The Information Exchange: Epic Dúnadan Edition

UGM week has come and gone, so we’re recording closer together than usual. Epic spent a week announcing things in front of 11,000 people and the group chat would not settle down. The absolute legend that is Ryan Brickner joins for the first time. He’s the freshest out of Epic of anyone here, which makes him useful for checking our takes against what the building actually thinks. We get into: \* **Epic Rangers** and whether that’s Texas coded, power in nature or a Tolkien callback. \* **Ergo** as an orchestration layer sitting directly on top of EHI, and what that implies for third party access. \* **Epic’s continued assault** on third parties, with post-discharge calls, Autonomous coding, payments, and eFax \* **Going down market** via Sonnet, Garden Plot, and Orchard \* **Leadership thoughts** with a brief read on who was on the UGM stage. And yes, for those tracking, we’re absolutely counting the prediction from a few episodes ago about federal action before end of summer as true (sorta) as various news outlets announced that the FTC has been looking at Verona. Let’s dig in. **Relevant Articles** \* UGM Hot Takes 2026**:** General purpose article about the announcements and pronouncements out of Verona this year \* Epic in the Crosshairs**:** Earlier signals that the FTC and others were looking at Epic in February \* Is Epic’s Garden Plot a Failure?**:** Prior art on historic Epic’s downmarket strategies and their relative successes \* The Lesson of Gates**:** Extrapolating out from the brief Microsoft court case mention \* The Epic Abdication**:** Relevant to the discussion of Seth Howard and other leaders Chapters \* **Epic Rangers, or Possibly Power Rangers (0:00 – 3:54):** A program announced early enough in the week to dominate the chatter and late enough in the planning that TLs were told not to discuss it. Epic staff sign long term contracts with customers, leave Verona, and become ultra analysts. \* **Forward Deployed, and the 320,000 Flex (3:54 – 4:46):** Rangers as Epic’s answer to Palantir, complete with a snarky tweet. Plus why 320,000 annual applications says more about the marginal cost of applying than about Epic. \* **Ergo and the Great Test of Our Time (4:46 – 6:56):** Ergo as an orchestration layer over Art, Emmie, Penny, and UpToDate, sitting directly on top of EHI. If Epic’s bundled solutions get API access to that data, information blocking says third parties should too. \* **Emmie Calls You Back (6:56 – 7:58):** Automated post-discharge outreach as a fix for the readmission problem, and what it frees up for the patients who need a human. \* **Boxing Out the On-Ramps (7:58 – 9:15):** Payments, autonomous coding, eFax, and AI care navigation. Epic moving into categories currently owned by Inovalon, R1, and a long list of point solutions. \* **The FTC Question Nobody Was Going to Answer (9:15 – 10:47):** Why anyone expected active investigation talk on stage is unclear. The antitrust paradox for systems of record and whether the market can be gerrymandered over the hump. \* **Sonnet, Garden Plot, Orchard (10:47 – 14:01):** Three down-market offerings where one or two would do. Sonnet has been tried since 2010 and apparently ripped out a few years ago. Orchard, pre-wired and single tenant, is the one with real appetite behind it. \* **Cool Things Ahead and the Succession Read (14:01 – End):** Seth Howard hosting the segment in Sumit’s absence. How much to index on that, where he sat in the big four, and whether the it factor is teachable. Transcript *We ran the transcript through an LLM to smooth it out. So it’s a rough approximation of the conversation (and in many cases significantly clearer than our rambling), but notably diverges from the word-by-word blows quite a bit.* **Brendan Keeler (00:00):** Alright. Here we are. It’s UGM Week, special episode. We don’t usually get together this frequently. We have a new guest, Ryan Brickner, here for the first time to provide his perspective on Epic along with the rest of us. So let’s dive in. Who has a thought or a hot take? **Pryce Ancona (00:17):** Gosh. A lot happened. A lot of chatter is to be expected and you have to sift through the chatter to determine what’s actually exciting and what you didn’t know about. Let’s talk about Epic Rangers first. That was one of the first things I heard about, and it’s always intriguing to me as someone who left Wisconsin to move to Texas and thinks about how I used to work for Epic. I’m always astonished at how they tweak rules to allow folks to either stay on or not stay on. It’s obviously very purposeful. We’ve seen hypotheses around the strategies with Epic Rangers, but does anybody want to explain the program? **Brendan Keeler (00:57):** It’s really evocative of Power Rangers for me. Maybe in Texas it’s different, like Texas Walker Ranger, but I’m thinking Power Rangers and I’m like, I’m a twenty two year old at Epic, yeah, I’ll be a Ranger. **Pryce Ancona (01:09):** I wanna be a Ranger. I’m actually getting more of the Aragorn