By Epic SystemsLearning Objectives
- Understand Epic Cosmos as the research database and the broader Epic AI feature set
- Identify the major AI capabilities (the Art, Penny and Emmie agents, and the Curiosity models)
- Evaluate Epic Cosmos's role in healthcare AI vs separate ambient AI scribes
What Is Epic Cosmos?
Epic Systems' Cosmos is the research database underlying Epic's AI strategy — encompassing 310 million patients from 22.6 billion encounters representing patients in all 50 US states. Combined with Epic's embedded AI features — the Art clinician assistant, the Penny revenue-cycle agent, the patient-facing Emmie, and the Curiosity predictive models — Cosmos forms the foundation of one of the largest healthcare AI platforms by deployment scale. Epic reported in March 2026 that more than 85 percent of its customers use at least one Epic AI product.
Epic dominates the US enterprise EHR market — its software runs the clinical workflow for the majority of large US hospitals and health systems. Adding AI features at the Epic platform layer means hundreds of thousands of physicians get the AI capability without separate procurement; it ships with their existing EHR. In Basket drafting alone is used by over 150 organizations and generates over 1 million drafts monthly.
💡Key Concept
Why Epic-native AI matters: Healthcare AI startups (Abridge, Suki, Augmedix) require separate procurement, integration work, and physician adoption. Epic's AI ships inside the EHR physicians already use — physicians see the AI suggestion next to the patient chart they're already reviewing. The trade-off: Epic's AI capabilities may trail best-of-breed startups in any single feature, but the integration depth and zero-friction adoption make platform-level AI the high-leverage path for system-wide AI rollout.
🎯Tip
Visit Epic Cosmos: cosmos.epic.com — Cosmos research access for Epic customer organizations; AI features ship with Epic EHR
Status & Pricing
Epic AI features are included with Epic EHR licensing — no separate AI subscription. Epic licensing is custom-quote and notoriously not publicly disclosed.
- Includes Cosmos research access for participating organizations
- Includes embedded AI features
- Multi-year contracts
- In Basket message drafting
- Chart with Art ambient notes
- 1 million+ drafts monthly
- Prior authorization
- 42% faster submissions at Summit Health
- 20%+ fewer coding denials
- Scheduling and visit prep
- Billing and lab-result questions
- Ask Emmie in MyChart
- 310 million patients
- 22.6 billion encounters
- All 50 US states
- Predicts risk, length of stay, outcomes
- Researcher virtual lab from February 2026
- Built with Yale and Microsoft
For most US health systems already on Epic, AI features arrive as part of the EHR — meaningful versus the per-clinician costs of standalone AI scribes ($200 to $800 per provider per month).
Core AI Features
Cosmos Research Database (310 Million Patients)
Epic's Cosmos aggregates de-identified patient data across participating Epic customer organizations:
- 310 million patients
- 22.6 billion encounters
- Patients from all 50 US states
Cosmos enables population-scale research and real-world evidence generation that no single health system could produce alone. Researchers access Cosmos through queries answered without identifying individual patients.
Art — the clinician assistant
Art is Epic's clinician-facing AI persona. It began as Augmented Response Technology (ART), the In Basket feature that pre-drafts responses to patient messages from the message content plus chart data, and Epic has since grown the name into a broader assistant. Clinicians review, edit, and send — preserving physician oversight while reducing typing time.
Chart with Art is the ambient-documentation capability: it listens during the visit and drafts the clinical note. Epic launched it for outpatient specialties in February 2026 and for bedside nursing in March, with Houston Methodist among the early sites. Art also drafts hospital-course notes and surfaces incidental findings.
Scale: In Basket drafting reached 150+ organizations and over 1 million drafts generated monthly, and Epic reports 85 percent or more of its customers now use at least one Epic AI product.
