With the health information technology landscape increasingly shaped by high-stakes legal and political battles, we sat down with Faisal Zain, a leading expert in medical technology and Health IT innovation. We explored the complex dynamics of market competition, data interoperability, and patient rights through the lens of a significant antitrust lawsuit. Our conversation delves into how a major EHR vendor defends its market position, the nuanced roles of technology companies versus healthcare providers in managing patient data, the business strategies behind API access, and the future of litigation in this rapidly evolving field.
The Texas Attorney General alleges that large EHR systems can create monopolies that freeze out competitors. How can an EHR company demonstrate that its market success stems from innovation rather than anticompetitive practices? Please share specific examples of product developments that address customer needs.
That’s the core of the debate, isn’t it? A company in this position has to show its work, to prove that its market share was earned, not unfairly captured. The strongest defense is a relentless focus on the customer and the patient. You can’t just say you’re innovative; you have to point to the tangible results. For instance, creating a patient-facing application like MyChart isn’t just a feature; it’s a direct response to the need for patients to be more involved in their own care. It allows them to communicate with their doctors and monitor their family’s health, all with the goal of helping people get well and stay well. It’s about building a better product, not a bigger wall. This kind of success, rooted in an unwavering goal of improving patient outcomes, is the story a company must tell, backed by a history of constant product evolution based on direct feedback from the healthcare providers using the system every day.
A key claim in the lawsuit suggests an EHR vendor is undermining parental rights by controlling access to children’s medical records. What is the typical role of a vendor versus a healthcare provider in setting these proxy access policies? Could you walk me through that decision-making process?
This is a critical point of misunderstanding that gets tangled in political rhetoric. The EHR vendor is the software developer, the architect of the digital filing cabinet, but they are not the librarian. The medical records themselves belong to the patient, and the healthcare provider—the hospital or clinic—acts as the legal custodian of that data. It is the provider, guided by state and federal laws, who establishes the policies for who can access what information and when. The EHR company provides the tools and the configuration options, but the final decision rests squarely with the healthcare organization. They are the ones who must navigate the sensitive legal and ethical lines of parental access versus adolescent privacy. To suggest a software company in Wisconsin is making these deeply personal and legally bound decisions for a family in Texas is to fundamentally misrepresent the chain of responsibility.
With over 725 million patient records exchanged monthly, a majority between different systems, what are the primary technical and logistical challenges that still impede full interoperability? Can you provide metrics showing how frameworks like TEFCA have improved this data sharing?
The scale of data exchange today is staggering and directly refutes the idea that these systems are closed-off fortresses. When you see a single company’s customers exchanging over 725 million records in a single month, with more than half of those going to different, competing EHR systems, it paints a picture of a deeply interconnected network. Frameworks like TEFCA are the superhighways built on top of existing roads. For example, being the first EHR to sign on to TEFCA and having 86% of your customers already set up or signed up to use it demonstrates a massive commitment. The 200 billion targeted data exchanges—specific requests for things like medication lists or problem histories—show the granularity and sophistication of this sharing. The primary challenges are no longer about just building the pipes but about standardizing the “language” of the data flowing through them and ensuring every single provider, big or small, is connected to the network. It’s about that last mile, ensuring the data is not just available but truly usable at the point of care.
Some EHR platforms offer a library of free, open APIs while also developing private APIs for partners. What is the business rationale behind this dual approach, and how does it balance third-party innovation with the need to protect a company’s own intellectual property?
It’s a very smart, balanced strategy that reflects the reality of the modern tech ecosystem. By providing a library of over 500 standards-based APIs for free, a company cultivates a vibrant community of third-party developers. This allows for innovation at the edges, where smaller companies can create niche applications—used by over 1,500 different apps in this case—that add value to the core platform without requiring the central company to build everything itself. At the same time, when you’re collaborating on a deep, strategic level with major partners like Oracle Health, Microsoft, or Amazon, you’re co-developing complex, proprietary technology. That involves significant investment in research, development, and maintenance. Charging for these private APIs isn’t just about “moving electrons around”; it’s about valuing the intellectual property and the immense effort that goes into creating and sustaining those high-level integrations. It’s a way to foster broad innovation while funding and protecting the core business.
Antitrust allegations can sometimes be contradictory, suggesting a company’s prices are too high for customers yet predatorily low for competitors. From a business standpoint, how does a company defend its pricing strategy against such conflicting claims, and what evidence demonstrates fair market competition?
This is a classic “heads I win, tails you lose” argument from a prosecutor. It’s a legal tactic designed to box a company in. The defense has to be grounded in the simple, and often boring, reality of market economics. You demonstrate that your pricing is a reflection of the value you provide, the R&D you invest, and the competitive landscape you operate in. Courts are rightly cautious about claims of predatory pricing because it’s a very high bar to prove. A company can defend itself by showing that its prices are rational and sustainable, not designed to bleed out competitors before being jacked up. The best evidence is a healthy market with choices, customer testimonials affirming the value they receive, and a track record of reinvesting revenue back into product improvement. When the state’s allegations are based on what the company calls “blatantly distorted facts,” the defense becomes a meticulous process of dismantling the flawed narrative with a mountain of real-world business data.
What is your forecast for the future of litigation involving EHR companies, particularly as it intersects with state-level political issues and evolving antitrust scrutiny?
I believe we are entering a new, more contentious era. For a long time, the focus was on technical standards and federal incentives. Now, as EHRs have become the fundamental infrastructure of healthcare, they are becoming targets in broader political and ideological battles. We’re seeing state attorneys general using antitrust law as a vehicle to address hot-button social issues, framing complex technology decisions as partisan acts by “woke corporations.” This trend will likely accelerate. Future lawsuits will be less about technical non-compliance and more about these politicized narratives, forcing EHR companies to become much more sophisticated in their legal and public relations strategies. They will have to defend not only their business practices but also their role as neutral platforms in an increasingly polarized society. This will be a significant and costly distraction from their core mission of improving healthcare.
