Bob Wachter

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.

on this is a 62-year-old man with a history of congestive heart failure who comes in with shortness of breath and chest pain.

Impossible, the AI couldn't deal with that.

So it was really not computable until recently.

Now that it is, and now that generative AI creates the capacity for all sorts of magic,

The idea that Epic is going to own the entire enterprise and you're going to need to use Epic-built tools for all of the different use cases of AI, and there are going to be hundreds, I think that's going to really slow things down.

And the government is forcing Epic to become more open and more amenable to bolting on third-party tools.

So who do you think will ultimately win the AI healthcare platform wars?

Do you think it'll be...

the big incumbents like Google and Microsoft?

Do you think it'll be the well-funded AI startups?

Will it maybe be someone or something else?

I was on Google's healthcare advisory board when Eric Schmidt came in and said, this is one of the biggest things that people search on.