It’s one of those lessons that’s easy to lose track of. Amid the noise of valuations and fundraising, it’s easy to forget that the whole point is to build a profitable business.

Right now there’s a huge gulf between the AI haves and the have-nots. The haves seem exempt from any of this. Profitability, cash flow, none of it appears to matter.

And for now, that’s true. While the party is on, it makes sense to dance.

But the party will end. All parties end eventually.

Which is why I keep coming back to a simple line: people come for the magic, but they stay for the math.

The magic matters enormously. It’s what gets people to the door. And a rare few can hold off the math for a very long time.

But the safe bet is that you’re not one of them. For the rest of us, the math is what keeps the lights on. Better to start making it work as early as we can.

     

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The more I sat with it, the more places it turned up.

Hiring is the obvious one. Better to work with a sprinter who has bad technique than someone with good technique and average potential. Technique you can coach. Raw speed you can’t. It’s hiring for slope, not just intercept.

Then there’s choosing which company to join. Think of it like drilling for oil. Better to be at place that’s struck oil but is drilling with a terrible bit than somewhere with a beautiful bit and no oil under it. You can always swap the bit.

The funny part is that all three analogies – the house, the sprinter, the drill bit – came from the same friend.

Maybe that’s the real lesson. The best ideas are simple and widely applicable. And the role of good stories and analogies is to help us remember them in different contexts.

     

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I think that’s what awe really is. We reach for the word “awesome” in the moments something helps us see our own insignificance — and windows into nature do that for me every time. So this is my small way of sharing it, and passing it along.

Banff was Canada’s first national park, and one of the very first anywhere — the second oldest surviving park in North America, after Yellowstone.

Interestingly, Banff wasn’t established with a grand vision of protecting the wilderness. It started with an argument. In 1883, railway workers found hot springs in the Bow Valley, and the fight over who owned them — and who had the right to profit from them — got messy enough that the government stepped in and set the land aside. Conservation won, almost by accident.

On most lists of the most beautiful places on earth, Banff lands in the top five, and you can see why the moment you see one of the glacial lakes. This is the Peyto Lake.

That impossible blue isn’t a trick of the camera — it comes from rock flour, fine rock ground up by the glaciers and left suspended in the water, scattering the light back as turquoise.

Lake Louise looks similarly splendid (while remaining a frigid 4 degrees Celsius even in the summer) after a hike that involves traversing through snow in the summer.

Then you pair those lakes with peaks you can climb. At Moraine Lake, the Valley of the Ten Peaks rises straight out of the water.

I also loved the many wildlife crossings that have been built in Banff that you can see on the drive. I learnt that there are over 40 overpasses and underpasses built across the Trans-Canada Highway, now so grown over with grass and trees that they look like natural hills.

We didn’t see much wildlife near them as there were far more people than animals at Banff. But the crossings themselves were remarkable because animal-car collisions here have fallen more than 80% since the crossings went in.

Banff National Park earns its place as one of the most beautiful places on this planet. I hope to go back.

     

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I’ve loved Uncle Iroh’s depth of wisdom. This was another one that hit hard.

     

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To understand why Epic exists, you need to understand what happened to American healthcare after World War II.

The wage freeze of 1942 didn’t just create employer-sponsored insurance — it created a three-way relationship between patients, providers, and payers that hadn’t existed before. A doctor saw a patient. But now a third party — the insurer — decided what to pay, and under what conditions. To get paid, physicians had to document, code, and justify every interaction to a bureaucracy with its own rules.

Medicare and Medicaid in 1965 added the federal government as the largest single payer in the country. The documentation requirements didn’t just continue — they multiplied. A diagnosis needed a code. A procedure needed a code. The attending physician’s notes had to justify both. By the 1970s and 80s, as private insurers followed the same model, getting paid had become a full-time administrative task running parallel to the actual practice of medicine.

This created the conditions for a software behemoth.

In 1979, a computer science graduate student named Judy Faulkner started a company in a Madison, Wisconsin basement with $70,000 borrowed from friends and family. She called it Human Services Computing. Her co-founder wanted to raise venture capital and grow fast. Faulkner refused. He left in 1983.

