Why Won’t Epic Just Build It?
We recently shared a post mapping various Generative AI use cases across the clinical workflow. Since then, we’ve had numerous conversations with startups building AI solutions across those categories.
In almost every discussion, one question surfaces: Why wouldn’t Epic just build all of this itself?
That question has become even more complex with recent announcements from OpenAI, which appears to be moving more directly into the healthcare enterprise space. The dynamic is fascinating and, understandably, tense. The very technologies and platforms enabling innovation may also become competitors.
It is a valid concern. However, the answer is not a simple binary of build versus buy. It requires a more nuanced understanding of platform strategy, specialization, and ecosystem dynamics.
Epic’s Core Competency
Epic’s core competency is, and likely always will be, the EHR. It is the central nervous system of the health system, responsible for managing patient data, regulatory compliance, billing, interoperability, and complex clinical workflows at a massive scale.
Building and maintaining that infrastructure is an enormous undertaking. Expecting any EHR vendor to lead innovation in every niche of AI-driven functionality simultaneously is unrealistic.
EHRs are platforms. Platforms create ecosystems.
Historically, we have seen that platforms thrive when they enable complementary innovation rather than attempting to own every edge use case.
Why Interoperability Matters
The rise of standards like HL7 FHIR and SMART on FHIR is not accidental. It reflects a broader recognition that healthcare innovation cannot remain locked inside monolithic systems.
Regulatory pressure, interoperability mandates, and evolving APIs are reshaping the landscape. These shifts create space for a marketplace of specialized AI solutions that can plug into core EHR infrastructure.
This does not eliminate competitive overlap. It does, however, suggest that the long-term architecture of healthcare AI will be modular rather than vertically consolidated.
The OpenAI Factor
The conversation becomes even more complex when foundational model providers begin moving closer to enterprise healthcare solutions.
When an LLM provider expands into verticalized offerings, it introduces a new dynamic. Startups building on top of these models must ask whether they are building with a partner or a future competitor.
At the same time, foundational model providers face their own limitations. Deep clinical workflow integration, regulatory alignment, health system change management, and domain-specific configuration require more than raw model capability.
The gap between model capability and operational healthcare value remains significant.
The Bigger Picture: Intersection Points
This is not a single-player game.
Epic is not the only EHR. OpenAI is not the only LLM. There is a diverse ecosystem of EHR vendors, AI model providers, and healthcare-focused technology companies.
The more strategic question is not what one large platform might build. It is where the true intersection points lie between technological capability and healthcare-specific opportunity.
Where does AI meaningfully augment clinical cognition?
Where does it reduce administrative friction?
Where does it unlock new workflows that legacy systems were never designed to handle?
We are still at the beginning of this journey. The landscape will evolve through experimentation, collaboration, competition, and consolidation.
Threat or Distribution Channel?
For startups, the real question may not be whether Epic or OpenAI are threats. It may be whether they represent distribution channels, infrastructure layers, or potential collaborators.
Platform ecosystems often reward those who build differentiated value at the edge while integrating deeply with the core.
From our perspective, the opportunity lies in designing systems that are interoperable, modular, and capable of working across vendors and model providers. The future of healthcare AI will likely be shaped less by who owns the model and more by who solves the right problems within clinical and operational workflows.
We are continuing to explore these dynamics and would welcome discussion from others navigating this space.
Do you see Epic primarily as a competitive threat or as a distribution opportunity? How do you view foundational model providers entering the healthcare enterprise space?