Everything You Need to Know About the Particle vs. Epic Lawsuit

Particle made news this week when it filed its antitrust lawsuit against Epic, alleging anticompetitive behavior in the payer platform category. We sat down with Elion advisor and interoperability expert Brendan Keeler to unpack the claims in the suit as well as potential ramifications.

Here, we’re breaking down a timeline of the events that led up to this suit:

Epic became widely distributed as the dominant EHR system over the 2010s, reaching 81–94% of the U.S. population with at least one record in Epic by the 2020s. The large scale of individual deployments implies high switching costs, and Epic adds other services to increase value and further raise these costs.

In 2021, Epic implemented the Epic Payer Platform (EPP), which grew to become the dominant payer platform (i.e. a system for payer access to medical records). Other players could not compete effectively because Epic did not have to provide them with records, as they were not related to a “treatment” Purpose of Use (PoU). Although the 21st Century Cures Act and subsequent rules were passed in 2016 and 2020, Epic was not technically engaging in information blocking because other payer platforms lacked a protected PoU.

In 2023, as care shifted to value-based models and payers became “payviders” (entities that both treat and pay for the populations under their care), Particle shifted to providing a payer platform rather than a provider-focused platform, using the “treatment” PoU to legally request EHR records from Epic. After requesting records for treatment purposes, these records could also be used for “healthcare operations” purposes. Particle began acquiring customers for its payer platform and became a legitimate competitor to Epic.

In the Spring of 2024, Epic responded by cutting off access to Epic-stored health records for Particle’s customers without prior notice. These customers included both traditional healthcare providers and payers, who lost access to key medical records affecting both treatment and operations. Particle sued with the following complaints:

• Epic required manual approval for new Particle customers or expansions to access Epic-stored data—a practice exclusive to Particle’s customers—which often delayed onboarding by over a month.

• Particle alleges that Epic told some of its customers that their access to Epic EHR data would be restored only if they ceased their relationship with Particle. As a result, XCures, previously a Particle customer, ended its contract.

• Particle claims that Epic damaged its reputation by implying that Particle posed security and privacy risks.

• Finally, Epic initiated a dispute against Particle within Carequality, alleging misuse of the “treatment” PoU by Particle’s customers. Carequality found no wrongdoing by Particle but imposed a “corrective action plan,” potentially as a result of Epic’s influence.

• In response, Epic issued a statement calling on Particle to ask Carequality to release its resolution.