Particle Health, Epic resolve dispute but antitrust lawsuit continues

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Nonprofit health information exchange network Carequality has finished an investigation into a dispute between Epic and Particle Health regarding the accessibility of patients' health data.

The results of the independent Dispute Resolution Process resolve the dispute, reinforcing "the integrity of Carequality's framework and the community's commitment to its collectively established principles of trust," the organization said in a statement.

The dispute revolved largely around who is able to access patient data and for what reason, as well as how to better protect that data.

Though this particular dispute is now resolved, Particle Trust's antitrust lawsuit against Epic is ongoing. Filed in September, the lawsuit accuses Epic of engaging in anticompetitive practices, using its control over electronic health records to further solidify its dominance in the payer platform market.

Epic has said the claims are baseless. Carequality is not involved in the ongoing lawsuit.

WHAT'S THE IMPACT?

The core of the patient data dispute centers on the compliance of Epic and Particle Trust with Carequality's Interoperability Framework, specifically regarding the accessibility and sharing of patient health information. The dispute raised concerns about whether all participating entities were fulfilling their obligations to provide access to data across various systems, as required by Carequality.

Upon review, the resolution panel found that Particle Health had failed to meet the expected standards for data accessibility, particularly in responding to information requests in a timely manner. The failure to provide access to requested health information within the specified time frame violated the Carequality framework, which emphasizes the seamless, real-time exchange of patient data among participants to improve efficiency and quality.

As part of the resolution, Particle Health was required to implement corrective measures, including system upgrades and policy changes to ensure future compliance. These measures included steps such as increased monitoring of data exchange activities, regular audits and mandatory training for staff to better understand the Carequality framework.

In the dispute, Particle Health accused Epic of blocking some of Particle's customers from accessing data – which is permissible under Carequality's framework if the decision is based on objective criteria, and applied consistently across all participants.

In response, Epic agreed to update its policies with more objective criteria, which will be used to determine if a Carequality-participating entity is in fact performing treatment. For six months, Epic will also be required to provide information demonstrating evidence of its compliance with these policies.

To monitor the implementation of these measures, regular audits will be conducted to ensure Particle Health is adhering to the prescribed changes and that data exchange activities align with the framework's standards. Carequality will maintain oversight to ensure that the network remains fully interoperable, and may issue periodic reports on compliance levels.

If compliance isn't met, Carequality has the authority to impose further sanctions. These penalties could range from financial repercussions to banishment from the network.

THE LARGER TREND

In the ongoing antitrust lawsuit, Particle Health alleged Epic took actions that stifled Particle's ability to exchange health information. Over the past six months, according to the suit, Epic cut off data access for Particle customers and flooded the company's support staff with security concerns Particle considered "baseless."

According to the lawsuit, Epic's "manipulation" of EHR access is already having negative consequences for doctors and patients. The complaint details how a network of community oncology practices has seen over 2,800 patients' quality of care harmed because clinical information was blocked.

This instance, said the complaint, "shows just how far Epic is willing to go to harm Particle: It is willing to cut its own customers off from vital patient data, risking the lives of the most vulnerable patients in the process."

Epic said in a statement that Particle's claims are "baseless."

"This lawsuit attempts to divert attention from the real issue: Particle's unlawful actions on the Carequality health information exchange network violated HIPAA privacy regulations," said Epic. "Particle's complaint mischaracterizes Carequality's decision, which in fact proposes banning Particle customers that were accessing patient data for impermissible purposes."

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.