Electronic health records company PointClickCare is asking a district court to throw out Real Time Medical Systems' lawsuit alleging information blocking.

PointClickCare filed a renewed motion to dismiss Monday, arguing RTMS' case is built on "deficient" claims and that the company's allegation of unfair competition "fails" as a "matter of law," the company wrote in its motion to dismiss.

"Real Time's case, built on faulty claims and a misinterpretation of the law, should be dismissed entirely. Their goal is clear: to exploit our software with dangerous bots to extract critical healthcare data for free. Real Time's actions—and this lawsuit—pose a profound risk to our customers, the confidential health information of the patients we serve, and the entire healthcare industry," a PointClickCare spokesperson said in a statement to Fierce Healthcare.

RTMS filed a lawsuit against PointClickCare in the U.S. District Court for the District of Maryland back in January 2024, alleging information blocking and other practices that substantially interfered with its business operations and harmed its facility customers. 

PointClickCare, an EHR giant in the long‐term and post‐acute care provider market, works with more than 27,000 long‐term and post‐acute care providers, 3,600 ambulatory clinics, 2,800 hospitals, 350 risk-bearing providers and 70 state and government agencies.

RTMS provides analytics services to skilled nursing facilities by accessing health records from the large EHR provider. RTMS' customers include around 1,700 skilled nursing facilities as well as health insurers, CVS Health Corporation and the state of Maryland, according to court documents.

Last summer, a district court judge granted a preliminary injunction to bar PointClickCare from blocking RTMS' access to its clients' patient data. PointClickCare filed an appeal to overturn the preliminary injunction, but, three months ago, the Fourth Circuit Court of Appeals affirmed the district court's order, ruling that the EHR company can't block RTMS from accessing patient data from its skilled nursing facility customers.

PointClickCare argues the preliminary injunction record was "limited and one-sided," according to court documents. With the injunction in place, PointClickCare is unable to use "technical security protocols to prevent RTMS’s bots from monopolizing PointClickCare’s computing power and ransacking its electronic health information [EHI] repository," the company argued in the motion to dismiss.

In a statement, a spokesperson for Real Time Medical Systems said the company's HITRUST certified platform has been proven to prevent hospitalizations and life-changing medical complications.

"For nearly a decade, Real Time was able to access the patient data that PCC electronically stores for our shared customers benefiting healthcare providers and patients alike. It is unfortunate that PCC has filed another motion to dismiss that rehashing the same arguments that were rejected by the District Court Judge and the Fourth Circuit," the spokesperson said. "PCC had an opportunity to present its evidence at a two-day hearing and make its arguments—which were found to be lacking. PCC’s blocking of access to patient data is not just against the law, but it also endangers patients.”

RTMS is resting its claim of unfair competition under Maryland state law in part on a violation of the 21st Century Cures Act’s prohibition on information blocking. 

Information blocking is defined in 2016’s 21st Century Cures Act as the intentional interference with access, exchange or use of electronic health information except when required by law or under certain exceptions (PDF).

Since April 2021, there have been 1,321 claims of information blocking submitted to the federal government's information blocking complaint portal. The Department of Health and Human Services' health IT arm categorized 1,241 of those as "possible claims."

So far, there has been no enforcement action against an actor as it relates to an information blocking violation at the federal level.

The outcome of RTMS' lawsuit against PointClickCare will likely set a precedent as it relates to legal claims of information blocking in healthcare and access to data. While the 21st Century Cures Act was enacted in 2016, it has taken several years for the industry to fully implement the provisions. It is likely that there will continue to be litigation in the health tech market as the legal lines are drawn on what constitutes information blocking.

In March, Brendan Keeler, a self-described advocate for interoperability and healthcare integration, said the Fourth Circuit Court of Appeal's decision to uphold the preliminary injunction against PointClickCare is a wake-up call for EHR companies. "The high-level takeaway is that people can sue for information blocking and not wait for regulators to figure it out," he said.

The appeals court ruling established that violations of the Cures Act can support state law unfair competition claims even though the act lacks a private right of action, noted Keeler, interoperability and data liquidity practice lead at healthcare strategy and software development firm HTD Health.

"Apps can sue EHRs to litigate when they feel blocked via the information blocking provisions," Keeler said.

But, PointClickCare contends that RTMS' lawsuit isn't about access to data but about PointClickCare's ability to safeguard its customers' data and the personal health information of patients as well as the integrity and performance of its system.

RTMS frequently accesses the health records in question using “bots,” or automated users, and company executives told the court it has been using bots to pull data from PointClickCare’s EHR for the past 10 years.