⚠️Warning
"ART" is no longer just an acronym. Older material — including earlier versions of this page — expands ART as In-Basket Augmented Response Technology and treats it as a single message-drafting feature. Epic now presents Art as a named clinician persona alongside Penny and Emmie, with message drafting as one capability among several. Expect both usages in the wild.
Penny — the revenue-cycle agent
Penny is Epic's AI for revenue cycle and operations, with prior authorization as the headline workflow. Epic reports a 42 percent reduction in prior-authorization submission time at Summit Health and a decline of more than 20 percent in coding denials. This is the agent most likely to produce a measurable financial result, and it is the one least visible to clinicians and patients.
Agent Factory — build your own agents
Agent Factory is Epic's no-code platform for assembling custom AI agents inside Epic workflows, drawing on roughly 120 existing AI capabilities. Early adopters are using it now; Epic has signalled general availability in 2027, so treat it as a roadmap item rather than something to plan this year's staffing around.
Note Summarization with Citations
Generative AI creates concise summaries of recent chart entries, external data, and notes — helping clinicians quickly grasp patient status. Critical innovation: summaries include citations linking back to source information, supporting verification and audit.
Used in scenarios like patient handoffs, specialty referrals, pre-procedure review, and chart review for new patients — workflows where reviewing pages of notes manually is impractical.
Pre-visit coordination
Across the Art and Emmie personas, Epic's agents aim to turn pre-visit prep from manual triage into automated coordination:
- Chat with patients about their needs before visits
- Identify missing tasks such as labs, imaging and prior records
- Help schedule and complete the missing items
- Create easy-to-read summaries for clinicians
Curiosity — predictive medical foundation models
Curiosity is the layer that makes Cosmos more than a query tool. Announced in September 2025 and developed with researchers from Yale and Microsoft, it is a set of medical foundation models trained on time-ordered sequences of medical events — more than 100 billion of them — that simulate likely paths through a patient's health journey. It estimates disease risk, length of stay and treatment outcomes, with worked examples including extended hospitalisation, 30-day readmission, cardiovascular risk and the emergence of conditions such as pancreatic cancer.
Starting February 2026, researchers at Cosmos participating organizations can explore Curiosity in a virtual lab, with visualization tools for inspecting projected trajectories and validating predictions against real outcomes.
📝Note
Curiosity and CoMET are the same work under two names. Epic's own product name is Curiosity. The accompanying Yale and Microsoft paper calls the model family CoMET (Cosmos Medical Event Transformer), and much of the trade coverage uses that name instead. If you are searching, try both.
Emmie — the patient-facing agent
Emmie is Epic's AI for patients, covering appointment support, visit preparation, billing questions and explanations of lab results. Reported results: a 58 percent reduction in billing messages at Rush University and more than 14,900 appointments rescheduled at Ochsner Health, saving roughly 750 staff hours. Ask Emmie, the conversational assistant inside MyChart, launched first at Sutter Health with broader availability to follow.
ChatGPT integration (September 2026)
On September 1, 2026 OpenAI opened an Epic integration for ChatGPT for Healthcare, its clinician-facing product. Healthcare organizations can connect Epic environments so that authorized patient context — visit notes, laboratory results, medications, specialist documentation — reaches ChatGPT, letting a clinician ask what has changed since a patient's last visit rather than reading the chart end to end. It runs in two shapes: pulling EHR context into ChatGPT, and embedding ChatGPT inside an Epic layout so the work happens without leaving the chart. The University of California, San Francisco health system is a pilot partner.
💡Key Concept
Why this one is strategically different from Epic's other AI partnerships. Epic's existing AI relationships — Microsoft and Nuance for ambient documentation, Abridge and Suki alongside them — are component deals: a vendor supplies a narrow capability that Epic embeds. This one points the other way. A general-purpose frontier model sits outside the chart and Epic brokers access to the record for it, which makes Epic the gatekeeper of clinical context rather than the assembler of a feature. Whoever holds that position sets the terms for every model vendor that wants in.
