You know why I’m interested in the Particle v Epic EHR (electronic health record) systems lawsuit? It’s because … data. Say I’m thinking about this like, say, a plan sponsor and I want data so I can do better population health or do care navigation to help my members avoid downstream bad things or steer and tier to high-quality docs and point solutions and, and, and …
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To do anything that has anything to do with population health, I need data. And when I say data, we often think claims data as plan sponsors; and we think about getting it from carriers. But where does the claims data originate? Oh, right … the gleam in the eye of a lot of claims data is EHR data. Someone typed something into an EHR system that metamorphosized, ultimately, into a claim that wound up in a carrier’s dataset.
Plan sponsors want the claims part of the claims data, obviously, to see prices; but they also want those underlying data elements that indicate the health of their members. Said another way, they want the insights gleaned from some clinician somewhere who typed something into an EHR system that turned into codes that drove claims.
So, yeah … Particle v Epic. Particle was getting EHR data and passing it on to other parties, and we get into the what’s and the who’s and the commentary. But bottom line, what I wanted to get into today is this: Will this lawsuit result in more access to data for downstream entities who need it, or less?
What are the implications here of Epic shutting down access to its EHR data to Particle and Particle filing an antitrust lawsuit saying Epic did this because Epic wanted to use their monopoly power here to advantage their own payer platform business?
Oh, the plot thickens. Payer platform business? For an EHR system. What is that exactly? More intrigue. What’s going on there? Because, yeah, probably a lot of plan sponsors and patients are, I’m gonna say, unaware of this part of the equation as to what data the carriers seem to have and where are they getting it from and what things they may be doing with it that plan sponsors and/or members who are their customers may or may not be aware of.
Knowledge is power here, especially in the fight over trying to get data out of carriers who won’t hand it over when the carriers themselves are getting that data through interoperability networks that potentially plan sponsors also qualify for. Chucking that in there as a point to ponder.
This whole “I’m intrigued” bit here, though, was not rhetorical. I really am/was intrigued—so intrigued, as a matter of fact, that I called Brendan Keeler to come on the pod and talk this out with me.
Brendan, by the way, has written a very detailed account of the Epic/Particle dustup. There is a part one and a part two.
Before we kick in here, though, I did just want to make at least one point on background.
First, so many, many people want to get their mitts on EHR data for good reasons and maybe not-so-good reasons from the standpoint of the patients whose personal health information is being fought over here. The basic rule is that to get EHR data, you have to be involved in the treatment of the patient.
So, this is the current governance as it stands. You have to be involved in the treatment of the patient if you want EHR data. So involved in the treatment, actually, that you have to have your own treatment data to share back. This is called reciprocity, right? Like, how can you say that you’re treating a patient if then you don’t have any data as to that treatment?
On-site clinics, by the way, are providing treatment—just saying, in case anybody is thinking the same thing I’m thinking right now. Okay, back to the lawsuit.
The real kicker of this whole Particle v Epic and Epic cutting off Particle thing, as far as I’m concerned, is over the secondary use of said treatment data once someone gets it (ie, someone gets EHR data transmitted to them because they are doing something or other to treat the patient, but now they have that data). And at that point, is it a free-for-all what they do with it? Can they, I don’t know, sell it to anyone they want?
Said another way, what if I realize I need EHR data for, I don’t know, I’m a lawyer trying to do lawyer things or I’m public health entity or whatever. It doesn’t matter. If I throw a medical professional in a room and cook up something this person is doing, that could be considered treatment if you squint at it. Tricky, right? Now I can get EHR data.
So, yeah … there’s that motto “If you ain’t cheatin’, you ain’t tryin’,” which Pryce Ancona said, ironically, on Health Tech Nerds the other day; and I cracked up. But it’s so not funny. Because you have some people—maybe or maybe not—kind of violating, let’s just say, the spirit of the endeavor. And then you have others who really, really need the data to do something really, really good who can’t get it. Is this because of a monopoly entity doing monopoly antitrust stuff? We discuss, but massive spoiler alert, where this conversation is going is, okay, so does this lawsuit ultimately make it easier or harder to get data for righteous good reasons?
And Brendan Keeler suggests this case, this lawsuit, actually could be a good thing because what it will do at a minimum is pave the path to get data and really delineate a good use case from some of this profit motivated back-and-forth where patient information is getting fought over and the patient has little to no control over what goes on and neither do plan sponsors. He uses the term increased data liquidity, which is a term I think I will heretofore adopt because it will make me sound smart. Data liquidity.
Lastly, lastly, lastly here, just as context in case anyone indulges in further reading and winds up confused, there are so-called interoperability frameworks out there, such as Carequality or CommonWell or eHealth Exchange. These interoperability frameworks are also in this mix.
We do not have all day, and thus we don’t get into these in the conversation that follows. But just be aware, they’re on and about the scene. For the full skinny on what interoperability frameworks are and do, listen to episode 376 with Lisa Bari, MBA, MPH.
Brendan Keeler, my guest today, as a matter of fact, is on the steering committee of the Carequality interoperability framework. Brendan Keeler has had a long history in this whole exact space, so he was the perfect guest to dig in on this topic in a really well-balanced way, I’m gonna say. Brendan is currently the interoperability and data liquidity practice lead at HTD Health.
Also mentioned in this episode are HTD Health; Pryce Ancona; Lisa Bari, MBA, MPH; Health Tech Nerds; and Tom Nash.
You can learn more at HTD Health and by following Brendan on LinkedIn.
You can also sign up for his Health API Guy newsletter on Substack.
Brendan Keeler is the Portland-based interoperability practice lead for HTD Health, a leading strategic consultancy and development agency. He provides subject matter expertise and executive partnership for all projects related to integration, interoperability, and connectivity, working with digital health, tech-enabled care, payers, providers, pharmaceutical clients, and more. He previously held product positions at Epic, Redox, Zus Health, and Flexpa. He also advises digital health start-ups and authors Health API Guy, providing analysis on industry trends in interoperability and health tech regulation. Reach out to contact him here or via social media.
07:21 Who can gain access to EHR data?
10:31 Are there limits to how EHR data can be used secondarily?
11:36 Can EHR data be shared secondarily?
15:47 Part one and part two of Brendan’s comprehensive account of the Epic/Particle dustup.
15:57 What was the dispute that started Epic v Particle?
18:21 What are the two viewpoints in this dispute with Epic’s actions?
26:16 What progress has been seen since this lawsuit began?
28:00 Who else will be impacted by the likely rule cementing from this lawsuit?
Recent past interviews:
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Claire Brockbank, Cora Opsahl, Dan Nardi, Dr Spencer Dorn (EP451), Marilyn Bartlett, Dr Marty Makary, Shawn Gremminger (Part 2), Shawn Gremminger (Part 1), Elizabeth Mitchell (Summer Shorts 9), Dr Will Shrank (Encore! EP413), Dr Amy Scanlan (Encore! EP402)
