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Newsday: Epic's Code Red - Why AI Agents Are Healthcare's Next Power Struggle with Jacob Hansen

Aversure offers virtual care solutions supported by a secure, scalable infrastructure that helps you to lead your organization into a future where cutting edge technology is at your fingertips. and Compassionate Care Converge. For more information, check them out at thisweekhealth. com slash Avisure.

I'm Bill Russell, creator of this week Health, where our mission is to transform healthcare one connection at a time. Welcome to Newsday, breaking Down the Health it headlines that matter most. Let's jump into the news.

And, what'd you say? Technology officer.

Jacob Hansen: That's the one.

Bill Russell: Wow. pretty good with Avasure and, we love, love talking to you. We get to talk about where, this whole AI movement's going, where the whole, product movement's going. And, you sent us some stories today and I've been reading a couple of different things on this very topic, so I'm looking forward to this.

first story, we're gonna look at Brandon, or Brendan, Keeler Health, API guy, published just today. How's that for breaking news? Of course, by the time this airs, it'll be a week old. By the way, did you guys check out the artwork on this article?

Drex DeFord | This Week Health: Yeah.

Bill Russell: Very nice. I mean, Judy, Judy looks like she's conquering the new world in that, ship going over.

Jacob Hansen: it was entertaining for sure. He used some AI to develop some fantastic artwork.

Bill Russell: Oh, I think he was sitting there with his pens last night doing a little ink drawing and whatnot. Uh, really what this is about is the, EPIC AI charting the scribe thing that is going on, and, I learned a couple things from this article. you know, I mean the, the first thing is you had, epic CMO, Jackie Gerhardt talking about, you know, they're not viewing it as a scribe, just a scribe.

And I don't know if that's a, token thing or if, it probably is partially a token thing, but it's also, using the right model for the right tool, which is. Pretty smart architecture. So, Jacob, you sent this one over, so I'll, I'll give you, uh, I'd, I'd love for you to, to talk a little bit about what you know, what, what jumped out at you in this story.

There was a particular graphic in there. that talked about, how the, I think it said the arena is heating up is the phrase that was used it was basically referencing all these different, uh, existing AI use cases. Right. Rev cycle's been around for a long time for back office, interactions with the patient.

A business depends on that dynamic, pushes vendors to expand laterally. It's now a race to build out all the functions a business might need, and then later said, the model makers will be the arms dealers. And I thought that was particularly interesting because we are hearing about vendor consolidation on the daily from health systems, right?

I think it's gonna be really interesting to watch.

And the thing is, I think as Epic was sort of looking at this entire thing, they said, Hey, we gotta protect, we gotta protect ourselves here. Right? Like they're starting to work at the. first of all, they're, the interface to our client. And second of all, they're starting to work across this whole layer.

they're gonna create the workflow. They're gonna create, things that generate value.

Sarah Richardson: Jacob,

I consider your product becoming an aggregator, almost like middleware, for all the right reasons. So all those conversations you can capture, you can distribute, you become one of those 500. Because of the ability to integrate in so many different aspects of the patient room, your technology's already set up and in many cases already doing some of that.

Jacob Hansen: it's also going to really pull hard at the appetite for taking on cost with infrastructure, with cloud compute. I mean, you think about it. as the endpoint as the aggregator, right? We could play that role. what if the health system says I have, and let's just pretend in the future it's some big number 15 vision AI models that I want to interrogate the video coming out of that room. if you take that video and you start streaming that out to the cloud in 15 different places, what does that mean in terms of, broadband and, and um, capacity? What do we have to be able to support? It just could get out of control relatively quickly. if you [00:08:00] don't grant everybody access at the same time, what do you do to arbitrate it? You gotta have rules. You gotta have somebody working hard about clinically. What matters most? How do we empower health systems with that kind of choice to say, here's the different tools we want to use. Here's the priority order by which they get access. Becomes an interesting thing that we really have only started to scratch the surface on.

