A startup has filed an antitrust lawsuit against Epic Systems alleging that the company is leveraging its position in the EHR market to stifle competition in the payer platform sector.
Particle Health, an intelligent data platform that aggregates and delivers actionable patient data and insights to healthcare companies, filed the lawsuit Sept. 23 in the U.S. District Court for the Southern District of New York. The lawsuit alleges that Epic is stopping Particle from entering the emerging payer platform market.
"Epic Systems controls the medical information of nearly every American — meaning one private company has unchecked power over our healthcare," Jason Prestinario, CEO of Particle, said in a news release shared with Becker's. "Now, Epic is using that power to thwart an emerging industry intended to bring payers and providers into closer collaboration for better patient care."
Here are seven key points to know about the lawsuit and the history between Epic and Particle:
- The lawsuit accuses Epic of violating the Sherman Act, a U.S. law designed to prevent unfair competition. Particle alleges that Epic has limited its access to patient records within the Carequality network over the past six months to block the company's entry into the payer platform market. Carequality is a nationwide health information exchange framework that allows participating organizations to securely share data. In recent months, Epic has raised concerns that Particle and some of its participating organizations may have been misrepresenting the reasons behind their record retrievals, prompting Epic to block some of them from using Carequality to access patient medical records.
- Additionally, Particle alleges that Epic has made false complaints about the company and overwhelmed its support team with "unfounded security concerns."
- Particle's lawsuit is asking for unspecific financial damages and a court order to make Epic stop these practices.
- In response to the lawsuit, an Epic spokesperson told Becker's 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," the spokesperson told Becker's. "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."
- This legal battle follows Epic's actions in March, when it filed a formal complaint with Carequality, alleging that Particle misrepresented its reasons for retrieving patient records. Organizations in the Carequality network must follow specific rules, mainly related to patient treatment, for data exchange. Under HIPAA, patient data is protected, requiring their consent or knowledge for third-party access. After reviewing the situation, Epic told CNBC in April that its customers requested that the company block a small number of groups from using Particle's Carequality connection to access their data. Particle, however, claimed that access to its data was not fully severed at that time and refuted Epic's claims.
- Epic also filed a similar complaint against Integritort, a company providing medical record analyses for legal cases. According to Politico, Particle Health also suspended Integritort from its platform in March, stating that it had found evidence showing the company was making data requests unrelated to patient treatment.
- Epic holds the largest market share for digital health records in hospitals. In 2023, Epic covered more than half of all U.S. acute care hospital beds, expanding its lead in the hospital market to 39.1%, according to KLAS Research (Oracle Health came in second at 23.1%). Additionally, Epic added 19 new health system clients at its annual Users Group Meeting in August, bringing its revenue to $4.9 billion for 2023.