information exchange, and to prompt the government to improve interoperability standards and policies. While consumer demand and government weight can potentially produce some movement, what leverage do individual providers have?

To be sure, there are some health IT developers that are working to improve access to medical records for providers despite the challenges. In Maryland, there is the nonprofit Chesapeake Regional Information System for our Patients (CRISP), which has implemented a statewide health information exchange. As a provider, I can access a patient’s medical records from my computer in the emergency department and look at medical record documents such as discharge summaries, laboratory and imaging results, and prescription information from other providers. Upcoming enhancements will include actual image exchange. In Washington and Oregon, there is the Emergency Department Information Exchange (EDIE) by Collective Medical Technologies, which is a private, for-profit corporation. Again, this system allows for real-time access in the emergency department to medical records from many participating health care institutions.

Why would they give away potential profit? Aside from governmental pressure and consumer demand, what is their incentive? How will it benefit their shareholders?

Both of these models are add-on systems to regular EHRs from the major health IT developers. Both have required substantial infrastructure development and investment from private and public partners. They are works in progress but have substantially positively affected the ability of emergency providers to deliver care in the states where they have been deployed. But, as stated, they are not the core health system EHRs.

It would be great to see this pledge fulfill its promise. Obtaining the most recent CT angiogram from an outside hospital on a patient presenting with chest pain can save time and money and reduce patient exposure to ionizing radiation. True health IT interoperability is critically needed to improve our ability to efficiently and effectively deliver modern care.

I just hope my colleagues and I don’t end up septic in the ED after eating this savory morsel.

Dr. Hirshon is professor in the departments of emergency medicine and of epidemiology and public health at the University of Maryland School of Medicine in Baltimore.

Reference

1. HHS announces major commitments from healthcare industry to make electronic health records work better for patients and providers. US Department of Health and Human Services Website. Accessed April 15, 2016.