Epic UGM: AI Ambitions Meet Health System Reality

This is a preview of the August 20 edition of Access Health-Tap here to obtain this newsletter delivered straight to your inbox on Thursday mornings.

Key points

• Inova Health has 70 AI features in production, regarding 20 percent of which are agentic, Chief Data and AI Officer Jon McManus informed me at UGM.
• Costco intends to enter the Medicare market through a partnership with nonprofit insurer SCAN Group, according to The Wall Street Journal.
• And read on to the Pulse Check section for a closer look at Epic's Agent Factory, in practice.
• Optum Health CEO Krista Nelson notes value-based care can deliver on the "quadruple aim"-but the push from Washington will test the industry's ability to scale it.
• Abridge notes clinicians at more than 300 enterprise health systems have adopted its decision-support capabilities since their April launch.

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If last year's Epic User Group Session felt like science fiction, this year's felt distinctly down-to-earth.

At least, that was my impression as the futuristic sets and big-picture visions of AI transformation offered way to a theme of Midwestern hospitality at Epic's sprawling Verona, Wisconsin, campus this week.

Don't mistake the approachable packaging for a retreat from the company's AI ambitions-quite the opposite. Epic's message this year was that much of what sounded futuristic 12 months ago is getting closer to everyday work.

One skit captured that transition particularly well. In an Inside Out -esque portrayal of an AI agent at work, Epic employees played the different components operating behind the scenes. Each enthusiastically declared, "This is my favorite part!" before doing their job and, eventually, pressing a giant button to send out the query. It was characteristically Epic: playful, elaborate, a little strange.

But it additionally captured two conversations I kept hearing throughout the general session and in the halls afterward.

First, we're talking less regarding what AI might someday do and more concerning what it is doing today.

Second, proving that the technology works doesn't necessarily mean health systems are ready to employ all of it. Epic repeatedly encouraged customers to turn on more features and create better apply of the products already at their fingertips. Some health system leaders, meanwhile, are still figuring out whether they have the individuals and infrastructure to safely manage everything that's becoming available. Agent Factory is a good example of both.

In practice, the platform gives health systems tools to build and adapt agentic workflows for their own needs. Instead of waiting for Epic to develop a capability or buying another product from another vendor, they can increasingly build it themselves. And some are already seeing results.

Inova Health has 70 AI features in production, regarding 20 percent of which are agentic, Chief Data and AI Officer Jon McManus informed me at UGM. Its Agent Factory work on infection prevention has cut chart-review time 15-fold. During a measles exposure, McManus remarked, that can shrink a process that might otherwise eat up much of the 72-hour window for intervention to concerning six hours.

ECU Health offered another example. Vice President of Clinical Operations Jacob Parrish remarked an Agent Factory workflow has assisted drive an 86 percent growth in transfers landing at regional hospitals by prompting transfer nurses to consider alternatives to automatically sending patients to the medical center.

"When you get into the actual operational value, it's there, " Parrish informed me.

So, the technology can work. But who is going to keep it working?

That's the question Dr. Hasan Ahmad, associate CMIO at Parkview Health, left UGM asking.

Agentic systems aren't "build it and forget it, " Ahmad informed me. Models change. Inputs change. Prompts change. Outputs can change with them. And somebody has to watch for that degradation, or model drift.

"These agents are going to be built with Epic, but eventually, organizations are going to own the maintenance and monitoring, " Ahmad remarked. "That's going to require extra resources, time, data scientists, informaticists, and governance infrastructure – and some organizations are not going to be able to do that. That's the part of the discussion I would like to see more of."

Parkview has identified potential Agent Factory employ cases. But Ahmad isn't ready to separate the excitement around building them from the realities of operating them.

"We've identified candidate use cases, but we're still going to need more clarity from Epic on what the operational model is going to look like, " he remarked. "I think Epic is interested in developing these concepts and ideas. Nevertheless, building something is different from running it inside a health system."

Epic isn't ignoring that difficulty. Nurse Executive Johnston Thayer informed me the business is building an Evaluation Suite that will allow health systems to evaluate agents before they go live, monitor whether they continue operating within defined guardrails afterward and measure whether they're actually producing the intended outcomes.

Still, the general session's lack of detail here left a number of executives I spoke with on Wednesday-including Ahmad-with questions.

Then there's another group watching all of this closely: Epic's partners and competitors.