Uh, and you know, that. Made end user physicians and nurses and Lab and RAD and everyone else happy because they had their thing that worked for them. And so I think we're in this really interesting point where we're going through an evolution right now of are we going to be on one platform? Are we going to figure out how to use a lot of different solutions that really satisfy our needs? All in the context of do we have the resources to manage all of those? Bananas. Uh, as Sarah would say, as we look at lots and lots and lots of different solutions, when we already have 500, you know, applications inside most of our organizations, how are we gonna do that and do it well?

these organizations create a. Code red environment where they're like, if we don't do something, we're going to,

Drex DeFord | This Week Health: alive.

Bill Russell: we're gonna be, get, get eaten alive. And this was a code red moment for, epic. And it's at, at one point they had a very strong partnership with a bridge. As the rumor mill goes, they had an investment in a bridge.

They ended up selling off that investment, middle of last year and announcing their own, direction here. 'cause they realized that whole aspect of, Hey, wait a minute, they're gonna be orchestrating workflow on top of our platform. Like, that's where value is generated for the clinician, for the health system.

Emmy Penny. They came out with those three, which I've not heard great things about yet. they're there and they're developing and everyone gives Epic the benefit of the doubt. 'cause generally their first release of anything is okay. It, it, it is almost like a pilot. they get to see what it directionally is going to do.

they have enough trust and faith in Epic because they've done this over and over again where they, they announced something to slow things down. They come out with, and then three years later they're sitting there going, okay, this is functional. It's working. But the thing I think that flies under the radar is their agent factory.

Like they're taking this data and they're doing these really cool things and they're enhancing workflow. And what Epic is saying is, look, we have this. agent factory where they're focused now on, the ability to build out these multi-step, functions within the EHR in their factory setting, which will have the guardrails and whatnot.

They're essentially positioning themselves as, Hey, we're gonna be able to augment your workforce, augment your workflows, take things to the next level they want to protect that the value that gets generated from the system and not just be known as the system of record, if you will, and get, pushed into that.

I don't know if you saw this, but, Claude code, they released, this legal framework for doing like NDA reviews and all this other, so Claude code, I'm sorry, not cloud, cloud cowork can do multi-step ag agent AI stuff. And then they release this framework from within that. So lit.

Literally you could take your legal document, drop it in there and say, do your legal review on this, and it comes back with whatever. and essentially the argument's being made that this is trimmed like a hundred billion dollars in market cap off of companies that were sort of positioning themselves to do this kind of stuff.

that's the kind of cannibalization we're looking at This age agentic world that we're entering in, people are, if nothing else, they don't know where it's gonna lead. And they're going, oh my gosh, this is gonna change how software's developed. This is gonna change where the value creation is done.

Like where's the growth gonna come from? It's gonna become, uh, the fact of life that if you're in a driving position, you're gonna have to start looking what is happening, in these workflows next to yours. And there's likely gonna be somebody already doing it. But can you bolt it on top of yours, bundle and do it better? uh, it's gonna be a, a, the notion of innovating there, I think it'll be a funny word to use, this idea of innovation because of how fast things are coming out and changing. it's really who can do it and do it well in a way that covers enough different workflows to make it even feasible.

Or are you gonna say, no, no, no, we've gotta keep value on, on the data streams at our layer, like we're gonna have our own layer that creates value.

So computer vision and the platform itself are huge focuses for Avior. There's no question though. in the world we live in now, we cannot have any pride of ownership or authorship over different utilities that you use. Just like what we saw in that article about Epic, if somebody else has something that they've created that we can [00:17:00] use inside of our stack, we're gonna do it. We don't need to build everything. We will be too slow if we do it that way. It's just the facts.

Bill Russell: what would constitute a code? Red? So Sarah and Drex, you're a CIO. What would constitute a code red that you're looking at in terms of this world that we're entering into that you're just looking at going, Hey, this is either this is unsustainable or this is coming faster. there's something in this article as well about this of, Hey, one of the things that could change is everyone's trying to take this layer.

Outside of Epic, completely like, like this whole caring for people and what they're trying to take it outside. It is like, you know, if, if that ever happens, not only does the value of Epic go down, but the value of the health system goes down.

