Epic vs Particle: The Data Exchange Debate

It probably would have been impossible to wander onto any of your healthcare newsfeeds last week and miss the drama unfolding between Epic and Particle.

If for some reason the solar eclipse blacked out your internet, the basic timeline looks like this:

  • April 8 – Rumors began circulating that Epic cut off data access to patient information platform Particle Health.
  • April 9 – Particle confirmed that Epic ceased responding to medical record requests through the Carequality network (updates ongoing).
  • April 10-11 – All hell broke loose.
  • April 11 – Epic released an Issue Notification detailing the issues and steps toward a resolution.
  • April 12 – Our shepherd through the dark forest of interoperability, Brendan “Health API Guy” Keeler, published a masterful breakdown of the situation and its downstream implications.

Without wading too far into the data exchange weeds, Particle “combines data from 270 million plus patients’ medical records by aggregating and unifying healthcare records from thousands of sources”… sources like Carequality.

  • Carequality is effectively one of the country’s largest health information networks, facilitating data exchange between qualified network members (i.e. Particle) who agree to only query patient data for “Permitted Purposes” such as Treatment, Health Care Operations, or Public Health Activities.
  • The problem at the heart of the Particle controversy arises due to the fact that Treatment is the only purpose that organizations like Epic are actually required to respond to, causing all sorts of companies to warp their true purposes to Treatment-shaped requests.

Epic’s Issue Notification went as far as specifically naming certain Particle customers that it felt violated the Treatment case, including a company named Integritort that was allegedly using the patient data to try and identify potential class action lawsuit participants.

  • Particle maintains that all of its partners directly support Treatment, and that “the ability for one implementor to decide, without evidence or even so much as a warning, to disconnect providers at massive scale, jeopardizes clinical operations for hundreds of thousands of patients as well as the trust that is so critical to a trust-based exchange.”

The Takeaway

Since we know a perfect takeaway when we see one, we’ll leave it to the Health API Guy to wrap up the story:

“The tactical actions and who’s right or wrong really isn’t that important. Instead, they can serve as a catalyst and accelerant for the change needed. These events occurred because fraud and abuse are happening because the status quo of the networks only working for Treatment leads to the worst possible incentives. Health data is needed by a broader set of stakeholders in order to serve the patient.”

In other words, now’s the time to make viable paths for other Permitted Purposes a reality.

Everything That Washed Ashore at Epic UGM

Epic went with a Castaway theme for this year’s User Group Meeting, and it’s easy to see why considering Tom Hanks would need years on a deserted island to sort through all the new features and partnerships announced at the show.

Luckily for Hanks, we already rounded up all the biggest news from the event, starting with the headline grabber: 

Microsoft and Epic are going all-in on AI. Microsoft CEO Satya Nadella even attended in-person to lay out how the partnership will reshape clinical workflows with generative AI.

  • Ambient clinical note generation powered by Nuance DAX Express 
  • Added in-basket messaging features that auto-generate first-draft responses
  • Rev cycle enhancements that provide coding staff with suggestions based on EHR data
  • New Look-Alikes program that matches patients with unidentified conditions to others with similar symptoms to help inform novel treatments

Epic CEO Judy Faulkner also took the stage in a sweet island explorer / Burning Man costume to share Epic’s overhauled partnership program, which now includes four distinct categories.

  • Cornerstone Partners – tech that serves as the backbone of Epic’s own software (InterSystems, Microsoft)
  • Partners – market leaders in specific areas (Nuance for ambient voice, PressGaney for consumer surveys)
  • Member Services – established integrations providing complementary value 
  • Pals – new category that allows innovative vendors to work closely with its EHR, including Abridge for ambient voice and the just-announced addition of Talkdesk for contact center workforce management

A new app “Showroom” will be the home base for the above partners, replacing the App Orchard that Epic shut down last year. 

  • When Showroom officially launches in a few weeks, it’ll be exclusive to a much more curated cohort of Partners and Pals than the Orchard’s 800+ third-party vendors, a decision that Epic said will help users find the “signal in the noise” and facilitate deeper collaborations. 

The Takeaway

Under the bright lights of an island-themed stage, Epic’s new features look nothing short of transformative, and its newfound willingness to play nice with partners could make a huge impact on nearly all aspects of care delivery. The real question will be whether these enhancements can be deployed as envisioned so that they can live up to their potential. It’s a massive undertaking, but there are countless clinicians that would love if Epic could pull it off.  

Telehealth Rarely Requires In-Person Follow-Ups

Epic Research tied a nice ribbon on the end of 2022 with a study suggesting that telehealth is an efficient use of resources for most specialties, rarely requiring an in-person follow-up within 90 days.

The research appears to indicate that telehealth isn’t usually duplicative of in-person visits, adding weight to the argument that regulators should view it as an alternative, rather than an additional encounter.

After examining over 35M telehealth visits conducted between March 2020 and May 2022, Epic Research found a pretty wide spread between specialties for both the number of telehealth visits and in-person follow-up percentages.

The main finding was that high follow-up rates were present only in specialties that require regular in-person visits for hands-on care, such as obstetrics and surgery. 

  • Mental health and psychiatry had the highest telehealth utilization and some of the lowest need for in-person follow-up. No surprises there.
  • Only 15% of telemental health visits needed an in-person follow-up within the next three months.
  • On the opposite end of the spectrum, obstetrics (92%), fertility (54%), and geriatrics (50%) had the highest need for in-person follow-ups.
  • In specialties that could be consultations (e.g. genetics, nutrition), the researchers stated that telehealth might even replace the need for in-person visits.

The Takeaway

While the numbers certainly look good for telehealth at first glance, the pandemic itself might be doing them a lot of favors.

Many medical offices closed at the beginning of the study period, and most didn’t reopen to in-person appointments for several months. Plenty of patients also remain wary of in-person visits due to the risk of virus exposure. Both factors probably skewed the in-person follow-ups to a lower range.

Those details aside, Epic Research gave a great overview of in-person follow-up needs by specialty, and the more data we can wrap around telehealth’s impact the better.

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