Physician in the Loop

VA signs $775.72 million ambient AI contract; Heidi raises $340 million for agents; robotic thyroid ultrasound tested; AMA presses CMS on prior auth deadline

Show Notes

VA signs $775.72 million ambient AI contract; Heidi raises $340 million for agents; robotic thyroid ultrasound tested; AMA presses CMS on prior auth deadline

The voices on this episode are generated, and so is the script, from the day's post at Physician in the Loop. Every fact in the post links to its source.

Read the post and its sources

The Department of Veterans Affairs (VA) on Tuesday selected Abridge and Knowtex for a five-year ambient AI enterprise contract with a $775.72 million ceiling across all eligible vendors, Abridge announced and Nextgov reported. The contract is a multiple-award vehicle; the ceiling is a maximum across every vendor eligible to compete for task orders, and money is awarded one task order at a time. The VA began piloting both scribes in October 2025, according to Nextgov. Abridge said its platform is live at more than 75 VA medical centers on both of the department's record systems, in primary care and about a dozen specialties. The VA has published no results from its pilot.

The same day, Heidi, a scribe company, raised $340 million: $100 million of equity at a $900 million valuation and a $240 million facility from General Catalyst. The company's pitch, reported by HIT Consultant, is that the scribe was a first step and that the next is agents that prepopulate order sets, draft referrals and assemble the chart before the visit, with a clinician approving before any action is taken. In Boston, Jane Moran, Mass General Brigham's chief information and digital officer, told the World Medical Innovation Forum that the system is "not allowing autonomous AI across different platforms." The Massachusetts Nurses Association rallied outside the forum's hotel, and about 4,000 Brigham nurses vote Thursday on authorizing an open-ended strike.

In other developments, a Shanghai group reported in npj Digital Medicine a prospective multicenter trial of a fully autonomous robotic thyroid ultrasound that avoided about three-quarters of on-site exams and missed about a fifth of biopsy recommendations; Jefferson Health said its ambient AI rollout saved 1 million clinician hours in its first year and set a target of 10 million by 2028; the American Medical Association (AMA) asked the Centers for Medicare & Medicaid Services (CMS) to hold payers to the Jan. 1, 2027, electronic prior authorization deadline; and the Food and Drug Administration (FDA) updated its list of AI-enabled devices Tuesday to say "over 1,600," up from the 1,500 cited in this site's long read. The Senate Health, Education, Labor and Pensions (HELP) Committee hears from Dr. Heidi Overton, the nominee for FDA commissioner, on Thursday at 10:30 a.m. Eastern time. Colorado's attorney general faced a Wednesday deadline for a revised draft of the state's automated-decision and chatbot rules, and the rulemaking page had not posted one as of Wednesday morning. California's governor has seven days left to act on four health AI bills.

In this episode

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Nora: This is Physician in the Loop, the daily briefing on AI in medicine. I'm Nora Davis.

James: And I'm James Hudson. It's Wednesday, September 23rd, 2026.

Nora: The VA just set a $775.72 million ceiling on ambient AI documentation, picking Abridge and Knowtex for a five-year contract, Abridge announced and Nextgov reported.

James: $775.72 million. Is that going to one contractor, or is it split some other way?

Nora: Today I've got that VA contract, plus how Mass General Brigham is drawing lines around autonomous AI while its nurses head toward a strike vote.

James: I've got Heidi's new funding round and its push into AI agents, and a robotic thyroid ultrasound trial out of Shanghai.

Nora: So on the VA deal: it's a multiple-award vehicle. The $775.72 million ceiling covers every eligible vendor, and money moves one task order at a time.

James: And Abridge is actually running somewhere already?

Nora: Abridge said its platform is live at more than 75 VA medical centers, on both of the department's record systems, in primary care and about a dozen specialties.

James: Has the VA published anything on how it's going?

Nora: No. No time-per-note figure, no note-quality audit, no clinician survey. The VA started piloting both scribes in October 2025, per Nextgov.

James: So the price tag is public before the results are.

Nora: The release does quote former VA secretary David Shulkin, and Abridge's chief executive talked about preserving clinical context across providers, specialties, and the EHR migration.

James: Preserving context is nice. I'd still like a number on note quality.

Nora: Fair. None to share yet.

James: Same day, Heidi raised $340 million: $100 million of equity at a $900 million valuation, plus a $240 million facility from General Catalyst, MobiHealthNews reported.