We deployed EHRs, but what we really wanted from Epic was tell us how to do the workflows better, use the tool to do the workflow flows. And that's really why we paid a premium for it. I feel like we're getting to this point now where with the agent conversation, The code red concern that I have is, are we making a decision?

Are some health systems ultimately gonna make a decision that we're not really gonna do innovation anymore? The innovation that we do is going to be. the folks at Epic saying, leave the innovation to us. We'll tell you what agents to use. We'll tell you how one workflow connects to the other. you know, we are gonna give you all the advice and guidance that you need on innovation.

Sarah Richardson: Oh, see, I'm gonna totally take the counter on

Drex DeFord | This Week Health: Let's go,

Sarah Richardson: and you know that

Bill Russell: All right.

Drex DeFord | This Week Health: let's go.

I want to disrupt where I'm being held hostage, which is what Bill has already talked about. Bill's been really polite in his fiction series about taking a scenario that's actually there. We haven't quite dipped into the fact you're also held hostage by your EMRs right now the amount of money you're spending to get almost good enough and wait for it, now you get to actually pull those elements in.

And I've always had like a ninja crew. Who did stuff they weren't supposed to do to disrupt and have better outcomes in my facilities. This now almost makes me wanna jump back into a hospital and be like, let's code Reddit from our own

Bill Russell: Yeah,

Sarah Richardson: of my phone calls because you have everything you already talked about in place and you know how to do it.

And we could just ideate and think, where do I become an innovation test bed for you? That benefits everything happening in my health system.

Jacob Hansen: Gonna say.

Sarah Richardson: But we

Jacob Hansen: I.

Sarah Richardson: it right. We also don't wanna be the ones who went out there first and all of a sudden those canaries are laying dead in front of your mind.

Jacob Hansen: Yep. That's the, that's the, I think that's the uh, um. interesting piece of the, the puzzle with this is, everybody's concerned about being first.

Drex DeFord | This Week Health: Mm-hmm.

I think that's gonna create some interesting friction as well.

Bill Russell: So, just to close this one out, all these stories sort of weave together really nice. Aaron, Einstein, who is the CMO at Notable has been on the show before. love talking to Aaron. so we talked about technology, we talked about the scribe, we talked about agents, and the platform.

When you look at these age agent workflows, they're a lot more fluid, a lot more. rapid in terms of the development. And so there's two things I think about here. One is the, staff. The staff to build this out is really gonna have to understand the entire workflow. It's no longer gonna be just listening to somebody.

In fact, I would say some of the nurses don't understand the entire workflow. Some of the doctors don't understand the entire workflow. And so your, your team, your clinical informaticists are gonna become. And, and this was the point of his, his story are gonna become critical and they're gonna become more than just, builders.

They're gonna be AI builders, they're gonna be people that see this workflow and they're gonna be able to create the on the, uh, uh, agent factory. They're gonna be able to create these multi-step, workflows that are going to change how your system operates. And so, you know, it shifts from order taker.

Alright, so when we start layering these things on top.

Drex DeFord | This Week Health: Nonstop.

Bill Russell: Are we going to get to the point where that's a form of best of breed, and then all of a sudden These upgrades are breaking more things that they didn't anticipate, or the guardrails gonna be such that the agent factory takes all that into account and allows that, that lower level to be able to continue to change.

That's for me, that's the red carpet.

Drex DeFord | This Week Health: red.

Bill Russell: Code red. Thank you. Red carpet. Red bull code. Red. Uh, but it could be a Red Bull moment, man. We need to start studying. We need to start, it's gonna be a, a, an interesting shift,

Drex DeFord | This Week Health: shaking his head no, though.

Bill Russell: please.

Sarah Richardson: able to release code daily and not have it be disruptive.

Bill Russell: That's a different world.

Jacob Hansen: that's where I was going as a product guy is, is how many of, in what way will these various, AI vendors who take advantage of the infrastructure that. Epic or somebody else is providing. In what way are they all supporting continuous integration and deployment principles? How, how is their architecture going to support that?

She, she brings such rigor to. If we're gonna use this, what does this mean to, measurable patient or staff outcomes? Why do we believe it? Did we run a study that actually demonstrates it? Otherwise, it's just noise.

