OMERS Ventures Principal Investor Christina Farr

Digital Health

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.

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The Wire

• Cobot Hauls In $100M: Collaborative robotics manufacturer Cobot hauled in $100M in Series B funding to support AI-driven productivity enhancements with “human-capable cobots.” The company’s first cobot is about six feet tall with four wheels, sensors, and carts – a bit like an industrial Moxi from Diligent Robotics – and is set to work alongside humans to streamline manual workflows across healthcare and other industries. Cobot was founded by a former Amazon robotics VP and backed by both GC and Mayo Clinic, so it’ll be interesting to see the cobot in action once in-hospital trials begin later this year.

• CHN + Notable: Indiana-based Community Health Network is embarking on an enterprise-wide deployment of Notable’s AI platform for healthcare operations to improve patient loyalty and increase staff efficiency across 200+ sites of care. The initial deployment will focus on resource-intensive processes such as automated chart review, care gap scheduling, and pre-visit planning. From there, Notable’s Flow Studio will provide a no-code interface for CHN staff to build and execute custom automations for more robust clinical and patient experience use cases.

• Telehealth Adoption in Specialty Care: AMA researchers spoke with practicing physicians from nine medical specialties to better understand the clinical conditions driving the use of telehealth and other forms of digitally enabled care. The handy table that starts on page 5 of the report gives a full breakdown of each specialty, showing which use cases are prompting specialists to employ various modalities such as live video, live audio, asynchronous, or remote patient-monitoring. 

• New Ransom Demands: Just when you think UnitedHealth Group might be starting to move past February’s ransomware attack, a second cybercrime group named RansonHub is threatening to leak 4 terabytes of patient data unless more ransom is forked over. RansonHub is positioning itself as a disgruntled affiliate of the Blackcat/ALPHV group that was cut out of the $22M ransom from a few weeks back, claiming that it helped execute the original attack and still holds mountains of sensitive records and active military personnel PII.

• Poor US PCP Access: A new ten-country Commonwealth Fund study highlighted the US’ primary care access challenges, finding that the US has among the lowest share of patients who report having a “regular doctor” (#9, 87%), a longstanding relationship with their PCP (#10, 43%), access to PCP home visits (#10, 29%), and access to their PCP outside of normal hours (#7, 52%). The report encouraged more investment in US primary care, noting that it represents just 4.7% of overall US healthcare spending, versus 14% in other high-income countries. 

• Greenway Clinical Assist Launch: Health IT services provider Greenway Health is teaming up with Nabla to debut Greenway Clinical Assist, which uses a blend of proprietary and industry-leading LLMs to transcribe patient-provider encounters and instantly generate structured clinical notes. The partnership will integrate Nabla’s ambient AI assistant with Greenway’s Prime Suite and Intergy EHR solutions, slashing up to two hours of documentation and administrative workload per provider.

• Health Plan UX Problems: If it seems like a lot of your patients have problems navigating their health plans’ websites and apps, that’s probably because most of them offer poor digital experiences. A new J.D. Power Study of 5,590 members of large MA and commercial plans found that 32% of plan websites and apps lack basic functionality (leading to 42% of users encountering problems finding info within the past year), while only 21% excel in areas like explaining coverage details, managing deductibles, and offering telehealth services.

• Full Self-Driving Healthcare: The latest Dem Dry Bones from Dr. Benjamin Schwartz offered a short-and-sweet exploration of why the next stop on the journey to value-based care should be tight integration between PCPs and specialists, or “full self-driving healthcare.” VBC success hinges on finding an equilibrium where primary care can function at its highest level through the support of good specialty care, and specialty care can offer its greatest value through the support of effective primary care. Instead of asking PCPs to do more specialty care or asking specialists to do more primary care, Dr. Schwartz lays out why the ideal answer for patients is actually “automatic” coordination in the gap between the two.

• App Directs Patients to Statins: Web applications connected to a direct-shipping system could be effective for guiding high-cholesterol patients to check their eligibility for statins and order the medication without a traditional prescription. Among 1,196 patients in the TACTiC study with a 139.6 mg/dL average LDL-C who accessed the web app from an online advertisement, 90.1% correctly used the app to self-select for statins eligibility, and the new statin-takers went on to achieve a 35.5% LDL reduction in six months.

• PAM Joins Forces With Luna: PAM Health is joining forces with Luna to expand access to high-quality rehab experiences to post-acute patients across 22 states. Through the new service, called PAM Health Therapy at Home powered by Luna, patients referred to in-home physical therapy will speak with a concierge team member who will match them with a licensed physical therapist based on specialty, geography, and schedule. Luna will then execute the care plan while ensuring patients and therapists remain matched for the entire duration to improve consistency.

• SDOH Screening Impact: A new CDC report found that women from disadvantaged economic backgrounds are less likely to get a mammography screening. Researchers analyzed 2022 mammography screening rates for women aged 50-74, which ranged from 64% to 86% depending on state. Screenings varied greatly between women with no adverse social determinants of health and those with three or more factors (83% vs. 66%). Social isolation, life dissatisfaction, and negative economic factors also predicted skipping mammograms over the previous two years.

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