What Faulkner built — slowly and deliberately over the following two decades — was deceptively simple in concept. A single database. She called it Chronicles. Every clinical record, every billing entry, every scheduling note, every lab result — all of it living in one place, all of it connected. No separate systems that needed to talk to each other. No data loss between the clinical side and the billing side. One source of truth for the entire patient journey.

The contrast with competitors was stark. Cerner, Epic’s main rival, had grown quickly through acquisitions — eventually an amalgamation of 24 different companies stitched together. Integration was always incomplete. Data lived in silos. Chronicles was the opposite of that.

By 2001, Epic had fewer than 90 customers and $50 million in revenue. Then the phone rang.

In 2003, Kaiser Permanente — the largest nonprofit health system in America, the one that appears earlier in this series — issued a request for proposals for a new electronic health record system. The contract was part of a $4 billion infrastructure project covering 30 hospitals, 400 clinics, and 11,000 physicians.

Kaiser’s initial instinct was to split the work. Use Epic for outpatient care — where Epic’s reputation was strongest — and Cerner for everything else. Judy Faulkner said no. Splitting clinical records between two systems meant data loss at the handoff between outpatient and inpatient care. Bad patient experience. Bad medicine. All or nothing.

Kaiser also asked for equity in the deal. Cerner offered 10%. Faulkner said no to that too. Epic didn’t negotiate. It didn’t discount. It didn’t give away equity. They knew they had better software and just prepared harder — Epic’s team flew in the night before the technical due diligence meeting and rebuilt their entire presentation to model Kaiser’s specific transaction flow.

Epic won. Revenue went from $50 million to $162 million almost overnight. The Kaiser deal established Epic as the gold standard for large health systems. The floodgates opened.

Then in 2009, the federal government accelerated everything.

The HITECH Act set aside $27 billion — eventually rising to $35 billion — to incentivize hospitals and providers to adopt electronic health records. In 2008, only 10% of American hospitals used EHRs. The incentives were enormous — up to $44,000 per physician, up to $6.37 million annually per hospital. After 2015, providers who hadn’t adopted EHRs faced Medicare reimbursement reductions.

Epic has faced criticism for its role in drafting the HITECH legislation — Judy Faulkner was involved in the process. Whether that shaped the outcome in Epic’s favor is debated. What’s less debated: Epic was already winning before HITECH. Kaiser had already chosen them. The legislation added tailwinds to a company already on the ascent. It also added complexity — the Meaningful Use requirements created new documentation mandates that compounded the billing burden EHRs were supposed to reduce.

Today Epic supports the records of over 250 million Americans and generates $6.7 billion in annual revenue. Faulkner, who still runs the company at 82, has never taken outside investment, never made an acquisition, and has committed to giving 99% of her assets to charity.

A unified patient record that follows someone across a health system catches drug interactions, flags allergies, and surfaces clinical history at the point of care. Hospital mortality statistics improve meaningfully after EHR implementations mature. MyChart — Epic’s patient portal launched in 1999 — gave patients access to their own records a decade before competitors thought to try it.

And yet physicians today spend roughly half their working hours on EHR documentation. The tool built to manage billing complexity created its own complexity. Doctors enter data not because it helps them treat patients but because it satisfies reimbursement requirements. EHRs became the single most cited cause of physician burnout in the country.

The software that runs American healthcare was built because billing became as complicated as medicine itself. It made medicine safer — and it made being a doctor significantly harder.

Paul Starr’s line applies here too. The dream of reason did not take power into account. Epic didn’t create the billing complexity. It was built to survive it. But in doing so, it became the behemoth that now defines how American healthcare runs — for all its good and all its challenges.

Consider what switching away from Epic actually means. When one major health system attempted to migrate to a different EHR, the project took over a decade and cost tens of billions of dollars — and still wasn’t complete. That’s not a software contract. That’s infrastructure.

Epic controls records for over 250 million Americans, sits at the center of clinical workflows in more than half of US hospital beds, and keeps 35% of its revenue invested in R&D. Every year it expands further — into scheduling, billing, staffing, AI documentation, population health. The question healthcare startups ask isn’t whether to compete with Epic. It’s whether Epic has noticed them yet.