kind of vibe. Like this is perhaps someone from Epic that has fallen from grace, and though they were once the Dúnadan they are now just a lonely ranger, waiting for hobbits at the Prancing Pony Inn. **Brad Thorson (01:28):** Somebody insert a Sauron joke here, please. **Brendan Keeler (01:32):** You would think that they did a lot of thinking about the name given all these connotations. Like, wow, how cool. And no, the boots on the ground is they came up with it on like Sunday and they haven’t actually fleshed it out. They’re telling the TLs, the team leads, and the BFFs, “Don’t talk about it yet. We’re not ready.” So what is it? What was announced, Pryce? **Pryce Ancona (01:52):** The idea is that Epic employees who are interested in leaving Madison, and that’s a big deal because you have to work in Verona right outside of Madison if you want to work for Epic, those who want to leave could potentially sign long term contracts with Epic customers to continue supporting them. Question mark: as an Epic employee? Getting paid by the health system? Sort of hard to determine. But I’ve seen whispers in the Ex-Epic Slack channel. Brendan, maybe this is a way to allow Epic staff to go elsewhere, move back to where they’re from, and then leverage all these AI tools that are gonna help create configurations and do system setup for Epic clients, to be ultra analysts, if you will. They’re gonna have the power of multiple analysts by being plugged into Epic and aware of internal happenings, but full time for a particular customer. Maybe they are Power Rangers. A quirky little announcement in the midst of all the actual product announcements they made. **Brendan Keeler (02:57):** Brickner, you were the freshest from Epic. Would the Ranger opportunity have retained you? **Ryan Brickner (03:04):** I don’t know if they could have found a good enough position to retain me any longer, but I definitely think it’s a very exciting opportunity. I think it’s really interesting how it plays with their overall AI strategy, because it seems like the underpinning of the program is basically that all the grunt work analysts do right now is going to get automated away. So these analysts are gonna become much more strategy oriented, much more big picture oriented. And Epic is saying, “Hey, since this is gonna become more of a specialized role, here’s some more specialized folks that we’ve trained and that we trust on our side to do this kind of big picture thinking. Go and upgrade your health system even further.” So not for me, but I think it’s an awesome direction to see them going. **Brendan Keeler (03:54):** Yeah, and maybe this assuages some of the non-compete stuff. Not really, but at least there’s more opportunities for people. Certainly they upped their beef with Palantir. This is their forward deployed engineer, and they even did a snarky tweet about it. So we shall see. They also said, “we have 320,000 apply annually for jobs at Epic,” as if it’s a flex. I don’t think it’s a flex. AI has meant that the marginal cost of applying to a job is almost zero, so every company is flooded by crap applicants. It’s not like they have 320,000 tremendous applicants. They have bots that are firing off twenty applications at a go, coming out of Madison, UW or Notre Dame or wherever. What else do we find interesting? **Brad Thorson (04:46):** The Ergo announcement, obviously Judy spent a ton of time there. Ergo, what I read about it, is an orchestration layer on top of a bunch of different existing products and potentially workflows that you could build yourself. My big question coming out of it, as the only person here who hasn’t worked at Epic and hasn’t been part of a UGM, is that they’re going very much “we’re gonna control every aspect of our customers’ workflow.” But Ergo sits directly on top of EHI. So the big question for me is, does this mean everything you can do in Ergo has to be made available to third parties because of the information blocking laws? And potentially EHRs that try to become particularly insular actually erode their advantage of working with their customers on non-EHI centric workflows. Maybe there’s a place for headless EHRs in our future. Anybody excited by the words I said? **Brendan Keeler (05:47):** I have thoughts, but Pryce, you’re smiling. **Pryce Ancona (05:50):** No, no, I wanna hear you. **Brendan Keeler (05:51):** You mix together the Agent Factory stuff, which is their “build with agents,” that people are super excited about. I’m not as much. No-code builders have a long and torrid history of underperforming. But AI could fix them, maybe. The Ergo stuff, I think you’re right. It is a rebrand of some Art stuff and other AI things they’ve been doing, as well as the UpToDate partnership for clinical intelligence that’s in there. So it’s a rebrand, to your point. And it does beg the question: if API access to EHI is enabled for the internal bundled solutions of Art or Emmie or Penny or Ergo or you name it, do third party applications have equivalent access to do the same things and