Drex DeFord | This Week Health: It'll be interesting too, bill, that this idea of, know, you were sort of talking about the, the change that really happens now is that the CIO and the CIO's team through these agents,

Bill Russell: Well.

Drex DeFord | This Week Health: what,

Bill Russell: but Drex, I'm not sure it's knobs anymore. When you think about where this agent layer sits, it's as if it's a person sitting at a keyboard with a mouse and a keyboard going,

yeah.

Jacob Hansen: Giving away. It's giving away control in a way we've never seen before. And that's where I find some of the other phrases, the things that I'd seen in some of the articles on your site, augmented empathy. There's just certain things we're not going to offload or that we should not offload.

agents

for sure.

Bill Russell: it is, one of the first use cases I saw and I was reading about was the, uh, uh, problem lists.

Jacob Hansen: Mm-hmm.

Bill Russell: Or, or, or med rec. You know, this is the kind of thing that you could have an agent call a person before they come in. 'cause the agents can talk, right? So the agent calls ahead and says, Hey, just wanna verify some things.

'cause it's usually an assistant that you're talking to. But um, yeah, and think about that is that, that is not like database level access. that's access at a, layer almost above workflow.

Jacob Hansen: you just reminded me of something else earlier this week. I was in a conversation. Adam McMullen, our CEO and I, were meeting with a partner and we were chatting about some of the benefits that have come through. Digitization over the last, you know, call it 15, uh, plus years, where at times there was too much variability in care being provided, not enough, commonality and structure.

And it's gonna look for sort of the least common denominator. In what way do we actually leave behind too much variability and head to, a place where, you know, hammer sees a nail and smacks it, but it really wasn't the problem. Like I've sat with nurses so many times watching them work where they're sitting there and they're saying to themselves. I've seen this before.

Bill Russell: Jacob, I love the argument you're making. It's just not an argument anyone's made to here. Like, we're not, we're not arguing with you. We're not trying to intermediate, we're not trying to get in between the. Technology is not trying to get in between the clinician and the family member for empathy.

I can now build that, like I can go into Agent Factory and go step one, step two, step three, you know, bring in this, and do this

Drex DeFord | This Week Health: it

Bill Russell: thing.

Drex DeFord | This Week Health: for you.

Bill Russell: Yeah, I don't think, in fact, I know that Epic would never allow their agent factory to diagnose or get in between. they'll never do that.

Now, third parties. I mean, if we're talking open AI and we're talking, uh, well, especially open ai, I mean, they're flat out saying, Hey, we want to, all those things, your arguments you're making, they absolutely are positioning themselves to be an empathy machine, to be a diagnostic machine, to be all those things.

That's that. That's scary.

Bill Russell: Oh.

Jacob Hansen: I know we're just about out of time, but I just wanted to call out this last, thing I sent you guys about the Rent to Human site. Um,

Drex DeFord | This Week Health: Yes.

Jacob Hansen: I point this out because I just saw this yesterday, this new website built by a human, where it opens up to,

Bill Russell: Are you sure it was built by human?

I love innovation. I'm motivated by it. I love solving problems with technology. I see an article like that and that gives me serious pause. It does.

Bill Russell: Well, we just had this long conversation about Claude Bot or whatever it's called now, Open Claw is the now thing. And, so I kept digging deeper into it after our conversation yesterday, Drex and Sarah. And, essentially it's a series of heartbeats and, CR jobs and whatever, and it's ai.

It creates this AI circle on top of each other with, by the way, infinite memory. 'cause it's just storing things in markdown files and whatnot. And so it appears to be sentient in ways like it's doing these things, but the reality is if you turn off that CR job, it's done. It is like, and, and it's not making great decisions all along the way.

Bill Russell: the next step.

Drex DeFord | This Week Health: the empathy idea.

'cause I think we went 40 minutes and he's, he's a 30 minute kind of guy. So, Jacob, that's a testament to you. I love the conversation. Love where we took it. Love the content that you sent over. great discussion. So thanks everybody for being here.

Jacob Hansen: Thank you.

Sarah Richardson: Always fun.

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