Strengths
- Massive deployment scale: Epic dominates US enterprise EHR; AI ships to most US health systems
- Cosmos research database: 310 million patients — among the largest healthcare research databases
- Zero-friction adoption: AI features in the EHR physicians already use
- Named agents shipping with results: Art for clinicians, Penny for revenue cycle, Emmie for patients — 85 percent or more of Epic customers use at least one
- Citations in summaries: Defensible AI outputs with audit trail
- Bundled with EHR licensing: No separate AI procurement
- AI agent roadmap: Pre-visit prep + scheduling + workflow automation rolling out
Limitations & Considerations
- Less specialized than best-of-breed AI: Epic AI may trail Abridge or Suki on specific features
- Epic-only: Doesn't help non-Epic health systems
- Pricing opacity: Epic licensing notoriously not disclosed; total cost hard to compare
- Vendor lock-in: Deep Epic deployment makes switching even harder than today
- Feature rollout pace: Epic moves deliberately; new AI features ship slower than venture-funded startups
- Customer-organization participation in Cosmos varies: Not every Epic customer participates; data access varies
Best Use Cases
| Use Case | Why Epic Cosmos Fits | Caveat |
|---|---|---|
| System-wide AI rollout in Epic-based health systems | Zero-friction adoption | Less feature depth than specialized startups |
| Patient message volume reduction | Art pre-drafts In Basket messages at scale | Quality improves with physician feedback |
| Patient handoff and chart review | Note summarization with citations | Verify accuracy in your specialty |
| Population health research | Cosmos 310 million patient research database | Participating org status varies |
| Prior authorization and coding | Penny cut submission time 42% at Summit Health | Revenue-cycle results vary by payer mix |
When to choose alternatives:
- Specialty-tuned ambient documentation → Abridge, Suki AI, Augmedix for deeper specialty workflows
- Non-Epic health systems → Epic Cosmos doesn't apply; use Oracle Health, athenahealth, MEDITECH equivalents
- Single specific AI capability with best-in-class quality → specialized startup likely outperforms Epic on any one feature
- Smaller practices not on Epic → use lower-cost specialty AI tools rather than full EHR overhaul
- Deep voice-driven workflows → Suki AI for voice command + ambient hybrid
Key Takeaways
- Epic Cosmos is the research database of 310 million patients from 22.6 billion encounters underlying Epic's healthcare AI strategy
- Epic's AI is organised as three named agents: Art for clinicians (In Basket drafting plus Chart with Art ambient notes), Penny for revenue cycle (42 percent faster prior-authorization submissions at Summit Health), and Emmie for patients (more than 14,900 appointments rescheduled at Ochsner). Epic reports 85 percent or more of its customers use at least one
- Curiosity is the predictive layer built on Cosmos with Yale and Microsoft — medical foundation models trained on more than 100 billion medical events that simulate a patient's likely path; the Yale and Microsoft paper calls the model family CoMET, so search both names. A researcher virtual lab opened in February 2026
- Agent Factory lets health systems build their own no-code agents from roughly 120 Epic AI capabilities, with general availability signalled for 2027 — a roadmap item, not a this-year plan
- Epic dominates the US enterprise EHR market — AI features ship to most US health systems with zero separate procurement
- Bundled with Epic EHR licensing; trade-off vs specialized AI startups is integration depth + adoption ease vs single-feature best-in-class quality
- Since September 1, 2026, Epic environments can connect to OpenAI's ChatGPT for Healthcare, bringing authorized patient context into ChatGPT or embedding ChatGPT in the chart — a different shape from Epic's component-vendor AI deals, since it puts Epic in the position of brokering clinical context for an outside frontier model
- Best fit for system-wide AI rollout in Epic-based health systems; for specialty-tuned ambient documentation use Abridge, Suki AI, or Augmedix; for non-Epic systems use the equivalents in those EHR ecosystems