have the same data? That will be the great test of our time, both for Epic and every other EHR subject to the information blocking statute. **Brad Thorson (06:48):** It sounds like Ergo sits on top of Art, Emmie, Penny, whatever you want to plug into it. **Brendan Keeler (06:54):** Brickner, what was your favorite from UGM? **Ryan Brickner (06:56):** Definitely biased on this one, but I think the ability for Emmie to make post-discharge calls to patients is a huge step up for a lot of care coordination workflows. One of the single most expensive parts of our healthcare system is patients that get rehospitalized because nobody followed up with them after their first hospitalization to make sure they’re not right back in there three days, a week, a month later. Having the ability to automate these workflows instead of having somebody spend time on the phone again and again is going to let them follow up with these patients and get them the care they need faster. And it’s gonna free up a lot of man hours to work on specifically the patients they need to focus on, while still not letting the other patients fall through the cracks. I did a ton of work on pop health and post-discharge workflows at Epic, so, tiny bit biased, but I love the direction that’s going in. And Pryce, what was your favorite? **Pryce Ancona (07:58):** We’ve now mentioned two things in a row that piqued my interest, because there’s another vertical of solutions that Epic is trying to box out. Of course Epic is gonna say they’re focused on their customers and providing them all the tools they need. But when I’m hearing about the post-discharge calls, I’m thinking about some of the automated AI care navigation products on the market today. Hearing about the fact that they’re gonna start taking payments, doing payment transactions so they can potentially box out payment on-ramps for their customers. They are moving into autonomous coding, which was particularly surprising to me because, Brendan, we talk about how Epic is a massive system of record and they have tons of experience in the operations of the space, but oftentimes, aligned with your comment about them partnering with UpToDate, they’re looking to outsource someone who’s gonna do the crunching and machine learning on what codes should be on what claims. That’s Inovalon and that’s R1. To hear about all of that stuff starting to happen within the software suite, it’s like, no wonder the FTC is coming for ‘em. **Brendan Keeler (09:15):** Every article is like, where’s the discussion of the FTC investigation? And I’m like, if they’re under a Civil Investigative Demand, I don’t think they’re allowed to talk about it. So what are you expecting? “Yes, we are under investigation and here’s what we’re saying.” The expectations there were kinda whack. UGM is not about talking about your active litigation. Let’s be clear, if Epic had that conference, I would be there in a heartbeat. But that, and the drama around Sumit and Seth Howard, I wasn’t expecting them to say anything about it, and I don’t know why people were. Then there’s continued bundling, which systems of record do. And they do it not just in healthcare. I wrote an article about property management systems and the lawsuits there where they’re doing it today. It happens, but Epic and any market dominant organization are held to different standards of competition and anti-competition under antitrust laws. So is the bundling they’re doing anti-competitive? Is it plain vertical integration that can be competitive, as we’ve seen through Microsoft? It’s gonna potentially be litigated with the FTC if they think they have a case. It’ll be hard, because the paradox of antitrust for systems of record is that Epic still isn’t at seventy five or eighty percent market share unless you really gerrymander it. So can they gerrymander it? Can they get the market definition over the hump? It’s being tried already in private cases, but the FTC has the same barriers if and when they decide to use antitrust. So, not in scope of UGM. **Brad Thorson (10:47):** Or Flower Pot takes off and absolutely eats up. Jump in. **Pryce Ancona (10:51):** That was where I was gonna go next. First of all, the payment integration I mentioned is called Epic Savvy. Thank you, Brickner, for reminding me of that. And then eFax is another one that I’m now looking at on John Lynn’s Healthcare IT Today article, another on-ramp you could potentially box out. These are point solutions that Epic is starting to serve in some form or fashion. But Brendan, I’m particularly interested in your macroeconomic perspective. Epic is continuing to try to go down market with these smaller and smaller plant names. It’s either poems or plants or something. So Brendan, what was your take on this? **Brendan Keeler (11:27):** Okay, you go after market segments. You say, “What is the best route to go after this segment?” That’s usually how you do it. Instead they’re saying, we’ve got Sonnet, which is a reduced feature set. We’ve got Garden Plot, which is a hosted environment