Neither of those sound like good news for Oracle Health. After the lofty proclamations of the last couple years. still…
Particle Health Versus Epic Lawsuit Summary
Case Summary
Particle Health applies analytics to patient data that it retrieves from external sources to provide insights to payers, providers, and software developers. The company is suing Epic, accusing it of using its EHR market dominance to hinder competition in the payer platform market by blocking Particle’s access to essential medical records and by undermining its customer relationships.
Specific allegations include Epic cutting off access to Particle’s customers without reason, spreading false information about Particle’s security vulnerabilities, and delaying the onboarding of Particle’s new clients. The legal claims include antitrust violations under the Sherman Act, as well as tortious interference and defamation under state law.
Particle is asking the court to enjoin Epic from anticompetitive behavior and to compel it to pay damages to Particle.
Complaint Summary
Particle says in its federal antitrust lawsuit that it recognized in 2023 that payers are offering treatment-related services under value-based care arrangements, which it says constitutes data access for treatment purposes. It says that payers are then free to use the same data for secondary purposes under federal requirements.
The lawsuit centers around a 2023 incident when Epic learned that a Particle customer was sending data to Blue Cross Blue Shield of Michigan, after which Epic allegedly coerced clients into severing ties with Particle. By March 2024, Epic began cutting off Particle customers’ access to EHR data, offering to reinstate access only if they stopped using Particle’s platform.
Additionally, the complaint says that Epic spread false information in claiming that Particle improperly disclosed PHI and admitted wrongdoing, which the company denies. Epic also coerced its customers to overwhelm Particle with privacy-related inquiries.
Epic took the dispute to Carequality in accusing three Particle customers (not Particle itself) of misusing data, but the Carequality Steering Committee — where Epic holds influence — found the claims to be unfounded, although it still imposed a corrective action plan because of Epic’s powerful role.
Particle says that Epic’s actions caused its revenue to drop to one-third of projections and also harmed patients whose treatment information, specifically from the OneOncology network, was made unavailable to health systems.
Epic’s Response
“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. Particle’s complaint mischaracterizes Carequality’s decision, which in fact proposes banning Particle customers that were accessing patient data for impermissible purposes. Epic’s software is open and interoperable, allowing healthcare organizations to easily share data under HIPAA and all relevant regulations. Epic will continue to protect patient privacy and vigorously defend itself against Particle’s meritless claims.”
A previous Epic statement said that one of Particle Health’s customers is Integritort, which it says was identifying potential participants in class action lawsuits while claiming that it was retrieving data for treatment purposes. That company’s home page states, “Our advanced platform retrieves and analyzes real-time medical records, ensuring accurate and up-to-date information for each case. This not only minimizes the risk of fraudulent claims but also expedites the legal process, benefiting both plaintiffs and defendants.”
Most curious if individual patients (i.e. — those under One Oncology) consented to the Particle use of data? Did BCBS Michigan have authority without further patient consent/waiver?
Having represented vendors who have been handcuffed by Epic unwillingness to open APIs, etc; I can relate to their power and how frustrating it can be when health systems sometimes just need to create a benign integration. But when it comes to very specific PHI; this case may expose a nugget we don’t spend enough time exploring.
Is it possible that Epic’s closed system actually does protect patients?
This isn’t the anti-trust lawsuit that I wanted to see, but maybe it’s the one we need. Reading through the complaint, it’s pretty clear that Epic owns the railroad tracks and the trains (or at least controls their dispatch and destination). Health tech history is littered with companies that Epic’s killed by building competing software and natively integrating it into the platform. For the core clinical side, that’s been largely OK in the consumer’s eye — it’s often better tech, more easily accessed.
As Epic moves outside of core clinicals to everything from CRM and marketing to staff scheduling, and with Epic’s “you can integrate with us through one or two extremely specific pathways, and everything is considered our IP” approach, the argument gets a lot harder. My world is contact centers, and Epic has made it cost-prohibitive to realistically use any other platform than Cadence or Cheers for an agent to use when taking a phone call — integration, and IP restrictions, takes too much time and money for no real good reason, and it’s stifling any sort of innovation in the space; calling your doctor’s office is just as awful now as it was a decade ago, except they have decision trees.
Does Epic need to be broken up? I have no idea. But it does need to be broken open.
In my (not a lawyer) understanding of the claim, it all comes down to the question of whether Epic’s actions to stop responding to queries for data from Particle were justified.
If yes, then Epic was not acting anticompetitively. They were preventing a bad actor from continuing to take bad actions. If no, then Epic was acting anticompetitively.
I think that the argument that “payers who have value-based care arrangements are inherently providing ‘treatment'” is questionable and following that up with “therefore they can request any medical records they want, and once they have those records they’re allowed to data mine them for their own purposes” is downright terrifying.
I also think that “all of a sudden, a member of a network is making many more queries than a member their size normally would” should be treated with inherent suspicion from other members in the network. Quarantining that member pending investigation is a reasonable response.
I’m very curious about the claim of patient harm. Can Particle provide actual examples of patients who had their treatment negatively impacted by Epic’s decisions, or is this just a buzz word they’re throwing out there for their press release?
“whether Epic’s actions to stop responding to queries for data from Particle were justified.”
Carequality did not find Particle at fault. The six-month corrective action plan imposed by Carequality Steering Committee with no clarity or transparency may actually be seen by a jury (if this indeed goes to jury trial) as Epic using its influence with Carequality to punish a much smaller competitor.
Do you have a citation for this? I can’t find anything about this.
It’s about time people start bringing suits against Epic.
In any other part of the tech industry, Lena Khan is going after stuff even lesser than this. For whatever reason, they have not made healthcare as much of a priority.