Layered Market for AI Scribes
Brendan Keeler, interoperability lead at HTD Health, on GTM for AI medical scribes
Specialization makes AI medical scribes look more like vertical software than a consumer app, which means many companies can win at once. The hard part is not just turning speech into text. It is wiring the output into each clinic's actual workflow, EHR, specialty templates, orders, diagnoses, and billing steps. That favors vendors that go very deep on one EHR, one care setting, or one segment, instead of trying to cover the whole market at once.
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At the enterprise end, Abridge has gone deep on Epic, where integration depth matters more than generic note quality. It grew from about 8,000 to more than 60,000 clinicians across 100 plus health systems by pairing ambient documentation with billing ready notes and tighter workflow insertion inside major EHR deployments.
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Down market, the market fragments because small practices use many different systems. The interview maps outpatient care to Athenahealth and a long tail of specialty EHRs like behavioral health and dental systems, which creates room for narrow products built around one workflow instead of one national standard.
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That is why lightweight teams can still compete. DeepCura is described as a tiny team that ships quickly by focusing on specific EHRs, while PLG vendors like Freed can grow with individual doctors and small clinics, but hit limits once customers need deeper EHR integration and enterprise approvals.
The next phase is likely a layered market. Enterprise leaders will keep expanding inside the big EHR ecosystems, especially Epic, while smaller vendors keep owning niches where specialty workflow matters more than scale. Over time, the winners will be the products that remove not just note writing, but the full chain of orders, coding, and follow on admin inside each clinical setting.