Beyond EHR Vendors: Health Systems Owning Their AI Destiny

TL;DR

The hard truth: Fewer than 2% of health system leaders say their EHR's AI tools are fully developed, leaving 98% of providers waiting on vendor roadmaps that prioritize generic solutions over your competitive advantage.

The risk: Trusting EHR Vendor to drive your AI strategy means ceding innovation pace and differentiation to them. While you wait, leading health systems are building proprietary AI capabilities that competitors can't copy.

The opportunity: Map your high-impact operational and clinical use cases, build a reusable AI backbone, and roll out incrementally. The goal isn't just AI adoption, it's transforming AI from a vendor add-on into a strategic asset that accelerates speed to care and speed to cash.

The Vendor Trap: Why 98% of Health Systems Are Stuck Waiting

Most hospitals operate under a dangerous assumption: their EHR or enterprise IT vendor will "bring AI when it's ready." This creates strategic paralysis at the worst possible time. Vendor AI features are designed for the average customer, not for the unique workflows, populations, or reimbursement pressures of your organization. Waiting on these roadmaps means building their moat, not yours.

Recent CHIME-KLAS research reveals the magnitude of this problem. Only 15% of health system CIOs feel their current EHR vendor is "ahead of the curve" on AI, while 60% describe them as "behind" or "too slow." Even more telling: a separate study found that fewer than 2% of CIOs believe their EHR's AI functionality is fully mature.

This vendor dependency creates three concrete problems:

Innovation lag: You ship at the pace of EHR vendor updates, not at the pace your clinicians and CFO demand. While you wait for vendor roadmaps, financial pressures and staffing shortages intensify.

Loss of differentiation: The same vendor features your competitors get won't create lasting advantage. When one EHR vendor updates their system, every health system in your market gets identical capabilities.

Strategic blind spots: Critical workflows, prior authorization turnaround, denial management, oncology protocol design, rarely sit at the top of vendor roadmaps. These vendors serve hundreds of clients; your unique operational challenges aren't their priority.

The result? Strategic paralysis disguised as patience. While you wait for vendor AI to mature, forward-thinking competitors are building proprietary capabilities that will be impossible to replicate with off-the-shelf tools.

Key takeaway: Vendors are your system of record, not your system of growth.

The Data Ownership Reality Check

Here's what vendor dependency really costs: your data becomes their competitive advantage.

Every health system has unique patient demographics, referral patterns, coding practices, and care delivery models. This uniqueness is where AI can create lasting competitive advantage, but only if you own the models and infrastructure that turn data into outcomes.

Consider the math: when you feed your operational and clinical data into vendor-provided AI models, you're essentially training their algorithms to serve all their customers better. The insights derived from your patient population and workflows get absorbed into generic models that your competitors can access.

The alternative approach: provider-led AI strategy ensures your data remains your strategic asset. Your workflows and patient insights become the moat competitors can't easily copy.

The payoff:

Speed to care: reduce delays in protocols, authorizations, and treatment pathways.
Speed to cash: faster claims cycles, lower denial rates, fewer write-offs.
Differentiation: proprietary workflows and insights that competitors cannot copy.

Your Moat Lies in Data + Workflow

The one thing vendors can’t replicate is your data combined with your workflows. If you let vendors dictate the approach, your data fuels their models, and the advantage accrues to them. If you design and own the AI layer, your workflows and patient insights become the moat competitors can’t easily copy.

What You Control	Strategic Advantage
Patient & claims data	Proprietary training signals → models adapt to your population, not a generic one
Clinical workflows	AI tuned to local protocols improves speed to care, reduces variance
Operational workflows	Custom automation in eligibility, denials, and authorisation → faster speed to cash
Care delivery patterns	Insights into referral, coding, discharge → measurable ROI, unique to your system

Why Leading Health Systems Are Building Internal AI Capabilities

The provider-led approach isn't theoretical. Leading health systems are already proving its value:

One leading U.S. health system built an internal AI infrastructure and enablement program that dramatically increased AI projects across the organization. Instead of waiting for vendor solutions, their data science team focused on empowering clinicians and staff to develop AI use cases safely and effectively. The result: FDA-cleared algorithms and real clinical interventions that competitors using vendor AI cannot replicate.

Another large integrated health system leveraged its vast data to internally develop and vet AI tools, appointing a VP of AI and establishing comprehensive governance structures. This investment in internal AI capacity allowed them to create unique capabilities rather than relying on generic vendor offerings.

The pattern is clear: organizations at the forefront of AI often must innovate internally because vendor offerings aren't yet adequate for their specific needs.

The Build vs. Buy Decision Framework

The question isn't whether to abandon vendor systems, it's how to layer strategic AI capabilities on top of your existing infrastructure.

"Owning your AI destiny" doesn't always mean building from scratch. It can involve:

Partnering with specialized AI firms that understand healthcare workflows
Adopting open platforms that integrate with existing systems
Developing hybrid approaches that combine vendor tools with custom solutions

The key principle: You define the vision and ensure solutions are tailored to your unique needs, rather than accepting whatever generic features vendors eventually deliver.

Many CIOs initially try to stick with EHR-integrated AI (the "buy" path) but realize the limitations when 60% report their EHR's AI capabilities are still in infancy. The most successful approach evaluates whether building, buying, or partnering yields the best fit for high-priority use cases.

A 3-Step Framework to Owning Your AI Destiny

A provider-led AI strategy doesn't need to be overwhelming. The key is to start with focus, build the backbone once, and roll out in controlled increments.

