So, to make this concrete, Akasa uses computer vision to read medical records to replace medical coders because there aren't enough medical coders to get all the billing right and medical systems leave like $1T a year on the table.

The EHRs could give companies like Akasa API access so Akasa could then just run NLP, but the EHR vendors don't grant various third parties API access for various reasons, so instead Akasa gets a seat license for each medical system they service and uses computer vision to read the screen (a cadre of Akasa medical coders review errors to stay up to date with unannounced changes from the EHR vendors) and then runs the NLP to figure out which CPT codes to assign to actually put in a bill and send the payer so the hospitals can stay afloat.

So this 45x delta is how much more the medical systems pay Akasa because Epic won't work with Akasa.

This is but one example of why US medical bills are outrageously high.