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a16z Podcast · 3 min · Oct 20, 2026

Legacy healthcare software is ripe for computer-use agents

Healthcare’s fragmented workflows and legacy EHR software make it a strong fit for computer-use agents. Karan Singhal notes that virtual machines may make some systems easier for agents to access.

Karan Singhal

Karan Singhal is a leads health AI research at OpenAI.

Leads OpenAI's Health AI team and built the HealthBench evaluation, after earlier Med-PaLM work at Google.

  • JR

    Jay Rughani, Host · Partner, a16z

About this segment

Healthcare’s fragmented workflows and legacy EHR software make it a strong fit for computer-use agents. Karan Singhal notes that virtual machines may make some systems easier for agents to access.

From “Should You Trust ChatGPT With Your Health?”, Oct 20, 2026. Watch the full episode

“a virtual machine actually makes things easier in some ways for AI agents”
Karan Singhalat 13:34 · a16z Podcast13:34

Takeaways

  1. Healthcare systems often lack modern software connections.
  2. Some primary EHR systems run on virtual machines.
  3. Computer-use agents could help bridge fragmented workflows.

In this episode

Full episode
  1. 43:26Cheaper medical AI needs workflow integration to cut costs5:26
  2. 16:31OpenAI aggregates hundreds of physicians to handle disagreement2:30
  3. 11:47Legacy healthcare software is ripe for computer-use agents2:41

Up next · SourceryLong-context agents make local hardware cost-competitive with data centers3:28

Transcript

Transcribed by machine (Whisper) from the episode’s audio, so a word may be off here and there.

  1. 11:59

    and from a popularity perspective over the last few months, Instinct, Muse, GrokBot, OpenAI's Dots, you can give these AI apps an objective for folks who are not familiar and it can execute a series of tasks. So it's not just, hey, do this task and then it executes the task with a single loop. It can use your preferences. It can access all of your applications that you give it permission to. It can access your credit card information if you give that to them, and it can execute an objective on your behalf. One can't help but imagine the possibilities there in navigating our wonderful but often disjointed healthcare system, scheduling a appointment and making sure your insurance is covered for that appointment, covering that appointment, you know, helping you and guiding you to follow a care protocol that

  2. 12:51

    your doctor gave you post-discharge, even negotiating with your insurance company on a medical billing error, all kinds of tasks that just create friction in our healthcare system. Is that where you're kind of going with your work? Should we look forward to that from OpenAI? I'm very excited about that vision. I think if you look at from both the patient and clinician perspective, one of the most difficult things about the healthcare system and how it serves people is this kind of question of like fragmentation and kind of lack of connection of the ecosystem and healthcare is also one of those industries where you shouldn't expect everything to have an mcp connector tomorrow right it is a it is a place where there's legacy software there's not like necessarily the best connectivity with ai or software in the first

  3. 13:35

    place and many people are you know running their primaries ehr software in the healthcare ecosystem on like a vm for example so like virtual machine that they're running in the cloud yeah exactly and so there's actually like an interesting component where like a virtual machine actually makes things easier in some ways for AI agents, but this is absolutely ripe for agents and computer use. So I definitely think that this is like a place where a lot of the barriers that have traditionally existed between patients and getting the care they need and clinicians and delivering the care that they need and healthcare data in general, which is often kind of a bottleneck to the whole system working well for patients. I think a lot of those will dissolve.

  4. 14:10

    Okay. So we were talking about the use cases. You're helping us dream the dream before we keep going down that road,