Bob Wachter

Many companies are investing many billions of dollars to build out new AI infrastructure in healthcare for all sorts of applications, clinical treatment and risk prediction, drug discovery, revenue and staffing operations, on and on.

There's also one massive incumbent to consider, the electronic health record company Epic, which claims to maintain at least one record for 325 million people.

Here again is Bob Wachter, chair of the Department of Medicine at UCSF and the author of A Giant Leap, How AI is Transforming Healthcare and What That Means for Our Future.

Epic won this market.

This was a little tiny company started by Judy Faulkner in the basement of an apartment off the University of Wisconsin.

She became the most successful female entrepreneur probably in American history.

It's a really remarkable story.

I think they won because they were the best.

The best was partly integration.

Judy's theory of the case was, we're not going to bolt on 37 different tools by a bunch of different companies.

We're going to own the entire thing, and that is going to allow us to provide

an integrated solution, and medicine is so complex and there's so many moving parts that if you don't have an integrated solution, the thing's not going to work very well.

I do wonder how much of this kind of sclerotic nature of the electronic health record market and the attendant difficulty in using those data to move forward, as people have been trying to do in the past but not succeeding very much, how much of that is due to the fact that Epic already has

has a lot of success by playing the status quo and that they don't have much incentive maybe to innovate or to let others play with their data in a productive way.

I think all of that is true, and generally monopolies are bad.

I think it's going to become more true in the coming years because of AI than it has been true over the last 10 years.

I don't think Epic is the main part of the problem up until now.

And the reason I distinguish the past and now is once AI became a thing—

So much of our data is in the form of narratives in a medical record, which until generative AI, you know, was really unstructured data that was not useful.

You could analyze your hemoglobin and your creatinine and an EKG finding, but not my note, which might be a page long of narrative and try to sick the old kind of AI up.