Bearings
Weekly Intelligence by Purpose Health
By Jason Mudrick, Senior Director · Monday, September 7, 2026
Every Monday, Bearings sorts the week's healthcare IT news into what matters for the people who run health systems: what happened, why it matters, and what to do about it. This Labor Day week the throughline is stewardship: of a chart that three different AI tools now want to read, of the largest EHR contract in the country, of a hospital's ability to keep caring when its systems go dark, of rural money that now names hospitals, and of a prior-authorization workflow that changed on both ends at once.
Three AI tools now want to read the same chart, and the newest one did not come through the front door
On September 1, OpenAI announced that ChatGPT for Healthcare can connect to Epic: read-only access to notes, labs, medications, and specialist documentation, either imported into ChatGPT or surfaced inside supported Epic workflows, with a companion plugin for nine public sources such as PubMed and DailyMed. UCSF Health is the named pilot, and its CEO called the work exploratory. Neither company said whether the connection is a sanctioned partnership or standard third-party access; This Week Health's read is that it arrived over ordinary FHIR access, without warranty protections, and that "a badly built agent can fire 75 API calls into production Epic." Five health-system CIOs told Becker's what it would take to trust it: outputs traceable to the chart, audited, and validated locally rather than on the vendor's own 99.1% safety figure.
The same week produced the best ambient-AI evidence to date and its sharpest caution. WashU Medicine and BJC Health expanded Abridge from 450 to about 4,000 clinicians after documentation time fell 15% and after-hours work fell 20% by day 150. An Amsterdam teaching hospital became the first to run Epic's ambient tool in Dutch, cutting note-writing time 31%. Mercy took nursing ambient documentation to Android after a 22% cut in flowsheet time. And Healthcare Dive reported malpractice insurers warning that scribes "fail silently", while a physician essay in Becker's put measured savings near $3,044 per physician per year against a vendor's advertised $13,000.
Our takeMost Epic organizations now pay for three tools that summarize the same chart: the EHR's native AI, an ambient vendor, and whatever a service line connected on its own. The question for leadership is who may authorize an organization-level connection, which pathway it uses, how its outputs are traced and audited, and what happens to production performance when it misbehaves. Write those rules before the next pilot request arrives, and tie every ambient business case to explicit capacity and coding assumptions, because saved minutes have a way of becoming tomorrow's schedule.
How Purpose Health helps. Our AI Strategy practice runs the inventory, governance, and portfolio-rationalization work that turns three overlapping AI tools into one accountable program, with audit, consent, and review controls insurers are beginning to expect.
EHR ProgramsThe largest EHR program in the country drew a subpoena, and the conversion pipeline kept moving
On September 2 the House Committee on Veterans' Affairs voted 19-0 to subpoena Oracle's Larry Ellison and Mike Sicilia after the company withdrew from a hearing on the VA's electronic health record contract, whose ceiling has risen from $10 billion to roughly $27 billion with 17 of about 170 medical centers live. GAO testified that 14 of its 18 recommendations remain open, none of the 12 priority items (cost estimating, scheduling, testing, user adoption) fully implemented. In the same week, a 17-hospital West Virginia system announced it will launch Epic across all facilities in 2028, three years into a ten-year Oracle Health extension, and Adventist Health went live on Epic across 27 hospitals and more than 440 clinics in a single event. Epic now runs 21 of the 25 largest U.S. health systems.
Our takeThe VA story reaches well past one vendor. GAO's open items are the same ones that sink commercial programs: no credible cost estimate, no integrated schedule, testing and adoption treated as afterthoughts. Any board approving a multi-year EHR conversion this fall should be asking for those four artifacts before the contract, plus a cost-overrun clause with teeth. The organizations converting now, whether in one weekend or in waves, will succeed or fail on program discipline long before they succeed or fail on software.
How Purpose Health helps. Our Epic Practice brings the program management, certified analyst bench, and post-live optimization that carry a conversion from signed contract to stable operations, for regional systems and their community affiliates alike.
CybersecurityA health system spent the holiday week on paper
Maryland's Luminis Health alerted the state on August 31 that technology problems were forcing patient rerouting, then disclosed a cybersecurity incident that took its patient portal and phone system offline. By September 4, physicians were charting on paper, emergency crews were diverting patients, and no restoration timeline had been given. The same week, a non-malicious technology failure at a shared-service organization took five Ontario hospitals down for two to three days, and a vendor that archives legacy patient records reported a breach affecting 9.54 million people from its cloud environment. Defenders also had two front doors to fix: a Citrix NetScaler authentication bypass drew attacks within a day of a public proof of concept, and CISA added two exploited SonicWall flaws to its known-exploited list with a three-day federal deadline. A phishing service that walks victims through multifactor authentication had done so at 258 organizations.
