Epic vs. Abridge: When Your Biggest Partner Becomes Your Biggest Rival

A surgeon-founder's perspective on the evolution of the ambient scribe wars

Dr. Shivdev “Shiv” Rao, co-founder and CEO of Abridge, forged a landmark partnership with Epic in 2023 – a deal that helped catapult his startup to a $5.3 billion valuation. Two years later, that ally has morphed into a formidable competitor, putting Abridge at a crossroads.

A Partnership Written in the Stars – Until It Wasn’t

I remember hearing about Abridge’s integration with Epic back in 2023 and thinking it was a match made in digital health heaven. Epic Systems is the 800-pound gorilla of electronic health records, serving about 42% of US hospitals, while Abridge was a young AI company turning doctor-patient conversations into clinical notes. By plugging into Epic’s vast network, Abridge suddenly had distribution most startups only dream of. In the two years after that partnership, Abridge raised over $700 million and won marquee clients like Kaiser Permanente, Mayo Clinic, and Johns Hopkins. As Business Insider covered, Epic even took a small equity stake in the startup, which, at Abridge’s current valuation, would be worth hundreds of millions of dollars[1].

Yet, as almost every startup founder knows, dancing with an elephant is risky. Elephants are apt to squashing you either accidentally or on purpose…

Earlier this year, Epic quietly sold off its shares in Abridge[4]. Then in August, Epic announced it would launch its own AI “scribe” tool to automatically transcribe and summarize physician visits[5][6] – directly encroaching on Abridge’s core business. In hindsight, it was hardly a shock that Epic wanted its own slice of this booming AI pie[7]. The surprise (and heartbreak) was that Epic had incubated Abridge’s success in the first place. As one Abridge investor put it, the situation suddenly became “wait, what? What’s going on here?”[8]. Are they partners or rivals? The answer now is: both, and it’s messy.

Epic’s Playbook: From Friend to Foe

If you follow Epic’s history, this turn of events feels almost inevitable. Epic has a playbook of partnering with innovative add-ons, only to build its own versions later. A few years ago, Epic let telehealth companies like Amwell and Teladoc plug into its EHR…that is until Epic rolled out its own video visit feature in 2020[9]. It did the same with secure messaging, introducing an in-house messenger that edged out third-party tools[9]. Even giants like Salesforce weren’t immune; Epic unveiled a CRM tool in 2022 to challenge Salesforce’s health cloud[9]. In technology, there’s a well-worn phrase: “No one ever got fired for choosing IBM.” Epic’s brand carries similar weight in healthcare, and it knows it. Simply announcing a future Epic solution can freeze out competitors, much as IBM’s vaporware announcements once did[10]. Epic’s new AI scribe isn’t even out until 2026, but the signal alone may sway hospitals to hold off on outside vendors.

For Abridge, this has to feel like deja vu of every startup’s classic dilemma: hitching a ride with a whale, only to risk getting swallowed by it[6]. Abridge’s leaders insist they’re staying closely integrated with Epic for now. After all, many hospitals only consider Abridge because it works so wonderfully inside Epic’s workflow. (Epic’s software is so dominant that a tool not embedded in it faces an uphill battle in clinician adoption.) But Abridge is now wisely broadening support for other EHRs like Oracle Cerner, Meditech, and Athenahealth. They can no longer afford to “milk the Epic cow” for growth[11]. One could argue they pulled ahead technologically, building bespoke AI models and features, and Epic might take years to catch up. Still, even a delayed entrance by Epic casts a long and ominous shadow.

Health systems such as Kaiser Permanente embraced Abridge’s AI note-taking across tens of thousands of clinicians[12]. Now those same Epic-based institutions will weigh Epic’s in-house solution, testing the strength of Abridge’s head start.

From Epic’s perspective, one might wonder: if they saw this coming, why invest in Abridge at all, only to divest and compete? I would love to be a fly on the wall in Verona, Wisconsin (Epic’s home base) to know what changed. Perhaps Epic underestimated how quickly Abridge would prove the market – or perhaps owning a chunk of a rising star was simply a stopgap to learn and buy time. In any case, that early equity tie-up makes this breakup especially intriguing. Epic essentially funded a partner’s growth and then decided, “Thanks, we’ll take it from here.” It’s the Microsoft-OpenAI and Google-Anthropic tension in microcosm[6], played out in healthcare.