Last year, I spent much of UGM asking what Epic's expansion into ambient documentation and other AI capabilities meant for the firms already selling those products. Health tech leaders weren't exactly unconcerned. As one CEO informed me at the time, "it's really tough to go against Epic with something they do first-party."

This year, I put a version of that question to Abridge CEO Dr. Shiv Rao. How does Epic's push into agents and the expansion of Art affect his strategy?

While additionally working throughout EHRs and with payers and life sciences businesses, rao remarked Abridge is confident it is "headed in a very different direction." The business continues to partner with Epic, he observed. Even where their products may appear to compete, he expects health systems will see that "they're actually coming at these problems in a very different way."

That relationship is worth watching, especially since Epic spent plenty of time talking concerning community this year, too.

There was an emphasis on sharing features between health systems, announcements of more smaller platforms in the mold of Orchard and the introduction of Epic Rangers to support organizations hone the platform one-on-one. Increasingly, the firm seems to want provide the infrastructure on which customers and partners can build, customize and share their own.

But quietly, there is another conversation happening behind that all-of-us messaging and the whimsical, cotton-candy facade. Just days before UGM, Reuters documented that the Federal Trade Commission is investigating Epic, including how the business grants or withholds access to data. Epic denied engaging in anticompetitive behavior and remarked its health system customers, not the business, control access to patient records.

I heard versions of that same question throughout the week, albeit in much less legalistic terms. As Epic gives health systems more tools to build, share and deploy their own technology, its customers and partners are additionally working out where Epic's responsibility ends and theirs begins. Who owns the data? Who owns the innovation built on top of it? Who is responsible for keeping an agent safe once it leaves the Factory floor?

What did you create of the UGM news? Email me at [email protected] and let me know.

And read on to the Pulse Check section for a closer look at Epic's Agent Factory, in practice. Major health care headlines from the week.

Optum Health CEO Krista Nelson notes value-based care can deliver on the "quadruple aim"-but the push from Washington will test the industry's ability to scale it. During our virtual fireside chat on Monday, Nelson explained how Optum Health is reading CMS' signals and refining its value-based care strategy.

In a particularly timely move on Monday, Abridge expanded its clinical intelligence agent to every clinician at its partner health systems, including clinicians who do not apply Abridge for documentation. Organizations can provision access enterprise-wide through existing EHR workflows or a new mobile and web experience connected to the patient's longitudinal record, rather than requiring clinicians to adopt the tool individually. The agent is designed to backing clinicians before, during and after patient care using both EHR context and medical evidence. As well as the generation of referral letters and clinician handoffs, capabilities include pre-visit summaries, medical calculators populated with EHR data, chart queries and evidence-based clinical decision backing.

Abridge notes clinicians at more than 300 enterprise health systems have adopted its decision-support capabilities since their April launch. While queries per clinician have tripled over the past two months, as the firm continues expanding beyond its roots in ambient documentation toward a broader clinical intelligence platform, more than half of eligible Abridge clinicians are now monthly active users.

I asked Abridge CEO and cofounder Dr. Shiv Rao how health systems should approach change management as they expand clinical AI throughout the enterprise. "It's the biggest challenge with enterprise AI deployments because AI is moving so quickly, " Rao remarked. Health systems and their technology partners need to be "very deliberate" regarding which capabilities they deploy, in what order and how they package them so IT teams can absorb and manage the technology over time, he went on.

Rao remarked the tool uses a familiar, conversational interface, but goes beyond simply answering clinicians' questions. It can act on what they learn by carrying that information into subsequent tasks, such as updating a clinical note, placing an order or sharing relevant information with a research assistant working on a clinical trial.

He doesn't expect training to be a hassle, telling me that he hopes Abridge's "intuitive" and "elegant" interface will "make clear to all these health systems, but also all these end users, that once they start to get used to it, they'll be able to use the same agent to drive any number of other workflows as we turn those modules on for them."

Costco intends to enter the Medicare market through a partnership with nonprofit insurer SCAN Group, according to The Wall Street Journal. The firms will initially offer jointly branded Medicare Advantage aims in two states and a Medicare supplement plan in a third, targeting markets with roughly five million Medicare enrollees. Exact locations and timing have not yet been disclosed for pending regulatory approval.

Taken together, the developments around epic UGM: AI Ambitions Meet Health System Reality point to a situation that is still moving, and the coming days should bring more clarity.