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?