Great breakdown and assessment. I do think there is underappreciation of the populations that are either unwilling to adopt, have been unimpressed by the results, or where ambient isnt up to speed for certain workflows. I think there are a lot of opportunities for growth but like a lot of health tech, it relies on clinician-informed development and implementation for successful adoption. And the market currently has a lot of noise with half-baked scribes that need to either evolve or peter out and give way to those with more sophisticated options.
Great point. Too often ventureland forgets that the practices with the highest value use cases are also those with the smallest budgets + most implementation support required (FQs, rural pcps etc.). Scribes are becoming a quick + easily digestible case for AI in health - which also means attracting the a ton of grifters / non-clinical folks who swarm towards any "hot" new space.
Have you done any more posts about Epic? I'd like to understand it better. It seems like a tax on the whole system - expensive, bad UI, huge anti-competitive practices (fighting interoperability)
Great point, Kev. There’s a real case to be made that Epic’s dominance has created structural friction. A few recent examples (CureIS, Particle) show how tough it can be for third parties to navigate that. Between their foundational role in Carequality + their influence over hospital procurement, they’ve shaped who gets to play and who doesn’t.
At the same time, it’s easy to forget how we got here. During the HITECH push (when hospitals were scrambling to meet Meaningful Use), Epic offered hospitals something few others could: an all-in-one, compliant solution that just worked. That earned trust and justified early growth. The fact that they’re now entrenched is frustrating, but not entirely unearned.
And while Epic has a reputation for being closed, I’ve been struck by how their alignment can accelerate adoption. Abridge is a great example—Epic’s continued support has been key to their rapid scale across health systems.
It’s a common critique + not without merit, but Epic’s role strikes me as more nuanced than it’s often portrayed.
Very informative article, David
Thanks Naren. Next one will have to be on preclin R&D — regardless of ultimate approval, crazy to see cycles potentially reduced to months vs years.
Sounds like this one might be a $10B outcome soon?
Define “soon.” Bullish if margins don’t take a nap.
you haven't really mentioned direct to patients as a market, which is how they started out initially
Good call. They did start there, interesting to see how the enterprise shift has really defined the business. Appreciate you reading!
Great breakdown and assessment. I do think there is underappreciation of the populations that are either unwilling to adopt, have been unimpressed by the results, or where ambient isnt up to speed for certain workflows. I think there are a lot of opportunities for growth but like a lot of health tech, it relies on clinician-informed development and implementation for successful adoption. And the market currently has a lot of noise with half-baked scribes that need to either evolve or peter out and give way to those with more sophisticated options.
Great point. Too often ventureland forgets that the practices with the highest value use cases are also those with the smallest budgets + most implementation support required (FQs, rural pcps etc.). Scribes are becoming a quick + easily digestible case for AI in health - which also means attracting the a ton of grifters / non-clinical folks who swarm towards any "hot" new space.
Have you done any more posts about Epic? I'd like to understand it better. It seems like a tax on the whole system - expensive, bad UI, huge anti-competitive practices (fighting interoperability)
Great point, Kev. There’s a real case to be made that Epic’s dominance has created structural friction. A few recent examples (CureIS, Particle) show how tough it can be for third parties to navigate that. Between their foundational role in Carequality + their influence over hospital procurement, they’ve shaped who gets to play and who doesn’t.
At the same time, it’s easy to forget how we got here. During the HITECH push (when hospitals were scrambling to meet Meaningful Use), Epic offered hospitals something few others could: an all-in-one, compliant solution that just worked. That earned trust and justified early growth. The fact that they’re now entrenched is frustrating, but not entirely unearned.
And while Epic has a reputation for being closed, I’ve been struck by how their alignment can accelerate adoption. Abridge is a great example—Epic’s continued support has been key to their rapid scale across health systems.
It’s a common critique + not without merit, but Epic’s role strikes me as more nuanced than it’s often portrayed.