A new lawsuit filed yesterday in the U.S. District Court for the District of Maryland has the potential to reshape the contours of health information exchange in the United States. Audacious Inquiry, LLC, a Baltimore-based health IT innovator now owned by PointClickCare, together with its subsidiary Collective Medical Technologies, has sued the Chesapeake Regional Information System for our Patients, Inc. (CRISP), along with CRISP Shared Services and related affiliates. The case, captioned Audacious Inquiry LLC et al v. Chesapeake Regional Information System for our Patients et al (No. 1:2025-cv-02264), asserts claims of patent infringement under 35 U.S.C. § 271. The plaintiffs have demanded a jury trial.

The Players in the Dispute

Audacious Inquiry (“Ai”) has long been recognized for its role in advancing encounter notification services and real-time patient event alerts. Founded in Baltimore, Ai grew to prominence as one of the first companies to operationalize admission, discharge, and transfer (ADT) notifications on a wide scale. In 2021, Ai was acquired by PointClickCare Technologies, a Canadian company best known for its dominance in the post-acute EHR space. Through Collective Medical, which it also owns, Ai now has a formidable footprint in emergency department information sharing and high-utilizer patient management.

CRISP, by contrast, is Maryland’s state-designated health information exchange and has long been regarded as a model of statewide interoperability. It is more than just a Maryland project. Through CRISP Shared Services, it now provides technical, operational, and policy support to other regional HIEs across the Mid-Atlantic and beyond. This expansion has placed CRISP in direct competition with private vendors like Audacious Inquiry, blurring the lines between public utility and commercial enterprise.

What the Lawsuit Claims

The complaint filed yesterday alleges that CRISP and its affiliates are using patented technologies belonging to Audacious Inquiry and Collective without authorization. While the precise patents will be spelled out in the exhibits attached to the filing, the subject matter almost certainly involves the technical methods behind encounter notifications, real-time alerts, and care coordination platforms. Collective Medical has for years touted its intellectual property portfolio in this space, and today’s lawsuit marks the first time those patents have been asserted against a state-designated HIE.

By filing under § 271 of the Patent Act, the plaintiffs are seeking both damages and injunctive relief. If successful, they could not only recover money but also block CRISP from continuing to use the disputed technologies without a license. That possibility carries significant implications for hospitals, payors, and public health agencies that depend on CRISP’s systems every day.

Why This Case is Different

Patent disputes in health IT are not new. EHR vendors have fought over interface methods, and decision-support companies have sparred over algorithms. But what makes this lawsuit extraordinary is the identity of the defendant. CRISP is not a for-profit vendor competing in the commercial marketplace. It is the backbone of Maryland’s health data infrastructure, funded and supported in part by state initiatives and relied upon by nearly every provider in the region.

For years, interoperability has been guided by the assumption that its core functions, data exchange, encounter notifications, population health feeds. are part of a shared public good. The assertion of private patent rights against a state-designated HIE challenges that assumption head-on. If encounter notifications and care alerts are covered by enforceable patents, then interoperability is no longer simply about standards and governance; it is also about ownership and exclusivity.

The Broader Policy Context

This litigation lands at a pivotal moment for federal interoperability policy. The Office of the National Coordinator for Health IT has been rolling out the Trusted Exchange Framework and Common Agreement (TEFCA), designed to create a nationwide “network of networks.” Although CRISP has made clear that it does not intend to become a Qualified Health Information Network (QHIN) itself, it does plan to participate in TEFCA as a Participant in the eHealth Exchange QHIN, leveraging existing infrastructure rather than attempting to build or compete as a QHIN directly. In CRISP’s own words, it does not believe in “reinventing wheels” and sees its role as providing a path for Maryland providers, public health authorities, and affiliates to connect into TEFCA through established on-ramps like eHealth Exchange.

Meanwhile, Audacious Inquiry, through its parent PointClickCare and subsidiary Collective Medical, has deep ties to payors, post-acute providers, and population health networks. A clash between these two entities raises the possibility that TEFCA’s vision of a universal, cooperative exchange could be complicated by proprietary claims and litigation, even if CRISP’s participation model differs from that of QHIN applicants like Epic, CommonWell, and eHealth Exchange.

The Legal Terrain: Section 271 & Patent Enforcement

Under 35 U.S.C. § 271, infringement occurs when a patented invention is made, used, sold, or offered for sale without authorization. Plaintiffs may also allege inducement or contributory infringement if CRISP Shared Services is enabling others to make use of the patented technologies.

CRISP will likely mount a multifaceted defense. It may argue that the patents are invalid, either because the claimed inventions were obvious or not novel at the time of filing, or because they attempt to cover abstract ideas. It may also assert that its systems are sufficiently different to avoid infringement. The plaintiffs, for their part, will argue that CRISP’s encounter notification and care coordination services mirror the methods described in the patents. These disputes will turn on highly technical details and expert testimony.

Practical Stakes for Hospitals & Providers

Beyond the legal arguments, the potential consequences are immense. Hospitals and providers across Maryland depend on CRISP’s encounter notifications to coordinate care for patients moving in and out of emergency departments, inpatient wards, and post-acute facilities. Public health agencies rely on CRISP data for surveillance and emergency response. If CRISP were forced to suspend or re-engineer these services, the disruption would be felt immediately.

On the other hand, if CRISP successfully defends itself, the case could embolden other state HIEs to resist vendor claims of proprietary ownership. That outcome could tilt the balance of power toward publicly backed exchanges and away from private innovators asserting intellectual property.

Settlement or Showdown?

Patent cases are expensive, and many end in settlement. But resolution here may not be straightforward. CRISP’s status as a quasi-public entity makes a quiet licensing deal politically sensitive. At the same time, Audacious Inquiry risks reputational fallout if it is perceived as attacking a state-backed public good. Both sides have strong incentives to resolve the matter, but the politics and optics may make compromise difficult.

If the case proceeds toward trial, expect to see claim construction hearings, motions for summary judgment, and possibly amici briefs from industry groups or even policymakers concerned about the implications for TEFCA.

A Defining Moment for Interoperability?

The filing of Audacious Inquiry v. CRISP may ultimately prove to be more than a patent dispute. It is a referendum on how the United States views the ownership of interoperability. Should core functions like encounter notifications be protected innovations enforceable through patents, or should they be treated as shared public goods necessary for a functioning healthcare system?

The answers will not come quickly. Patent litigation moves slowly, and the case may not reach a courtroom for months or even years. But the filing itself has already forced the industry to confront difficult questions about innovation, competition, and public interest.