Epic has said more than 85% of its customers now use its AI tools, which sit inside the EHR their clinicians and billers work in every day. What those tools will cost a health system next year is getting harder to answer.
Part of the bill is now variable. It moves with how heavily staff use each feature, which AI model runs underneath it and, increasingly, what patients do with their own records outside the health system. The tools to forecast that spending are still being built.
Amy Trainor, BSN, RN, vice president and CIO of New Orleans-based Ochsner Health, described the problem to Becker’s in August at Epic’s Users Group Meeting in Verona, Wis.
“Each feature, hundreds of features, will show what that looks like. It could be $10. It could be $10,000, depending on what the usage and the price model looks like,” she said. “Planning a budget a year in advance is a little more difficult than it’s been in the past.”
Part of the swing comes from how the tools are priced. At the same meeting, Sha Edathumparampil, chief digital and information officer of Coral Gables, Fla.-based Baptist Health South Florida, compared Epic’s model with competing ambient listening products.
“The pricing model is super interesting. If you look at some of the competing products, [ambient listening tools are] one license fee,” he said. “But Epic, because of rising token costs and the economics around it, [has] a fixed fee and then a variable … [charge], which depends on which frontier model you use. It’s only increasing — some increase faster than others, so that’s a concern.”
Volume is the other variable. Aaron Miri, DHA, executive vice president and chief digital and information officer of Jacksonville, Fla.-based Baptist Health, weighed what heavier use of Epic’s agent-building tools would mean for his system’s bill.
“If we go hog wild with [Agent] Factory and others, which we intend to, there’s a cost of doing business. You may have savings on the operational side — great, thumbs up. Who’s paying the piper on the back end, paying for the tokens?” Dr. Miri said.
Earlier this month, Ryan Cameron, executive vice president and chief information and innovation officer of Omaha, Neb.-based Children’s Nebraska, tied the forecasting problem to governance.
“If you haven’t done your AI governance homework, if you haven’t set up your policies, if you haven’t set up your review committees, tokenization is just going to make things really more difficult,” Mr. Cameron said.
Some of the usage landing on health systems’ books isn’t something they chose to switch on. At Charlotte, N.C.-based Advocate Health, the number of patients linking their MyChart accounts to ChatGPT rose more than 7,000% from July to August, generating API calls against the system’s Epic EHR, Executive Vice President and CIO Bobbie Byrne, MD, disclosed to Becker’s for an Oct. 6 story.
“There is some cost to us based on the volume of patients and the number of requests each patient enters into Chat. There is compute power required for this, so that will be a cost to someone,” she said. “Right now we can absorb the amounts, but I would be concerned if the growth rate escalates.”
Epic acknowledged the traffic at its Open@Epic developer conference Oct. 21. Seth Howard, executive vice president of research and development at Epic, addressed the issue with software developers during the opening session.
“This is only increasing. Our customers are definitely noticing the extra traffic,” Mr. Howard said.
Under Epic’s model, the health systems running the software carry the infrastructure behind those connections.
“Epic ships code to our customers, but they own the system and they own the data,” Mr. Howard said. “So customers are in control.”
At the August meeting, Epic said it is building individualized cost-tracking and forecasting tools similar to those Microsoft offers its enterprise customers.
“Epic doesn’t have quite [that] all the way down to the user,” Ms. Trainor said at the time. “Right now it’s by function … and by time.”
Some health systems are already putting the visibility Epic does offer to use. Jason Muldrow, interim chief digital and information officer of St. Louis-based SSM Health, credited Epic in October.
“Epic’s journey on transparency around adoption and pricing has been especially helpful, allowing us to actively monitor utilization and ensure we’re realizing an appropriate return on our AI investments,” Mr. Muldrow said.
Health systems signing new Epic contracts are weighing the same math. Daniel Stross, vice president and CIO of Charleston, W.Va.-based Vandalia Health, which plans to go live on Epic in fall 2028, addressed in October whether usage-based pricing for Epic’s AI tools could become cost-prohibitive.
“Nobody has an endless budget for AI solutions, and so you really have to take a look at the value that they bring,” Mr. Stross said. “But we believe that the Epic AI solutions offer great value, and that’s why we plan to embrace the tools that are available in 2028.”
At Advocate, the question of who absorbs the cost of patient-driven traffic is still open.
“We certainly want patients to feel empowered in their care. If using ChatGPT helps patients further understand their health, I want to support it,” Dr. Byrne said. “Like many things in our healthcare system, there is a disconnect between who benefits and who pays.”
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