YUUKI EDGE — The Read · Issue #29 · September 29, 2026
Last week I wrote about a Medicare rule that helped one remote monitoring company and hurt another. It came down to a choice both companies had made years earlier about who sends the bill. This week's story has the same shape, in a different corner of healthcare AI, and no regulator was involved.
On September 22, Abridge announced that the VA had selected it for a new AI scribe contract. Three days later Knowtex, a much smaller company, announced it was one of only two "prime" vendors on the same contract. Headlines put the deal at $775 million. That number is a ceiling, shared by every vendor on the contract over five years. Nobody's been guaranteed a dollar of it yet.
The more interesting question is why the VA needed an outside scribe at all, when the biggest medical record company in the country now ships one of its own.
A quick primer on AI scribes
Here's what a clinician sees. They open an app on a phone or inside the medical record, ask the patient if it's OK to record, and have the visit. The tool listens, and a few minutes later a draft note shows up in the chart. The clinician reads it, fixes what's wrong and signs it. Newer versions also suggest billing codes and orders.
The health system pays for it, usually as a monthly license per clinician. And the note has to land in the medical record: Epic at most big hospitals, Oracle at others, and at the VA, a decades-old system called VistA.
For years, scribe companies treated the record vendors as partners. In February, Epic launched its own scribe, AI Charting, built right into the record. An Epic hospital can now turn on a scribe without bringing in a new vendor.
Three questions I'd ask about any AI scribe deal right now
1. How many record systems does the customer actually run? If it's one, and that one now ships a scribe, the outside vendor has to be clearly better at every renewal. If it's several, a scribe that works across all of them is doing something the record vendor can't. The VA runs its old system at most sites and Oracle's newer one at a growing number, so it's firmly in the second group.
2. What does the tool do after the note is written? Drafting the note is becoming the part everyone can do. Coding the visit, queuing up orders and prepping prior authorizations is where outside vendors still have room, at least until the record vendors build that in too.
3. When a buyer says "selected," what did they actually buy? A contract ceiling, a pilot and paid seats are three different things. If you're a founder, know which one you've signed. If you run a health system, know which one you're announcing.
What happened, and how the field splits
The VA started piloting two scribes, from Abridge and Knowtex, in October 2025, after a tech sprint that looked at more than 150 products. On September 18 it awarded the enterprise contract. From here, individual VA medical centers and regional networks place their own orders from the approved vendors.
Why go outside? Because no single record vendor covers the VA. Epic isn't there at all, and Oracle only covers the sites that have switched to its system. A scribe that works in both is the only kind that fits the whole VA today. Both companies say they're live at roughly 75 to 80 VA medical centers.
So here's the question for every scribe company: when the record system ships its own scribe, what's left for you?
The field splits three ways:
Scribes whose customers mostly run one record system that now has a built-in scribe. They're selling against something the customer already owns.
Scribes built to work across several record systems: federal buyers, health systems in the middle of switching, practices on smaller record systems, customers outside the US.
Scribes that have moved past the note into coding and revenue work, which the built-in tools don't do well yet.
The named companies in each group, and how I scored them, are in this week's paid issue.
Also this week
Heidi, an Australian-founded company that makes an AI scribe and other tools for clinicians, raised $100M in equity at a $900M valuation, plus $240M in growth financing from General Catalyst that gets paid back out of new-customer revenue.
CMS Administrator Mehmet Oz said about 800 tech companies have signed on to work with Medicare through its new ACCESS model, which pays for technology that helps patients manage chronic conditions (Sept 23).
Athenahealth, which makes medical record software for physician practices, added AI features to its athenaOne platform aimed at value-based care and population data (Sept 24).
The Medicare Rights Center, a patient advocacy group, published records it says show Medicare's AI-assisted prior authorization pilot, called WISeR, wrongly denying care (Sept 24).
Where I might be wrong
If Epic's scribe turns out weak in specialty or hospital care and clinicians won't use it, one-system hospitals will keep buying outside tools and the line I'm drawing matters less. And the VA is gradually moving sites onto Oracle, which sells its own AI agent. If that move speeds up, the VA looks more like a one-system customer every year. Either way, the three questions still work, because they're about your own setup.
If you want the names
This week's Yuuki Institutional issue names the companies in each group and scores each one on five things: how deeply it's wired into the record, how good its evidence is, how many signed customers it has, whether clinicians actually use it, and whether the record vendor can reach its position. Each gets a back, watch or pass call. It also covers what the VA contract is and isn't worth, and the risk I think most investors in this category aren't pricing in.
Founding rate, locked for as long as you stay: yuukiedge.com.
Yuuki Edge — the survival read on healthcare AI. Written by Victor Phillips, MD.