Carequality releases resolution for Epic and Particle dispute

Nonprofit interoperability framework Carequality has released a redacted version of the Steering Committee's dispute resolution between Particle Health and Epic, two members of the Carequality network.

The resolution, which both Epic and Particle Health have accepted, is the result of a thorough and robust process, Carequality noted in a press release.

The public release of the resolution comes following Particle Health's antitrust lawsuit last month, which alleged that Epic is using its market dominance to bar competition in the payer platform market.

In a statement released shortly after Particle Health filed the lawsuit, Epic called on Carequality to release the dispute resolution.

A panel of Carequality members and external subject matter experts reviewed claims made by Epic and Particle Health regarding each other's participation in Carequality to reach the resolution. Each party provided confidential information and advocated for their positions in meetings with the panel.

The panel provided its recommendations for resolution to the Steering Committee, and the Steering Committee adopted and accepted those recommendations.

Carequality outlined a summary of dispute resolution findings:

• Epic claimed that three customers of Particle Health were submitting Carequality queries indicating that the queries were for treatment purposes when they were not. Carequality found that two of those customers submitted queries that might have been based on signed authorizations but were not intended for treatment purposes, at least in certain instances. In June 2024, Particle Health informed the panel that it had terminated its contractual relationships with these two organizations. Based on Particle's termination, the entities are no longer part of Carequality. The resolution prohibits the two entities from participating in Carequality for another 12 months. After the 12-month suspension, the affected organizations are not allowed to rejoin Carequality without the approval of the Steering Committee.
• The third customer, acting as a business associate for healthcare providers, might be legitimately using Carequality for treatment purposes. Particle Health agreed to secure additional documentation from this customer to confirm its relationships with healthcare providers.
• The Carequality Steering Committee evaluated Particle Health's diligence in onboarding these customers and found that, although diligence was performed, it failed to detect the inaccurate information provided by each customer. Particle Health has agreed to a corrective action plan for six months to confirm compliance with Carequality's processes, including onboarding diligence, to prevent future issues with customers using the Carequality health information exchange (HIE) network.
• Epic claimed that Particle Health was "masking" the identity of its customers behind the Particle Health gateway, a claim that highlighted differences in the interpretation of certain Carequality technical requirements. A subject matter expert confirmed that Particle Health was not using a "masking gateway."
• Particle Health claimed that Epic violated Carequality antidiscrimination rules by failing to engage in exchange with certain Particle Health customers. Epic's decision not to exchange with certain Particle Health customers is generally permissible under the Carequality framework, if Epic bases its decision on objective criteria that are applied consistently across all those who participate in the HIE. Epic has agreed to update its policies with clear, objective criteria to be used to determine whether Epic believes an organization participating in Carequality is performing treatment. For six months, Epic will provide information to Carequality to confirm that it is acting in accordance with these policies.

Carequality officials said the organization will undertake two immediate steps to improve its framework.

First, the Carequality community will retrospectively assess how the dispute resolution process may be improved.

Second, the Carequality Board of Directors and Steering Committee have begun new compliance monitoring and auditing processes that aim to proactively identify potential future issues before a dispute arises and enhance the Carequality directory.

Hannah Nelson has been covering news related to health information technology and health data interoperability since 2020.