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    January 12, 2025 · updated May 8, 2026 · 2 min read

    The EHR bundling clock starts when the wedge works.

    The EHR bundling clock starts when the wedge works — by Thomas Jankowski, aided by AI
    The wedge starts the clock— TJ x AI

    The ambient-scribe category will generate roughly $600 million in 2025 revenue, growing at 2.4x year-over-year. Abridge will lead. Nuance DAX will hold the largest share by deployment count. Heidi will dominate the solo-practice segment. Suki, Augmedix, and the long tail of specialty competitors will fill in.

    By the end of 2025 Epic and Oracle will both have shipped native ambient-scribe features inside the EHR.

    That sequence is the structural pattern. The startups win the wedge through product-led growth. The EHR vendors ship the native version once the category is validated. The clock starts the day the validation lands. Every healthcare-AI category that is bundleable into the EHR runs on this clock, and the operator-class question is how long the clock runs before bundling absorbs the standalone category.

    For ambient scribes the clock started in mid-2024 with the JAMA validation study. The native EHR versions are shipping in 2025-2026. The bundling-clock window is roughly 24-36 months from validation-event to native-feature-deployment. After the EHR-native version ships, the standalone category compresses, the standalone vendors get acquired or wound down, and the category-leader graduates by either selling to the EHR vendor or building outside the EHR's procurement gravity.

    The part that holds is sharp.

    For startup founders in the ambient-scribe category: the exit window is 18-30 months from now. The Epic-or-Cerner acquisition price is set against the build-vs-buy comparison. Once Epic ships the native version, the build option is in production and the buy multiple compresses. Founders who recognize the clock and run the exit process actively in 2025-2026 capture the high multiple. Founders who hold out for a category-leader-pricing exit that the EHR vendor stops paying once their native version ships are the founders running on the wrong calendar.

    For health-system buyers:do not sign multi-year ambient-scribe contracts with standalone vendors in 2025. The migration path from standalone to EHR-native is going to be ugly, the contract terms with the standalone vendor will not favor the buyer in that migration, and the EHR-native version will be priced to undercut the standalone (because the EHR vendor uses scribe pricing as a strategic loss-leader to retain the EHR contract). Sign one-year terms with renewal options. Wait for the EHR-native version. Pay the productivity cost of the gap year.

    For category investors:the standalone-scribe category has a 12-18 month exit window. Investors who allocated against the category in 2022-2023 captured the early-stage gain. Investors allocating in 2025 against the standalone category are paying late-stage prices for assets that are in the bundling-clock window. The right investment thesis in 2025 is the ambient-scribe-adjacent category that the EHR vendor is not building (revenue-cycle automation, prior-auth-handling, the patient-engagement layer that runs outside the encounter), not the ambient-scribe category itself.

    The thing that crosses pillars is that the EHR-bundling clock recurs across every healthcare-AI category that is structurally bundleable. The categories with this shape: ambient scribes (clock started 2024), AI-driven coding-and-billing (clock starting 2025), patient-portal AI (clock starting 2025-2026), clinical-decision-support that integrates into the EHR workflow (clock at various stages depending on specialty). For each of those, the founder-class question is the same: when does the EHR-native version ship, and what does the exit window look like before it does.

    The categories without this shape are the ones that operate outside the EHR's procurement gravity. OpenEvidence (direct-to-clinician). The GLP-1 platforms (direct-to-consumer). The wearables stack (direct-to-consumer plus device-OEM relationships). Those categories do not get bundled by the EHR because the EHR is not the buyer. They face a different set of strategic threats — the platform threats, the FTC-rule threats, the consent-layer threats — but they don't run on the EHR-bundling clock.

    The read that survives is that ambient scribes were the cleanest case of the bundling-clock pattern, the exit window is closing on a predictable schedule, and the ambient-scribe-vendor founders who price this correctly are capturing real value while the window is open. The founders who don't are running against an EHR-vendor build cycle that wins the structural fight by default.

    The clock starts when the wedge works. The clock runs at 24-36 months. The exit happens before the EHR ships native, or the exit happens at a smaller number after. The operators in the category who price the clock correctly are the ones whose 2027 outcome is the right exit. The operators who don't are the standalone vendors looking for terms after the build option lands.

    —TJ