Your typical non-coastal state run health system does not have model access outside of people using their own unsanctioned/personal ChatGPT/Claude accounts. In particular even if you have model access, you won't automatically have API access. Maybe you have a request for an API key in security review or in the queue of some committee that will get to it in 6 months. This is the reality for my local health system. Local models have been a massive boon in the way of enabling this kind of powerful automation at a fraction of the cost without having to endure the usual process needed to send data over the wire to a third party
I am literally using Claude opus 4.1 right now.