Before the mid-1990s, everybody had their favorite textbook – every doctor was either a Harrison’s or a Cecil person. Then, seemingly overnight, the tomes (including one I edited, Hospital Medicine) began gathering dust on shelves everywhere, as a new kind of tool easily demonstrated its superiority in point-of-care medical knowledge retrieval.

Today, UpToDate remains an extraordinary resource, created by over 7,500 human experts charged with culling and interpreting the medical literature and guidelines to produce chapters on every conceivable clinical topic – and keeping the chapters, as the name says, up to date. From the time it emerged in the late 1990s until about 2023, it deservedly had what felt like an unshakeable position as the dominant point-of-care tool for health systems and clinicians.

And then, before you could say Clayton Christensen, OpenEvidence displaced UpToDate – particularly among doctors-in-training, often the vanguard of tech-driven change – because it could perform a trick that UpToDate couldn’t: take an entire clinical case, in all its staggering complexity, and produce an AI-generated “curbside consult” that was impressively accurate, context-specific, and, yes, up to date. Suddenly, UpToDate’s approach, which had seemed revolutionary a generation earlier, seemed stale.

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Thus my sense of déjà vu, as OpenEvidence is currently doing to UpToDate what UpToDate did to the textbook publishers. Based on its investments to date, OpenEvidence has been valued at $6 billion; one wonders whether that valuation was based partly on the assumption that UpToDate would sit back and allow its lunch to be eaten by its upstart rival.

If so, investors in OpenEvidence may be in for a rude awakening. In last week’s announcement, UpToDate said it would soon roll out its own AI-based tool, called UpToDate Expert AI. Note the careful branding, designed to highlight the fact that the UpToDate tool won’t scour the entire medical literature or the unfiltered internet for insights. Instead, UpToDate’s AI will draw its wisdom exclusively from its thousands of continuously updated chapters, written by experts.

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Finally, there’ll be another competitor, one that will approach decision support from a very different angle. Epic, the largest electronic health record (EHR) vendor, also announced a new set of AI tools last month. One of them, named “Art” for clinicians, is designed to review individual patients’ records as well as Epic’s database (“Cosmos”) of deidentified records on millions of patients cared for in health systems that use the company’s EHR.

I had no idea that some doctors were using AI tools already and they're billion dollar businesses. How often do they use these tools?