Episode Summary

Particle Health CEO Jason Prestinario joins MedCity Pivot to assess the state of U.S. healthcare interoperability with clear-eyed candor. He grades the technical infrastructure a B — data can move — but gives access governance a C, because the rules around who uses data, and how, remain murky and poorly enforced. Jason draws a direct line between true interoperability and the viability of value-based care: without frictionless data access, accountability for patient outcomes is impossible.

The conversation also covers Particle's antitrust lawsuit against Epic, now past its first major legal hurdle, and the broader wave of litigation challenging Epic's market dominance. Jason urges nuance: there's a meaningful difference between patients authorizing their own data use and bad actors harvesting records without consent — and conflating the two risks setting back the entire data-sharing ecosystem.

Key Takeaways

The data infrastructure gets a B — but access governance is still a C. The technical pipes for moving health records exist, but who can use them, when, and for what purpose remains the critical unsolved problem.
Interoperability is a 'nice to have' in fee-for-service care — but it's a hard requirement for value-based care. When a provider is accountable for outcomes that happen outside their four walls, they need data from outside those walls.
Information blocking penalties need teeth. Until healthcare organizations believe violations will result in real consequences, the rules won't change behavior — just like speed limits only work when drivers believe tickets are real.
There's a critical distinction between patients authorizing their own data use and third parties accessing data without consent. The current Epic lawsuit debate conflates two very different scenarios that deserve separate legal and regulatory treatment.
True patient data ownership is still largely a myth. Despite portals and progress, patients still face significant barriers — forgotten logins, provider-controlled systems — to accessing their own medical records programmatically.

Links and Resources

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Keywords

healthcare interoperability, Particle Health, Jason Prestinario, Epic lawsuit, antitrust healthcare, value-based care, CMS interoperability, TEFCA, Carequality, health data access, information blocking, 21st Century Cures Act, patient data ownership, HIPAA compliance, health information exchange, payer interoperability, digital health data, EHR data sharing, CommonWell, ONC rules

Episode Highlights

[00:04:22 - 00:05:16] Jason grades the interoperability 'pipes' a B-plus but gives data access governance a C at best.
[00:10:56 - 00:12:37] Interoperability shifts from 'nice to have' in fee-for-service to a hard requirement in value-based care.
[00:17:05 - 00:19:27] Jason explains why Particle sued Epic and what the case means for the broader healthcare data ecosystem.
[00:25:11 - 00:27:11] A key distinction: patient-authorized data use versus unauthorized third-party data harvesting.
[00:28:34 - 00:32:44] Why patients still can't easily access their own records — and what it would take to change that.
[00:29:02 - 00:29:41] Information blocking penalties only work when organizations believe the consequences are real.