FTC opens antitrust probe into Epic, the company that holds your medical records

The FTC's inquiry into Epic is not two separate investigations that happen to share a defendant. It is a probe into one architecture of control, according to three people who work in or advise health-care businesses that interface with Epic and were recently contacted by investigators.

Epic is the largest vendor of electronic health records in the United States. Its software holds the medical histories of millions of Americans at most of the country's largest and most influential hospitals, which are also among Epic's longest-standing customers. Federal investigators are now examining whether Epic has used that position in two ways: through non-compete-style agreements that bar employees from joining a wide swath of competing health-care businesses, and through hospital contracts that block rival technology companies from accessing the patient data and clinical information those companies need to run their businesses, according to STAT News, which first reported the inquiry.

The first line of inquiry targets the non-compete-style provisions themselves, which former Epic employees have described in private lawsuits as unusually broad for the sector. The second targets the data-access terms inside Epic's hospital contracts, the clauses that govern which third-party tools and integrations Epic will allow its hospital customers to use. Rival health-tech companies that build clinical decision support, billing, scheduling, or telehealth integrations on top of electronic health records have spent years arguing that those clauses effectively give Epic veto power over who gets to operate in a hospital's digital environment.

The two grievances look separate until the architecture is named. The same hospital contracts that lock former Epic employees out of competing health-care jobs, by limiting where they can work next without legal risk, are the contracts that govern which rival technology vendors get access to the patient data and clinical information they need. The chokepoint is the contract, and the question is what that contract is allowed to do.

State attorneys general across the country have joined the calls in parallel, according to the same sources, or have separately reached out to private lawyers for information. The state offices involved have not been named publicly. The subjects who described the contact said the federal investigators do not appear close to filing charges and that the inquiry may continue for several years. They also said the intensity of interest and the number of entities involved has been ramping up in recent months.

Epic is Wisconsin-based, and its main product remains the EHR software used by most of the largest U.S. hospitals. It has also branched into businesses serving health insurers and other large health-care entities, a move that broadens the universe of potential competitors whose employees could be affected by the non-compete provisions and whose products could be affected by the data-access terms.

The practices under investigation have generated continual complaints and lawsuits from former employees and rival companies over the years. The federal inquiry is the first public signal that regulators are testing whether those structural complaints add up to an antitrust case.

Asked for comment, an Epic spokesperson did not affirm or deny being contacted by the FTC. The company pointed to its work on interoperability, the technical ability for different systems to exchange and use patient data, in a written statement. "We are leaders in interoperability and do not engage in anticompetitive behavior," the spokesperson said.

The probe is at an early stage. The subjects who described the investigators' questions said the FTC is still in the information-gathering phase, and the inquiry could end without charges. The FTC is now treating the workforce question and the data question as one.