where you’re multi-tenant with other similar provider groups. And then you have Orchard, where it’s a hosted environment pre-wired to all these third parties, but you’re single tenant, you’re not with somebody else. It’s just quicker because we pre-wired a bunch of stuff, like your clearinghouse or whatever. They’ve tried these over the years. Sonnet they first tried in like 2010. They tried it again when I was at Epic. Apparently she said it on stage, but then some intelligence came in from people saying, no no no, Sonnet was ripped out a couple years ago. So what are they talking about? Is there something new coming? I don’t know why Sonnet is still around. They need to stop trying to make Sonnet happen, for sure. And they probably need to consolidate around the strategy that’s gonna help them. I can give them Garden Plot and Orchard, because maybe there’s a different buyer for multi-tenant hosted versus single-tenant hosted. But disambiguate it, clean it up, go to market with what’s working. I guarantee there’s gonna be tons of appetite for Orchard’s business model. That’s a really nice middle ground for mid-market providers in my mind. **Pryce Ancona (12:46):** My next question becomes, is Epic actually ready for that? You really don’t compare Epic by and large from a competitive perspective. You can’t really compare Epic and athenahealth, right? They’re serving pretty darn different markets. Of course they compete in a pretty big Venn diagram, but I’m thinking of one decently sized clinic assessing Athena versus Epic. One of them is bigger as a company, one of them has more hospital beds. Does that matter to a 10-clinic practice? I have no idea. Could they fall flat and just overprice? Not sure, but obviously they’ve thought about it a little bit. So, excited to see where that goes. **Brendan Keeler (13:25):** Does the same type of person who buys a Rivian buy a Chevy Malibu? Different market segments with different products for those market segments exist because of different needs. If I’m out living on my farm and I need a truck to get stuff around, versus I’m in the city, well, trucks are more popular than ever, but it’s space constrained and I have different buying inputs. Me as a single-doc practice needing software to run my business is the pickup truck to the Chevy Malibu of inpatient care. **Pryce Ancona (14:01):** Don’t tell me my Chrysler 300 looks like a Phantom. Or the other way around. What else? We briefly touched on how people were overfocused on expecting Epic to step on stage in front of 11,000 people and start talking about all their dirty laundry. But it was notable, according to many, that Seth Howard led the segment called, what’s it called? **Ryan Brickner (14:29):** Cool Things Ahead. **Pryce Ancona (14:30):** Cool Things Ahead, thank you. I was only at Epic for a year and a half. So Cool Things Ahead was led by someone new this year because Sumit’s gone. A little hotgossy, a little fun, a little spicy, but really, like everyone said, don’t overindex on it. **Brendan Keeler (14:48):** You can index on it a little bit, in the sense that Seth Howard was one of the ones you would have rumored before. He was a known leader, on stage and doing stuff in different capacities. Before the big four were announced, he was in the running. He was on the Kalshi thing pretty high. Garrett was present, he presented internally a decent amount and did some public facing things. Lipsky is well known and a leader to the TS division or whatever. And Erv has been a public face in various capacities. But of those four, Seth is the person with the right Venn diagram overlap, that he would essentially be the choice. I think they’re trial running him a bit and seeing: does he have the charisma? Does he have the right leadership capabilities? That’s my guess, because the criticism Jodel has for him is that he doesn’t have that it factor. Judy’s got plenty of things you could say or not say about her, but she’s got her own personality and drive and charisma. **Pryce Ancona (15:46):** “Charisma.” **Brendan Keeler (15:46):** If charisma is a unique personality set, she’s got something. That might be why they’re seeing, does he instill faith in customers? Does he have the communication abilities to be doing Cool Things Ahead? There’s more credence to that than there was a couple of weeks ago, but I think they’re gonna try out leaders in different capacities and figure out a go-forward plan in the months to come. **Pryce Ancona (16:08):** And credit to Seth Howard. From my perspective: Seth, you’re deciding if you want to lead Epic. You might not like it. Not everyone’s as crazy as Judy, so take your time, feel it out, hope you had fun at UGM, keep it up. **Brendan Keeler (16:22):** Well, with that, we’re running low on this extra short emergency episode. **Brendan Keeler (16:26):** We’ll see everyone for the FTC episode next week after that drops. Talk to y’all next week. **Ryan Brickner (16:31):** Have a good weekend. Get full access to Health API Guy at healthapiguy.substack.com/subscribe