Carequality today announced the resolution of its independent Dispute Resolution Process relating to the disputes between Particle Health and Epic, two members of the Carequality community. The resolution reinforces the integrity of Carequality’s framework and the community’s commitment to its collectively established principles of trust. Carequality, a 501(c)(3) non-profit interoperability framework, is releasing the resolution and a summary of its process below.
The resolution, which both Epic and Particle Health have accepted, is the result of a thorough and robust process. A panel of Carequality community members and external subject matter experts reviewed claims made by Epic and Particle Health relating to each other’s participation in Carequality. Each party provided confidential information and documentation, which they believed supported their claims, and advocated for their positions in meetings with the panel. The panel provided its Recommendations for Resolution to the Steering Committee, the Carequality framework’s governing body, and the Steering Committee adopted and accepted those recommendations.
We remain dedicated to maintaining the trust instilled in our interoperability framework and protecting sensitive patient information. We take any potential misuse of health data exchanged under our framework seriously, and we act to address any threats to the integrity of the system. The resolution of these Disputes not only affirms the effectiveness of our framework but also highlights our steadfast commitment to advancing interoperability while protecting patient data.
Note on the public release of the Final Resolution
The public version released by Carequality contains appropriate redactions to preserve the confidentiality of information from parties who have contributed to the process. Epic and Particle Health have consented to the public release of the full resolution, however other parties have not consented to the release of their confidential information. Carequality must maintain the trust of all who have participated in the process even as it ensures transparency.
Summary of dispute resolution findings
Epic claimed that three customers of Particle Health were submitting queries through Carequality indicating that the queries were for treatment purposes when they were not. Two of those customers were found to have submitted queries that may 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 Carequality Connections.
Resolution: These two entities are prohibited from participating in Carequality for another 12 months for any Permitted Purpose supported by the framework, including treatment. Following the 12 month suspension, the affected organizations are not allowed to rejoin Carequality without the explicit approval of the Steering Committee.
The third customer in question could be engaging in exchange through Carequality for treatment purposes. This customer serves as a Business Associate of healthcare providers.
Resolution: Particle Health agreed to secure additional written documentation from its customer to confirm that its customer has documentation of the relationships related to the healthcare providers for whom it provides services.
The Carequality Steering Committee evaluated whether Particle Health met its obligations as a Carequality Implementer by conducting sufficient diligence on the three customers in question before approving and onboarding them to Carequality. It appears that Particle Health did conduct diligence for onboarding purposes on each of the three customers although this diligence activity failed to reveal inaccurate information provided by each customer.
Resolution: Particle Health has agreed to a corrective action plan for a period of six months to confirm that Particle is following Carequality’s processes, including onboarding diligence, to prevent future issues with customers utilizing Carequality.
Epic claimed that Particle Health was “masking” the identity of its customers behind the Particle Health gateway. This claim highlighted differences in interpretation of certain Carequality technical requirements. With the assistance of a subject matter expert, it was demonstrated that Particle Health was not using a “masking gateway.”
Resolution: This resolution provides the parties, and all those who participate in Carequality, with additional clarity on technical requirements.
Particle Health claimed that Epic violated Carequality anti-discrimination rules by failing to engage in exchange with certain Particle Health customers. Epic’s decision to not exchange with certain Particle Health customers is generally permissible under the Carequality Interoperability Framework provided that Epic bases its decision on objective criteria that are applied consistently across all those who participate in Carequality.
Resolution: Epic has agreed to update its policies to include clear, objective criteria to be used by Epic to determine whether Epic believes an organization participating in Carequality is performing treatment and, for a period of six months, to provide information to Carequality to confirm that it is acting in accordance with these policies.
Much has been learned by the Carequality community in undergoing the first Dispute Resolution Process since our founding ten years ago. Following the conclusion of this process, we will undertake two immediate steps to strengthen our Framework. First, the community will retrospectively evaluate how the Dispute Resolution Process may be improved. Second, the Carequality Board of Directors and Steering Committee have already initiated new compliance monitoring and auditing processes to assist in pro-actively identifying potential future issues before a dispute arises and enhance the Carequality Directory. These steps are in addition to other recently announced steps to enhance our framework.
The final resolution with limited redaction is available now.
About Carequality
Carequality’s commitment to improving patient care is evident in the organization’s ability to facilitate the exchange of over one billion documents monthly. From our founding 10 years ago, we have been driven by a focus on community and patients, ensuring that they continue to benefit from the trusted exchange of health information.
As a cornerstone of interoperability for the nation, Carequality’s framework continues to play a vital role in facilitating the secure and efficient exchange of patient data. We are committed to driving innovation and improving patient outcomes, which is why Carequality is evolving to meet the needs of our dynamic community now, while making a plan to converge with the federally-endorsed Trusted Exchange Framework and Common Agreement (TEFCA) in the future.
About the Dispute Resolution Process:
The Carequality community is a diverse group of stakeholders that have developed and agreed to the Carequality Interoperability Framework, which is a collection of legal, governance, and technical documents that are used to operationalize the trusted exchange of health information nationwide. The framework agreed to by the Implementers and their Connections includes the Dispute Resolution Process to address any controversies or disagreements that may arise out of the interpretation or implementation of the framework. See our high-level overview of the process here.
This is the first time that an Implementer has formally invoked the Dispute Resolution Procession during the last ten years of health data exchange, highlighting the overall stability and resilience of the framework. While the process has proven to be effective, Carequality recognizes the importance of assessing the process retrospectively to consider if any enhancements would be beneficial.