Nora: What's the money for?

James: Chief executive Thomas Kelly says the scribe was step one. Next is agents that prepopulate order sets, draft referrals, and assemble the chart before the visit, with a clinician approving first.

Nora: And the numbers behind that pitch?

James: Heidi's own figures, from HIT Consultant: 2.8 million visits a week, 175 million total, 67 million clinical hours, $50 million in annual recurring revenue by April. All unaudited, and Heidi's media page hadn't posted the announcement.

Nora: Unaudited company numbers funding a jump from scribing to agents that touch orders and referrals.

James: SiliconANGLE says an evidence tool they already shipped has answered 10 million queries since March, and lists Beth Israel Lahey Health and NHS England's Midlands region as customers.

Nora: Big claims, big customers. Worth watching what the agents actually do once they ship.

James: Same company this site quoted Monday saying 83% of clinicians they surveyed use AI with no employer policy at all.

Nora: Third story: Mass General Brigham's chief information and digital officer, Jane Moran, told the World Medical Innovation Forum the system is "not allowing autonomous AI across different platforms," Becker's Hospital Review reported.

James: What does that actually look like day to day?

Nora: Staff get two versions of OpenAI's tools, Anthropic's Claude is ring-fenced in a pilot, they just signed with OpenEvidence, Microsoft Copilot runs internally, and anything touching patient data stays inside systems they control.

James: So agents that act across those platforms are out.

Nora: Moran called the approach strategic prioritization, not "1,000 flowers blooming." Becker's also quoted Brigham's chief information officer, Michael Sweet, saying every tool gets a decision date at launch, for production or shutdown.

James: And outside that same hotel, the nurses weren't talking about kill switches.

Nora: The Massachusetts Nurses Association rallied Tuesday and Wednesday over staffing and corporate priorities. About 4,000 Brigham nurses vote Thursday on authorizing an open-ended strike.

James: That's a lot riding on one vote.

Nora: It followed a one-day strike in July that The Boston Globe called the largest nurses' strike in the state's history.

James: Lighter item to close: a Shanghai group published in npj Digital Medicine a prospective trial of a fully autonomous robotic thyroid ultrasound, tested in 262 patients across three centers.

Nora: How did the robot do?

James: It avoided about three-quarters of the on-site exams that turned out not to be needed. It also missed about a fifth of the biopsy recommendations a human would have made.

Nora: So it saves visits but misses some biopsies. That's an awkward pair of numbers.

James: The robot was slower to scan than a person, 202 seconds against 147, though the AI read the images faster, 183 against 254.

Nora: Any conflicts worth flagging?

James: Three of the authors work for the technology companies involved, and the study was funded by the Chinese government.

Nora: A robot that scans slower but reads faster, and trims exams while missing some biopsies. Not a simple trade.

James: No, it isn't.

Nora: Before we go, two things to watch.

James: Thursday at 10:30 a.m. Eastern, the Senate HELP Committee hears from Dr. Heidi Overton, the nominee for FDA commissioner.

Nora: Anything new on the AI side of the agency before she sits down?

James: The FDA's AI-enabled device list now says over 1,600, up from the 1,500 this site had counted before Tuesday's update.

Nora: So the number keeps climbing right as the confirmation hearing lands.

James: The nominee would also inherit an August discussion paper on testing generative models, comments due October 19, plus a rule that just kept radiology AI under 510(k) review.

Nora: A lot waiting on one hearing.

James: Second one: California's governor has seven days left to act on four health AI bills.

Nora: Do we know which way he's leaning?

James: The post doesn't say. Just the seven days.

Nora: Colorado's attorney general faced a Wednesday deadline too, for revised chatbot and automated-decision rules, and hadn't posted a draft as of Wednesday morning.

James: Two different clocks, same quiet so far.

Nora: For physicians, the California bills are probably the bigger one to watch, four bills at once.

James: Four bills, seven days, and no signal yet on any of them.

Nora: Whatever he signs or vetoes, it'll shape what health systems can deploy without a state rule to point to.

James: Or without one, if the clock runs out first.

Nora: Seven days.

James: Seven days, four bills, and a governor who hasn't tipped his hand.

Nora: We'll know soon enough.

James: Four bills sitting on one desk, and nobody outside it knows which way this goes yet.

Nora: Sources and corrections are at physicianintheloop.org. I'm Nora Davis.

James: I'm James Hudson. See you tomorrow.