Is electronic health record giant Epic Systems thinking about giving direct “power to the patient” without going through a provider? Maybe not immediately, but in discussions about artificial intelligence and data democratization in the carefully scripted opening remarks of Epic’s annual Users Group Meeting, there were a couple of tantalizing hints.
Epic’s customers today are providers. While KLAS estimates the Epic EHR covers 44% of U.S. hospitals and 57% of all hospital beds, the company is increasingly adding providers ranging from rural clinics to dental groups. When looking at the company’s strategy, it’s essential to remember that Epic did not go from its first UGM, consisting of “one folding table with just a few people,” in the words of founder and chief executive officer Judy Faulkner, to being a $6.7 billion company drawing more than 20,000 in-person UGM attendees without paying close attention to those customers’ needs.
Helping Providers Help Patients
In that context, when Faulkner declares that Epic’s number one goal is to “help patients be healthy,” what she means is helping providers accomplish that goal with Epic’s help – if they want it. For instance, while Epic boasted that its patient-facing MyChart has added an AI-enabled agent named Emmie – the AI agent for physicians is “Art,” as in the “art of medicine” – each customer decides which MyChart capabilities to enable.
Moreover, this is a carefully considered patient-centeredness. Emmie – as a skit featuring Epic employees dressed as colorful AI agents illustrated – is designed to answer common questions more reliably than general-use chatbots. That, in turn, is meant to free up physician time (a second Epic goal is helping physicians “love their jobs”), avoid the hazards of patients turning to general-purpose chatbots and improve organizational productivity (Epic’s third goal is keeping health care organizations financially strong).
Those gains, though, aren’t free. As Becker’s Hospital Review reported, Emmy’s AI capabilities, like other AI enhancements Epic presented, come with a charge for use of AI “tokens.” Emmie’s bottom-line impact on hospitals will vary depending on the breadth and depth of patient usage, so it’s difficult to predict.
An Epic “Joke”
The reality is that AI is already allowing patients to find, create, control, and act upon an unprecedented breadth and depth of personalized information outside the traditional care system. Nor can the traditional care system always count on being part of the health relationship, as I noted in an article for the Petrie-Flom Center at Harvard Law School. For example, a review of breast cancer apps published 3 years ago found that even then about one-third of them used individualized, patient-reported health data obtained outside traditional care settings.
Faulkner, who’s described her parents as peace activists, dropped a hint that she understands “the times they are a-changin’,” as Bob Dylan famously sang. When listing the company’s different EHR versions, she mentioned “maybe someday Chirp for the ring.”
An Epic spokesman told me this was a “joke.” If it was a clumsy attempt at humor, I suspect it was motivated by underlying anxiety about competition from the popular Oura smart ring. Oura announced in June that its Oura Health Records will make it simple for users to bring EHR data from a variety of providers into the Oura system, making the individual Oura user, not the traditional Epic customer, the informational hub. “Make America healthy again,” in that case, starts with each individual, not each provider.
Other AI platforms are also trying to take advantage of data democratization. As the traditional care system ponders whether being “patient-centered” with Emmie will bust their budget, consumer-facing AI that enables “patient-directed” care continues to expand.
Patient-Directed Care
In an article for the National Academy of Medicine, two #PatientsUseAI leaders, Hugo Campos and Liz Salmi, wrote that “most Health AI systems serve institutional priorities.” In contrast, “patient-directed” AI empowers patients to “select their own tools, cross-check recommendations and explore perspectives institutional systems may overlook.”
By doing so, they added, patients “move from consumers of organizational AI to active agents of algorithmic resistance.” This “shifts long-standing power structures.”
Without explicitly acknowledging that power shift, veteran Epic executive Carl Dvorak warned in a presentation about the “EHR revolution” that EHR adoption “took way too long.” He added that “with AI, we’ve got to have a way to move faster…before patients decide we can no longer be trusted as their primary source of health care information.”
Dvorak, now head of international operations, alluded to an “Epic learning event” where an outside speaker cited patient safety activist Sue Sheridan: “Clinicians adopt AI at the speed of trust. Patients adopt it at the speed of desperation.” Unmentioned was that the invited speaker, National Academy of Medicine senior advisor Laura Adams, was focusing on the new revolution of “AI-enabled patient agency.” (The EHR “revolution,” in contrast, is decades old, hence not threatening to UGM attendees.)
Dvorak’s remarks seem to me to constitute one more senior leadership hint about Epic’s view of a direct-to-consumer future. It could also be a hint about a reported disagreement about AI strategy that led some Epic senior execs to recently decide to pursue opportunities elsewhere. It’s difficult to know, since Epic is epically opaque.
Faulkner long ago proved she’s a tough and savvy businesswoman. She built the company she began in her basement in 1979 into a global powerhouse so successful that the Federal Trade Commission has reportedly opened an antitrust investigation. (Epic says any such allegations are baseless.)
In the song “The Times They Are A-Changin’,” Dylan urges parents to recognize their inability to continue to “command” their children and instead “lend a hand.” To me, Epic appears to be quietly considering how, in the light of the waning ability of traditional providers to “command” their patients, it can take that advice and “lend a hand” to help AI-enabled patients help themselves.
Groovy.