Lessons for Startups and Health Systems

As a physician-founder working in health tech, I find this saga equal parts cautionary tale and validation of the market. On one hand, it reinforces a hard lesson: your big strategic partner today could turn into your competitor tomorrow. Any startup cozying up to an incumbent should think twice about dependency. On the other hand, Abridge’s rise shows there is real demand for solutions to clinician burnout and administrative overload. Even Epic couldn’t ignore it – which is why they’re scrambling to build a rival tool.

Here are a few takeaways and strategies, from my vantage point, for navigating such partnerships:

· Don’t Rely on One Platform: If your product lives inside another company’s ecosystem, diversify early. Abridge leaning into other EHR integrations now is a smart hedge.

· Leverage the Partnership Fully, But Prepare an Exit: Enjoy the distribution boost, but use that time to deepen your unique tech and relationships. Cement what makes you indispensable (e.g. Abridge’s specialized AI models and multi-language support).

· Transparency with Customers: Hospital executives value honesty. If a partner might become a competitor, address the elephant in the room. Abridge openly reassured customers that their Epic integration remains “100% solid” even after Epic’s announcements[8].

· Collaborate, But Keep Some Secrets: It’s important to work closely (Abridge engineers literally spent hours co-developing on Epic’s campus[13]), yet be mindful what intellectual property you expose. Today’s collaborator could be reverse-engineering your features for their roadmap.

For health system leaders, this dynamic is also a wake-up call. Innovation shouldn’t come to a halt just because the incumbent vendor offers an option. If anything, one could pilot both the startup solution and the native EHR solution in parallel, and compare outcomes. We need more iterative experimentation in healthcare. The comfortable choice – “just wait for Epic to bundle it” – might feel safe (no CIO ever got fired for staying with the default), but it could mean years of clinician burnout while we wait for that promised feature. In a domain as important as healthcare, we simply must do better.

The Human Cost of Standing Still

Technology races and corporate chess matches aside, my mind keeps returning to a patient encounter I had recently. An elderly patient with a complex medical history came to my clinic lugging a stack of paper records. His son accompanied him. They were late because cobbling together information from multiple providers was a nightmare. I gently asked if they knew how to use the online patient portal (MyChart) to access records. The patient hung his head, almost in shame, and said he just couldn’t figure it out – especially since his primary doctor is on a different system. He felt he had to apologize to me for being late and unprepared, when in fact the system had failed him. My heart broke a little hearing this.

This is a stark reminder that, despite all the fanfare around generative AI and ambient voice tech, our current tools are still not solving fundamental problems for patients or clinicians. We have world-class technology that can draft a note from a conversation, yet patients are still walking around with paper folders because our digital systems don’t talk to each other. The contrast is jarring. It tells me there is so much white space in healthcare – so many basic gaps left to fix.

As a clinician, I am rooting for anyone who can translate these AI conversations into better outcomes at the ground level. Yes, ROI in terms of revenue cycle efficiency is nice, but what about true patient impact? Can we reduce missed follow-ups, empower patients with clearer visit summaries, save doctors from burnout and improve care quality? Those should be the metrics that matter.

The true goal must be to transform conversations to outcomes

The Road Ahead: Cooperation in a Competitive Age

I remain optimistic (perhaps stubbornly so) that there’s a path where competition and collaboration can coexist in healthcare innovation. Companies like Abridge, Epic, Nuance, and others will compete fiercely, no doubt. Sometimes that might even spill into the courts – witness the ugly Doximity vs. OpenEvidence feud with dueling lawsuits over “AI for doctors” IP[14]. But at the end of the day, all of these efforts indicate that the status quo isn’t acceptable. The fact that Epic – historically conservative and insulated – is now chasing ambient AI validates what startups have been saying: documentation overload is a crisis, and smart automation is part of the cure.

For those of us building and implementing health tech, the takeaway is clear: keep the focus on the people at the center: the physicians and patients. If we do that, then whether a solution comes from a startup, an incumbent, or a partnership, we all win. My hope is that in another five years after the “GPT moment” shook our world, we won’t look around and find everything still largely the same. Progress in healthcare can feel maddeningly slow, but stories like Epic and Abridge’s rapid penetration with bold tech give me hope that change can happen fast when the pressure is on. Let’s embrace the tension, learn the lessons, and double down on solving the problems that truly matter at scale.

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[1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] Inside the Messiest Relationship in Healthcare AI - Business Insider

https://www.businessinsider.com/inside-messiest-relationship-in-healthcare-ai-abridge-epic-2025-9

[14] OpenEvidence and Doximity Clash in Billion-Dollar Race to Dominate AI for Doctors - Business Insider

https://www.businessinsider.com/doximity-openevidence-suing-each-other-as-doctor-ai-war-rages-2025-9