Clara Lin, MD, vice president and chief medical information officer at Seattle Children’s, doesn’t have a shortage of AI tools to consider. She has the opposite problem.
“Epic is coming out with like 100, 200, 300 … just so many different AI things all at once,” Dr. Lin told Becker’s at its annual IT + Revenue Cycle Conference last week in Chicago. “It’s impossible, obviously, to do a six-month pilot with every single one of them, because it’ll take you 100 years to get through all of them.”
Her team has stopped trying to pilot everything on its own timeline and started triaging the list instead, sorting for where the largest hard or soft return is likely to show up before committing resources. It’s the same instinct behind Seattle Children’s AI Review Board, which Dr. Lin co-founded and now chairs — the hospital’s formal governance structure for deciding what gets evaluated, in what order.
She’s not alone in describing the volume itself, not any single tool, as the actual issue. Andrew Rosenberg, MD, the former CIO of Ann Arbor-based Michigan Medicine, said Epic’s scale is quietly squeezing out competition, even when a rival product is better.
“We’ll start with Epic, and even if it isn’t as good, it’s good enough, and because it’s so linked to the overall ecosystem, and it’s part of our licensing, or it’s close enough … that’s what we’re still likely to lean into than bolt-ons,” Dr. Rosenberg said in an interview at the conference.
“The challenge that we all have as CIOs is we want competition, we want the diversity, we want things to improve,” he said. “But how do we justify the time, the expense, the training, the ongoing management … when the AIs embedded in Epic are either best or good enough? It’s a tough problem.”
At Cleveland-based University Hospitals, David Sylvan, chief strategy, innovation and marketing officer, said the answer isn’t to wait for Epic to catch up on everything — it’s to be selective about where not to.
“We cannot ignore the fact that we are an Epic-first shop, but we try to be appropriately not Epic-only,” Mr. Sylvan said. “There’s obviously a robust roadmap when it comes to what Epic is signaling that it’s going to be able to do. But not everything is ready right now, and speed to market, speed to impact is still … a driving imperative. So it’s going to be important for us to choose our spots … in anticipation of Epic being ready at some point.”
Chicago-based Rush University System for Health has already lived that gap firsthand. Senior Vice President CIO Jeff Gautney said his team is still waiting on an Epic registries tool that automatically reads a patient’s chart and decides whether it should be reported to a clinical registry.
“Epic’s been threatening for two years to deliver a product; I’m sure it’ll deliver it shortly,” Mr. Gautney said. In the meantime, Rush uses a company called Layer Health to do that work instead. Before bringing in Layer, he said, the health system had five people doing the same task manually, under an outsourced contract that ran roughly $1 million a year given the volume of work involved. “That’s not a job that’s coming back,” he said.
For smaller health systems, the triage decision often isn’t theirs to make in the first place. Bob Berbeco, CIO of Oskaloosa, Iowa-based Mahaska Health, runs his EHR through Epic’s Community Connect program under West Des Moines, Iowa-based UnityPoint Health. He said that means his AI rollout timeline largely follows UnityPoint’s, not his own evaluation of what Epic has shipped.
Other organizations have simply made waiting the policy. Sam Amirfar, MD, chief medical officer and CIO at Brooklyn (N.Y.) Hospital Center, said his team deliberately lets larger systems absorb the early complications of a new Epic AI feature before bringing it in-house.
“We prefer not to go first,” Dr. Amirfar said. “We wait to see what happens and what the complications are, and then maybe get a little cheaper. … We can’t deal with everyone having a complication at the same time. … We’ll ask Epic, ‘Hey, how new is this? Can we wait until someone else does it?’”