In healthcare technology, you don’t fear running out of runway. You fear ending up on Epic’s roadmap.

H/T: Acquired’s episode on Epic Systems

     

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Juvenile hawks are still learning to be adults. So they usually make a lot of noise as part of this process. This included chasing squirrels, walking around the yard, and constantly calling on each other at all hours of the day.

A few weeks ago, we had two juveniles show up again. We have no idea if they were connected to the pair who showed up two years ago. But, sure enough, they made themselves at home and woke us up on weekends with a din of high-pitched calls.

I was reminded of a time at home when my grandparents were telling me off for blasting music before heading out for an exam a few months before college.

My mom told me to not bother and told them – “You’ll miss this when he leaves home in a few months.”

They did. And said so many times after.

It is now good advice for me as a parent. But it turns out it was equally good advice for us as temporary juvenile hawk neighbors as well.

Now that they’re gone, we miss the din they created and are grateful for the time they shared space with us.

     

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It’s easy to fall into the comparison trap. You can compare this place to the last one, this beach to that one from 2 years ago, and so on. Doing so simply lets the memory of one good thing rob us of another.

It takes a quiet kind of discipline to reset our expectations and take an experience on its own merits, rather than dismissing it for all the things it isn’t.

After all, the only Zen on the mountaintop is the Zen you take with you.

     

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I asked him recently whether he’d ever thought about going pro.

Turns out he came up through the fourth division in Argentina, playing all the way to the under-21s. When he was in college, he’d train from early morning to early afternoon, then head to class.

In effect, he’d put in thousands of hours of practice over most of us at the game.

It’s the reminder that never gets old for me. What looks like natural talent almost never is. There’s usually some talent in the mix. But the thing you’re actually watching, the ease, the time on the ball, is a culmination of thousands of hours of practice that came before it.

     

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A few years ago, Ed was sued over “Thinking Out Loud.” The family of Marvin Gaye’s co-writer accused him of copying the feel of an old hit – “Let’s Get It On.” He talked about what it’s like to live through something like that said something true about court cases. You lose when you lose, and you also lose when you win, because of everything the fight takes out of you along the way. His ran for the better part of a decade.

He decided to fight it because the claim was that he’d copied a chord progression. And you cannot own a chord progression. They’re the building blocks of songs, used in hundreds of them, free for everyone to reach for. It mattered so much to him that he said he’d have walked away from music for good if he’d lost. And, to make his point, he played many songs before and after “Let’s Get It On” that all use the same chord progression to the grand jury (and won).

Here’s where the phone story comes full circle. As part of the case, he had to dig out that 2015 phone and switch it back on for discovery. Waiting inside were messages from a friend who has since died, arguments with an ex, conversations with family he’s no longer close to. A lot of old baggage that hit him all at once.

Out of that came a song, “Old Phone.” Writing it was how he closed the chapter, and then he put the phone away again.

He ended the story with a beautiful note about making music about a bad memory. When you go through something hard, creating a song about the experience means you’re able to walk away with gratitude.

This applies well beyond making music of course.

We don’t choose bad situations. But if we find the learning in it, we’ve made the best of it.

I found my old phone today
So full of love, yet so full of hate
I put it back inside there from whence it came
Nothing good will come from regretting

Conversations with my dead friends
Messages from all my exes
I kinda think that this was best left
There in the past, where it belongs
I feel an overwhelming sadness
Of all the friends I do not have left
Seeing how my family has fractured
Growin’ up and movin’ on

     

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He’d kept the same number since he was a teenager, and by the time he was famous, he was receiving thousands of texts a day. It got in the way of being present, so he cut it. Now he has an iPad, spends about an hour a week replying to email, and that’s it.

He’s often shared an example of how this has changed his life. He’s at dinner with his wife, and she gets up to go to the bathroom. Anyone in his position would reach for the phone and start scrolling. Ed just sits there. And it’s in that quiet, doing nothing, that his best lyrics and melodies tend to arrive.

What I love about this is how clear he is on what actually matters. Being a social media sensation does nothing for him if he isn’t making great music. And if the music is the point, then the job is to build a life with the conditions for it.

For Ed, that means doing the one thing few, if any, celebrities, will do. He turns off the phone.

     

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