Epic EHR monopoly violates federal antitrust laws, hurting business and patients, lawsuit says

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Electronic health record (EHR) giant Epic Systems Corp. has created a monopoly that bars competitors from entering the market, according to a new lawsuit.

Epic called the claims baseless and said the legal complaint is a cover for another company’s failings.

The legal battle sparked when Particle Health filed a federal antitrust lawsuit claiming Epic controls health information of up to 94% of Americans. That power has blocked Particle Health from entering the fledgling payer platform market. It is “just one example of Epic plotting to ‘snuff out’ competition in new markets that leverage medical records,” according to Particle Health’s announcement about the case.

“Epic Systems controls the medical information of nearly every American – meaning one private company has unchecked power over our health care,” Particle Health CEO Jason Prestinario said in the news release. “Now, Epic is using that power to thwart an emerging industry intended to bring payers and providers into closer collaboration for better patient care.”

Particle Health is seeking unspecified financial damages, along with a declaration under federal law that

Epic rebuts

The case is unfounded and is a diversion from Particle Health’s “unlawful actions” that violated the federal Health Insurance Portability and Accountability Act (HIPAA), an Epic representative said in a statement to Medical Economics. The Epic statement referred also to the companies’ dispute as they both worked with the Carequality health information exchange.

“Particle’s claims are baseless,” the Epic statement said. “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 health care 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.”

Rise of ‘pay-viders’

Epic is a massive monopolist in the EHR software market, with an estimated up to 94% of patients having at least one record stored in an Epic EHR, the lawsuit said. It is hugely expensive, promising efficiencies, streamlined process and cost savings, but also stamping out competition while generating billions of dollars for Epic, according to Particle Health.

Now Epic is attempting to control payer platforms, which are new software platforms for health insurance providers to request, retrieve and store large numbers of medical records. Health insurers previously obtained those records through a cumbersome, manual process, according to Particle Health.

Epic released its Epic Payer Platform in 2021. Any hypothetical competitor that could not access records in Epic EHRs would be “dead on arrival,” the lawsuit said.

Particle Health solved that issue, creating a record retrieval service that could interface with Epic and other EHRs. Meanwhile, value-based care began growing in the U.S. health care system and insurers became “pay-viders” offering some treatment-related services to patients and physicians, according to Particle Health.

The pay-viders needed some medical records, which thus opened the door to competition in the payer platform market, the lawsuit said. “As the first company to introduce viable competition to the payer platform market, Particle was on a meteoric growth path,” the company’s complaint said.

Epic strikes back

When Epic realized it, the company “used a multi-tentacled approach to try to squash Particle,” the news release said.

“Over the past six months, it has cut off access to data for Particle’s customers, lobbed now-discredited complaints, and overwhelmed Particle’s support operations by stoking baseless security concerns,” Particle’s news release said. “Absent repercussions, Epic will be incentivized to run this playbook again the next time a competitor emerges.”

Epic filed a formal complaint with Carequality, the interoperability network that worked with both companies. Epic made a different claim: that Particle Health and its participant organizations “might be inaccurately representing the purpose associated with their record retrievals,” according to a CNBC report. Epic suspended its connection with Particle Health on March 21.

“This poses potential security and privacy risks, including the potential for HIPAA Privacy Rule violations,” Epic said in the notice, which CNBC obtained and cited in its report.

Effects on patients

The problems go beyond screen time and computer communications, according to Particle Health. The company’s news release said its lawsuit outlines how Epic allegedly blocked doctors’ access to records of more than 2,800 patients in a network of community oncology practices.

“Our health care system stands at a crossroads,” Prestinario said. “Timely and complete medical information is critical to effective care. Regrettably, Epic is hoarding the data, showing how it can rapidly seize control of all markets that depend on the clinical records that rightfully belong to patients.”