Our takeRecovery is a capability you rehearse; no hosting contract supplies it on its own. An organization that cannot state a restoration timeline after a week has discovered that its backups, its isolated recovery environment, its portal and telephony contingencies, and its paper-to-chart reconciliation were never rehearsed together. Three moves for this month: inventory every internet-facing remote-access appliance and patch it inside the federal deadline rather than at the next maintenance window; treat archive and migration vendors as part of the security perimeter, because that is where the data now lives; and move administrative and clinical access to phishing-resistant authentication, since push-based MFA is being walked around at scale.
How Purpose Health helps. Our EHR Cloud Hosting services are built around patch velocity, identity architecture, and rehearsed recovery, so a bad day stays a bad day.
Rural HealthRural funding now names hospitals, and the clocks are running
The $50B Rural Health Transformation Program moved from state awards to funded projects with hospitals attached. Arkansas's $149.3M itemizes telehealth-equipped ambulances, AI-enabled smart rooms, "digital integration," and emergency teleconsultation at named hospitals. Michigan's $25M puts more than $16 million into a fund for rural providers to upgrade technology and digital systems. Indiana ($120M), New York ($76M), Hawaii ($58M), and Rhode Island followed, and in Kentucky the CMS administrator said the state's $213M begins disbursing in October, repeating that states that miss approved goals face clawback. Colorado expects to announce its $200M in awards by the end of September; Minnesota and Ohio have open solicitations. Meanwhile hospital groups asked CMS to publish awardee lists and progress reports; CMS plans only an annual report.
Our takeA rural hospital named in a state's technology allocation is holding committed money with a reporting clock already running, and most have never run a technology program of this size. The transparency gap makes it harder for those hospitals to learn from each other, so the practical advice is to borrow discipline from the states that publish everything: define the deliverable, the vendor, and the milestone before the first dollar moves. Delivery partners should be chosen now, before the first progress report is due.
How Purpose Health helps. Our MEDITECH Practice specializes in rapid Expanse implementations for community and critical-access hospitals, and our program-management teams turn grant categories into delivered, reportable outcomes.
Prior AuthorizationPrior authorization got simpler and harder in the same week
UnitedHealthcare will drop prior authorization on roughly 1,700 treatments, about 30% of its requirements, effective October 1, and expects more than 70% of remaining volume on standardized electronic submission by year-end. The American Hospital Association is convening CMS and Epic to brief hospitals on the January 1, 2027 Medicare Advantage electronic prior-authorization mandate. And The Sequoia Project named three industry gaps that could derail payer-to-payer compliance: no national directory for finding payer API endpoints, an implementation guide that CMS only recommends, and no agreed process for handling failed exchanges. Automation kept advancing: one e-prescribing network reports AI fully completing 63% of pharmacy authorizations with no clinician edits, and a denials platform cut peer-to-peer chart review from 15 to under 5 minutes per case in a health-system pilot.
Our takeFewer authorizations is good news that creates immediate work: every EHR rule set, work queue, and payer edit built around the old list needs maintenance before October 1, or the change shows up as denials. Sequoia's gaps are a reminder that the January deadline is met with plumbing: endpoint discovery, conformance testing against the guide, and exception handling are the parts no vendor platform ships. Four months remain; organizations that start now implement, and organizations that wait remediate.
How Purpose Health helps. Our Software Development & Integrations team delivers prior-authorization enablement across EHR-native, revenue-cycle-platform, and standalone paths, including the payer connectivity and exception handling the mandate depends on.
The week in one paragraphStewardship was the theme: a chart that three AI tools now want to read, an EHR program whose oversight gaps read like a checklist for every conversion, a hospital that kept caring on paper while its systems were dark, rural dollars that now carry hospital names and reporting clocks, and a prior-authorization workflow that simplified on one end and got more technical on the other. None of it is beyond preparation, and preparation is a choice available today.
Purpose Health partners with health systems on Epic and MEDITECH delivery, EHR cloud hosting, software development and integration, and AI strategy, in the United States and internationally. Talk to our team about any topic in this week's Bearings.
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