EHR Gatekeepers Decide AI Scribe Adoption
Brendan Keeler, interoperability lead at HTD Health, on GTM for AI medical scribes
The real power in AI medical scribes sits with the EHR gatekeeper, not the clinicians who first adopt the tool. In large health systems, ambient note taking is bought like core infrastructure, so a team can prefer Nabla or another scribe at the clinic level and still lose to the vendor with the deepest Epic relationship, strongest compliance posture, and clearest path to systemwide rollout. That is why Abridge could displace a local choice inside Kaiser.
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Abridge and Nuance were the only two companies identified as Epic development partners in the interview, which matters because deep integration means more than dropping a note into the chart. It means pulling chart context, filling structured fields, and reducing the extra clicks clinicians still have to do after the visit.
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The Kaiser example shows how healthcare software buying works in practice. The user is the doctor, but the buyer is the CIO, CFO, compliance team, and EHR leadership. HIPAA, business associate agreements, and security review turn even a well loved workflow tool into a top down enterprise decision.
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This creates a sharp market split. Abridge wins up market by tying itself tightly to Epic and hospital procurement, while companies like Freed grow bottom up in small practices where the doctor can buy directly and the EHR stack is less centralized. These are different distribution games, not just different products.
The next phase is likely more consolidation around EHR aligned scribes that expand into coding, prior authorization, and other workflow steps that start from the clinical conversation. The winners in enterprise care will be the companies that become part of the health system's operating stack, while independent tools will keep finding room in smaller practices and specialty niches.