A sign of the same name outside Epic's headquarters in Verona, Wisconsin.
Source: Yiem (via Wikipedia CC)
Patient data is inherently sensitive and valuable, and is protected by the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is a federal law that requires patient consent or knowledge for third-party access. One way to access Epic's electronic health records (EHR) is through an interoperability network called Carequality, which allows him to process more than 400,000 documents per month, according to his website for the company. will be easier to replace. Particle is a member of the Carequality network.
To join the network, organizations must be vetted and agree to adhere to clear “permitted purposes” for the exchange of patient data. Epic will respond to requests for data that fall under the permitted purpose of “Treatment.” This means the recipient is providing care to the person requesting the records.
Epic said in Thursday's notice that it formally partnered with Carequality on March 21, citing concerns that Particle and its participating organizations “may have misrepresented the objectives related to records searches.” He said he had filed a dispute. The company suspended its connection with Particle on the same day.
“This raises potential security and privacy risks, including possible violations of the HIPAA Privacy Rule,” Epic said in a notice obtained by CNBC.
CareQuality said in a blog post late Friday that it takes disputes “very seriously and is committed to maintaining the integrity of the dispute resolution process and authentic interactions within the framework.” The organization says it cannot comment on the existence of conflicts or the activities of its members.
Representatives for Epic and Particle did not respond to requests for comment.
Epic is a 45-year-old privately held company based in Wisconsin. The company is the largest EHR vendor by hospital market share in the U.S., accounting for 36% of the market, according to a May report from KLAS Research. Oracle ranks second with 25%, behind the software company's $28 billion acquisition of Cerner in 2022.
As of July 2022, Particle has raised a total of $39.3 million from investors including Menlo Ventures, Story Ventures, and Pruven Capital, according to the release. The New York-based startup said at the time that its technology “uniquely leverages data from the medical records of more than 270 million patients by aggregating and consolidating medical records from thousands of sources.” “We will combine.”
Epic said Particle introduced thousands of new participant connections to Carequality in October, claiming they fall under the treatment use case. In the months that followed, all of Particle's participating organizations claimed authorized therapeutic purposes for their requests, Epic said.
But Epic started noticing some red flags. The company said it observed anomalies in patient record exchange patterns, including requests for large numbers of records within certain geographic areas. Additionally, Epic said the companies associated with the particles have not returned any new data from patients, which “suggests non-therapeutic use cases.”
Epic and the Care Everywhere Governing Council, made up of 15 industry representatives, evaluated Particle's new participant connections and concluded that organizations such as Integritort, MDPortals, and Reveleer, which acquired MDPortals last year, are “compliant for treatment authorization purposes.” It is highly likely that they did not.” said the notification.
Epic said it has learned that another Carequality member plans to challenge Integritort's use of patient data to identify potential class action participants. On March 28, Epic discovered that a participant named Noveria claimed to be requesting records of his treatment, even though it had publicly advertised its product as a “personal health tool.” Announced.
Integritort, Reveleer and Novelia did not respond to requests for comment.
Epic said it has filed a formal complaint with Care Quality following the Governing Council's recommendation. According to the notice, Epic asked Particle on April 4 to provide additional information to explain how participants qualify for the treatment use case.
Michael Marchant, director of interoperability and innovation at UC Davis Health, chairs Epic's governing council. He said it's difficult to know exactly why Particle provided records to these organizations or whether it intentionally engaged in fraudulent activity. But he said companies must act responsibly even when pressured to deliver financial results.
“If they're selling to something we know is not a therapeutic organization to meet VC funding, margins, revenue goals, that's really bad,” Merchant said in an interview with CNBC. ” he said. .
In a statement on LinkedIn Wednesday, Particle founder Troy Bannister said Epic acted unilaterally and that Particle sees “rationality, legitimacy, and public arguments” surrounding these issues. No, he said.
Bannister wrote that to the best of the company's knowledge, “all affected partners are directly supporting treatment.” He said these organizations pull data for care providers and share data with the Carequality network.
“While we continue to maintain our connection to care quality, the ability of a single practitioner to make the decision to disconnect large-scale healthcare providers without evidence or warning is limited by the ability of a single practitioner to disconnect hundreds of thousands of providers. “Not only does it jeopardize clinical operations for patients, it also jeopardizes trust in the quality of care, which is critical for transactions based on trust,” Bannister wrote.
Bannister did not respond to Epic's April 4 request for additional information.
Formal dispute proceedings are still ongoing. Merchant, who also co-chairs the Care Quality Advisory Committee, said this is the first time in the network's history that complaints have reached this level.
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