John Halamka, MD, president of Mayo Clinic Platform, and Melek Somai, MD, VP and chief technology and product officer at Inception Health, examine why AI-assisted development is reopening the build option for new application requests. They weigh build against buying in-suite or niche, the integration tax that sinks third-party tools, and how abstraction layers and multi-cloud strategy help health systems avoid vendor and LLM lock-in.