Step 1: Map Your Opportunity Landscape

Split your AI opportunities into operational (speed to cash) and clinical (speed to care) categories:

Operational focus: Prior authorization, denials, eligibility checks, claims processing

Clinical focus: Care personalization, treatment protocol assistance, discharge summaries

Start with operational use cases for three strategic reasons:

Immediate ROI: McKinsey estimates that administrative automation alone could reduce U.S. healthcare costs by up to $265 billion annually
Lower risk: Operational AI has fewer patient safety implications than clinical AI
Stakeholder buy-in: Finance and operations teams see direct value, building support for clinical applications

Step 2: Build the AI Backbone (The Foundation for Scale)

Before chasing individual use cases, establish an enterprise-wide backbone that every AI project can plug into:

Core Components:

LLM router/orchestrator (multi-model support for different use cases)
Guardrails and policy enforcement (PHI protection, safety protocols, compliance monitoring)
Evaluation harness for benchmarking prompts and outputs
Observability platform for drift detection, cost management, and usage analytics
Data governance layer ensuring HIPAA compliance and audit trails

Why this matters: A Deloitte survey found 62% of healthcare executives cite lack of shared infrastructure as the top reason AI pilots stall. Without a unified backbone, you get "pilot sprawl", fragmented experiments that never scale.

Step 3: Roll Out Iteratively With ROI in Mind

Sequence use cases by impact × risk × implementation cost:

Phase 1: High-impact, low-risk operational use cases (prior auth automation, eligibility verification)

Phase 2: Clinical augmentation with human-in-the-loop validation (protocol recommendations, discharge summaries)

Phase 3: Advanced clinical decision support (with comprehensive safety frameworks)

Measure ROI early: Track reduction in denial rates, faster time-to-decision, physician hours saved, or claims processing acceleration. Administrative AI implementations often achieve ROI within 6-12 months when properly executed.

This creates a flywheel: each success builds executive and clinical trust for the next wave of AI deployment.

AI Governance: The Missing Piece Most Health Systems Ignore

Owning your AI destiny means owning the governance framework.

Essential governance components:

AI steering committee with clinical, operational, and technical leadership
Data use policies defining what patient information can be shared with third-party models
Bias monitoring and ethical AI frameworks
Human-in-the-loop requirements for clinical AI applications
Regular audit procedures for AI outputs and decisions

Without robust governance, even the best AI strategy becomes a compliance liability. Leading health systems treat governance as a competitive advantage, it enables faster, safer AI deployment while building trust with clinicians and regulators.

Common Pitfalls That Derail AI Strategies

Even well-intentioned AI roadmaps fail if you fall into these traps:

Waiting on vendor roadmaps → Guarantees you'll always lag competitors who are building proprietary capabilities

Chasing point solutions → Creates siloed pilots, duplicated infrastructure, and no path to scale

Skipping data readiness → Without governed, de-identified, and accessible data, no model delivers safely or effectively

Boiling the ocean → Large, multi-year AI programs collapse under cost and complexity; start focused and expand

Ignoring safety guardrails → Clinical AI without human oversight creates unacceptable patient safety risks

Measuring activity, not outcomes → Number of AI pilots means nothing if denial rates haven't improved or clinicians still wait hours for protocol guidance

From Vendor Add-On to Strategic Asset

The systems that win in the next decade will treat AI as a strategic layer, one that accelerates speed to care for patients and speed to cash for providers, while protecting the data-driven competitive moat that vendors cannot replicate.

The transformation isn't about big-bang AI implementations. It's about:

Owning the infrastructure backbone that enables consistent AI deployment
Sequencing use cases based on impact and organizational readiness
Proving ROI with each release to build momentum and trust
Maintaining governance frameworks that enable safe innovation

This approach shifts AI from "something in EHR's next upgrade cycle" to a core competitive advantage that defines how your health system competes in an increasingly challenging market.

The choice is binary: Continue waiting for vendor roadmaps while competitors build proprietary AI capabilities, or take control of your AI destiny and create differentiation that generic vendor tools cannot replicate.

Why Ideas2IT Is the Strategic Partner for Provider-Led AI

Owning your AI destiny requires more than vision, it demands a partner that understands healthcare workflows as deeply as it understands modern AI infrastructure.

That’s where Ideas2IT comes in.

Healthcare + Silicon Valley DNA: With 15+ years in provider and payer innovation, we bring domain expertise and the engineering rigor of top tech ecosystems.
Backbone-first approach: We design enterprise AI platforms that consolidate routing, guardrails, and observability, eliminating the pilot sprawl that stalls most initiatives.
Data as a moat: Our frameworks ensure your data remains governed, compliant, and proprietary, turning unique workflows into defensible advantage.
ROI-focused rollouts: From prior auth automation to oncology protocol support, we prioritize high-impact, low-risk use cases with measurable outcomes.

Health systems that wait on vendor roadmaps will always be followers. Partnering with Ideas2IT means defining your own innovation timeline, owning the AI infrastructure, and accelerating outcomes on your terms.

Explore our AI Consulting & Development Services.

‍

FAQ's

1. What if our data is fragmented across EHR and SaaS systems?
That’s the norm. The first step is to design a data platform layer that unifies access, de-identifies PHI, and standardizes lineage. Without this, AI projects stall. With it, you can safely build on top of both EHR and SaaS applications while retaining ownership.

2. How do we ensure compliance with HIPAA and other regulations?
Compliance guardrails must be built into the backbone: PHI masking, access policies, and audit logging at every step. Human-in-the-loop oversight ensures no unsafe outputs move into production. This creates an auditable safety layer regulators and clinicians can trust.

3. What’s the ROI window for operational AI use cases?
Operational automation (eligibility checks, prior auth, denials) typically shows ROI within 6–12 months.

4. How does this fit with existing vendor systems?
Vendors remain your system of record. The provider-led strategy layers AI capabilities on top, ensuring workflows are faster, safer, and tailored to your organization, instead of waiting for vendor upgrades.

‍

Ideas2IT Team