Plain thinking about on-site AI: the challenge each piece solves, who it is for, and the honest numbers underneath.
The challenge: useful AI needs your most sensitive data, and the data cannot leave. The solution: move the model into the building.
Per-token pricing punishes success. Owned hardware runs the routine tier at electricity, with payback typically inside a quarter at enterprise volume.
Once AI is load-bearing, a provider outage is your outage. Hospitals, government, and financial firms cannot accept that, and do not have to.
What practices are actually allowed to do with AI and patient records, and the architecture that removes the hardest question.