It is now 2020. Many of us enjoy amazing capabilities such as video streaming and driverless vehicles, brought to us by improved connectivity and artificial intelligence. There is still not healthcare interoperability though. There are many technology companies that are trying to address the healthcare interoperability shortcomings in different ways. Two, in particular, Health Gorilla and Particle Health, have solutions based on information-sharing networks. They aim to fill the gap by making patient health records accessible as needed to patients, providers, and other entities in the healthcare ecosystem. We wanted to better understand their similarities and differences as well as how they compare or relate to Health Information Exchanges (HIEs).

We did some investigating, but there isn't much information on the web about these companies apart from the information they provide on their websites. Particle Health states that they "build the infrastructure that allows patients and consumers to share their medical information with trusted solutions on the web". Health Gorilla states that they are "a secure interoperability solution that enables the entire healthcare ecosystem – patients, payers, providers, digital health solutions, and labs – to seamlessly share health data and aggregate each patient's entire clinical history in one place." From their value proposition, it seems they are both in the business of establishing connections between all of the entities through their service. To accomplish this, the companies must navigate complex challenges of interoperability; standards, regulation, finance, legal obstacles, and making agreements to pull data from thousands of providers.

Financial models vary between the companies. Particle Health says their service starts at $500/month for provider access to patient records, but free for patients to access their own records. Health Gorilla uses a per patient per month model, starting at 50 cents for providers with under 50 patients, graduating to 30 cents for those with more than 100. We wonder, in the per-patient pricing, if there is an incentive for providers to put all of their patients on the Health Gorilla service. Will it matter that some patients are long term and others only come in for one visit? Is this an advantage for the blanket fee model?

It is not clear what relationship either company will have with selling aggregated, de-identified data. If they control the transmission of the data, there is the possibility that they could sell to third parties, tapping into the lucrative data aggregation market. Health Gorilla has a history of working with Apple on consumer access to health information, and they have an app in the Apple Store, but little is said about the current state of the relationship. A relationship with Apple could signal a greater commitment to patient privacy, as Apple has been establishing itself as the company that cares about privacy.

Both companies proclaim a strength in their networks and sound similar to the concept of a health information exchange (HIE). If you aren't familiar with HIE's, they are regional networks of institutions and providers. The main difference between the two models is that HIE is enabled and receives funding from statewide grants provided by the Office of the National Coordinator for Health Information Technology (ONC). The two connectivity companies are private as far as we can tell, with no federal funding. Some HIEs also store data for providers in their network at a central location in addition to the transmission of the data. Neither company mentions offering storage capabilities, just a connection between entities. Particle Health states that their network includes exchanges. Does this mean they are a larger version of an HIE?

The model of using networks seems to be the limiter for these companies. If records are requested from a provider who is not in-network, does the company provide means to access those records? If so, how much time does it take to get records from out of network providers? Do they offer to transmit data out of the network? Would that work against their business model? If out-of-network data access is supported, is there an additional cost? Would the absence of this feature constitute data blocking? Particle Health touts access to 90% of acute EHR's in the U.S. It appears that their strategy is to start with a focus on inpatient data and build their network from there. There is a benefit to this strategy, having the most critical information available in the most critical situations. The underlying question is will either company tap into the network effect and pass the tipping point where their reach is undeniable?

Researching these companies and their solutions led us to other solutions and new legislation from the ONC called TEFCA (Trusted Exchange Framework and Common Agreement) that may impact the operation of these companies. We will look into this in our next post.