The EHR company alleges that RTMS infiltrates its software and extracts data from its EHI repository using these automated bots that disrupt its systems, causing slowdowns and even outages for its paying customers. 

"RTMS pays PointClickCare nothing for this access or the problems its bots cause. Nevertheless, RTMS asserts that it should be able to continue this practice based on an expansive and incorrect view of federal and Maryland data-sharing laws," the company wrote in court documents.

The federal information blocking rule makes broad exceptions for security and other concerns.

PointClickCare uses certain security protocols, referred to as indecipherable CAPTCHAs, and RTMS argues in its lawsuit that these security measures block user accounts, constituting information blocking under the Cures Act. 

PointClickCare defended its actions to put in security protocols and said its activities fall under three common exceptions: the manner exception, the health IT-performance exception and the security exception. Its security policies are designed to prevent potentially malicious bot use—not block information, the company claims.

The company asserts that RTMS’ centerpiece unfair competition claim "fails as a matter of law because RTMS has admitted that its hands are unclean," the EHR company wrote in the motion to dismiss. "RTMS’ bot-based access to PointClickCare’s systems breaches customer contracts with PointClickCare that bar such access. RTMS alleges that it knew as much but kept running bots anyway, unlawfully and unreasonably interfering with PointClickCare’s contracts with its customers," the company wrote.

However, in its decision to grant the preliminary injunction, the Fourth Circuit agreed with the district court’s finding that there was no evidence RTMS posed a security concern to PointClickCare and that "none of the exceptions that PointClickCare invokes apply."

The Fourth Circuit also found that the evidence instead suggested PointClickCare's actions were taken to harm its competitor.

"The present record strongly supports an inference that PointClickCare sought to leverage its control over its EHR system to harm Real Time’s business, and that its cited reasons for its actions (security and system performance) were a cover for its true motivations (hurting a competitor)," the Fourth Circuit judges wrote.

In its lawsuit, RTMS argues that PointClickCare, as early as 2020, began developing and marketing products to compete with RTMS in the fields of patient-data analyses, medical alerts and value-based care software. The EHR company has acquired a number of companies that provide analytics capabilities including Collective Medical in December 2020 and Patient Pattern in March 2023.

In its motion to dismiss, PointClickCare pushed back on all RTMS' legal claims. It argued that RTMS' demand for a declaratory judgment alleging that PointClickCare violated the Cures Act and Maryland’s Nursing Home Records Act "fails because RTMS does not identify any private right of action for either statutory claim."

PointClickCare also claims that it has offered RTMS alternative methods to access the data. "It is not PointClickCare’s reasonable requests but RTMS’s intransigence—its repeated and stubborn demands to be allowed to run bots on PointClickCare’s system and its consistent refusal to pay a reasonable rate for substitute, bespoke access—that has left the parties unable to reach agreement," the company wrote.

RTMS’ unlawful tying claim "fails because RTMS fails to allege any of the three essential elements of the claim, including, most notably, that customers are coerced into purchasing a tied product," PointClickCare wrote in court documents.

And, the EHR company lays out reasons to dismiss RTMS’ contract-related claims. "As to its tortious interference claim, RTMS fails to allege that PointClickCare caused a breach or termination of any of RTMS’s contracts—an essential element of the claim." 

"RTMS cannot and does not plausibly allege that it was an intended beneficiary of PointClickCare’s contracts, which is fatal to RTMS’s third-party-beneficiary breach of contract claim. And RTMS likewise fails to sufficiently allege any breach of RTMS’s and PointClickCare’s Mutual Nondisclosure Agreement," the company argued.

PointClickCare also claims that the company's "defective claims" do not merit injunctive relief.

Another lawsuit involving an EHR giant also is being closely watched. Health tech company Particle filed an antitrust lawsuit against Epic in September in the Southern District of New York alleging the EHR behemoth is trying to muscle out competition. The 81-page lawsuit (PDF) alleges Epic engaged in monopolistic, anticompetitive practices, using its "power over EHRs to expand its dominance into the fledgling market for payer platforms," according to the lawsuit. In late December, Epic Systems asked a district court to throw out Particle's antitrust lawsuit, arguing that the startup failed to present the EHR company's anticompetitive conduct in its suit.

The case is Real Time Medical Systems Inc. v. PointClickCare Technologies Inc., case number 8:24-cv-00313, in the U.S. District Court for the District of Maryland. 

Editor's Note: This story has been updated with a statement from Real Time Medical Systems.