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For the first time in history, Epic will have to face antitrust claims in court after it failed to dismiss Particle Health’s allegations that the EHR giant has been wielding its monopoly power to stifle competition.

Here’s the overly-simplified version. Particle combines health data from 270M+ patients’ medical records by aggregating “thousands of sources”… sources like Carequality.

Carequality is effectively one of the largest health information networks, facilitating data exchange between network members (like Particle) who agree to only query patient data for “Permitted Purposes” such as Treatment, Health Operations, or Public Health Activities.

The problem at the heart of the lawsuit 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.

Particle vs. Epic. Particle’s case alleges that Epic used its EHR monopoly to hamstring competition in the market for “payor platforms,” which allow payors to retrieve patient data to make decisions about care and coverage.

Last spring, Epic said that Particle was allowing its customers to inappropriately label their Carequality data requests as Treatment, then proceeded to stop responding to EHR requests from 34 Particle customers.

Particle’s lawsuit alleged that Epic trumped up the Carequality accusations in order to block it from serving its payor platform customers.

Epic filed to dismiss all nine of Particle’s claims. On Friday, the judge sided with Epic on five of the nine claims, dismissing the allegations that Epic maintained a conspiracy to uphold its market dominance, as well as claims of defamation and trade libel.

However, the court declined to throw out all three of Particle’s federal monopolization claims, as well as a state claim that Epic had interfered with a business contract.

Those claims will move forward into discovery, and Epic will now have to turn over documents that can shed light on whether its practices withstand legal scrutiny.

The Takeaway

Get the popcorn ready. Epic’s motion to dismiss was only partially successful, meaning it will now have to actually admit, deny, or qualify Particle’s remaining allegations. That deadline is quickly approaching on September 16th – then the real legal fireworks can get started.

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.

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