DiMe’s new AI governance toolkit🤔, Epic's AI brain walks out 🧠, BYO Salesforce
⚡ Around the Wards
Epic’s AI leader and interop chief exit weeks before UGM — Seth Hain (AI/Curiosity), Dave Fuhrmann (Care Everywhere), and others depart after President Sumit Rana’s July 3 resignation. Brendan Keeler predicts Epic will announce an in-house LLM at UGM to fill the gap. (Full analysis below.)
Curative CEO vibecoded his own CRM to replace $600K/yr Salesforce — A team of three, two months, zero enterprise software. The clinicians.build thesis in its purest form.
Nabla brings in enterprise sales CEO — Brian Manning (ex-Bamboo Health, where he scaled to $140M+ ARR) replaces co-founder Alex LeBrun, who moves to Executive Chairman/Chief AI Officer.
🔮 My bet: by UGM 2027, half the standalone scribe companies will have been acquired or pivoted beyond documentation.
🎧 Podcast: 229 Project — “Clinical AI on Trial” — Yaw Fellin (UpToDate GM) and Matt Troup (Abridge) on shadow-AI spread in health systems and “automaticity bias” as emerging liability.
🧭 The Curbside
“Is DiMe’s new AI governance toolkit ready to deploy?”
Short answer: It’s the most actionable governance resource available right now — open-source charter template, risk triage, performance metrics — built with FDA, MGB, and UPMC input.
What changed: DiMe surveyed 230+ health systems and found 82% have no governance structure for AI already in clinical use. They launched the “Operationalizing AI Governance” toolkit July 21 to close the gap.
Builder read: If you’re a clinician-builder selling into health systems, you need to know this toolkit exists — your buyer’s governance committee is about to adopt it, and your pitch deck should already speak its language. The UVA “Total Mission Value” framework released the same day evaluates AI across five axes (patient care, staff experience, operations, economics, education). Cost-only ROI answers one of five questions.
🔬 The Big Thing
Epic’s AI brain drain is the canary, not the crisis.
Four executives are leaving Epic, including Seth Hain — the person who led Curiosity AI, the AI Trust and Assurance Suite, and much of what Epic was going to say at UGM next month.
Dave Fuhrmann, who ran Care Everywhere (Epic’s HIE backbone), is also departing. This follows President Sumit Rana’s July 3 announcement.
The departures hit AI and interoperability — the two pillars clinician-builders depend on most.
But here’s the thing. The AI roadmap at Epic — 150+ features, conversational search, Agent Factory, the trust suite — was built under specific people with specific judgment calls.
Those judgment calls are the product. The code is the implementation.
Brendan Keeler wrote that he expects Epic to announce an in-house or open-weight LLM at UGM for the Art/Penny/Emmie assistant layer. That would be a massive signal — Epic moving from “integrate LLM partners” to “own the model.”
If Keeler is right, that announcement lands without the person who built the AI strategy presenting it.
😤 “Epic will be fine. They’re too big to be disrupted by turnover.” Sure. But the question isn’t whether Epic survives — it’s whether the AI roadmap stays the same. If you’re building on Agent Factory, your product decisions depend on their product decisions. Personnel changes at the top change the product.
😤 “This is just normal executive churn.” Four departures in three weeks, including the president and the AI lead, weeks before UGM? You tell me.
😤 “Clinician-builders shouldn’t care about Epic’s org chart.” You should care about anything that changes what API surfaces and AI tools are available on the platform your patients use.
📡 Builder’s Radar
CommonSpirit’s 25-member committee fired the scribe vendor. Here’s the blueprint.
CommonSpirit Health disclosed at the AHA Leadership Summit that their AI governance committee — 25 members — evaluated an ambient scribe deployment, rejected 17 use cases, and terminated the vendor contract mid-engagement.
Same session: Intermountain shared their 30-day PULSE review framework. WellSpan revealed their ANNA AI agent handles 140,000 calls per month.
The pattern: health systems that deploy AI successfully are the ones with a governance kill switch.
😤 “So governance committees just slow everything down.” CommonSpirit avoided deploying 17 use cases that failed their safety criteria.
A CEO vibecoded his own CRM to replace $600K/year Salesforce.
Fred Turner, CEO of Curative, ditched a $600K/yr Salesforce contract. A team of three vibecoded a replacement CRM in two months. Their AI agent “Gwen” now handles contract workflows at $70 per task vs. $1,500 from outside counsel.
This is the clinicians.build thesis in its purest form: domain expertise + AI tools + willingness to build = you don’t need enterprise software for everything.
😤 “Vibecoded software doesn’t scale. It’ll break.” Maybe. But $600K/year was also breaking — the budget, and the team’s patience with a tool that didn’t fit their workflow.
💡 80/20: Before renewing your next SaaS contract, ask: “Could we build the 80% of this we actually use?” If the answer involves domain knowledge your team already has and data that stays on your servers, the math has changed.
Nabla brings in enterprise sales CEO — the scribe market is now a GTM race.
Brian Manning scaled Bamboo Health to $140M+ ARR. Now he’s running Nabla. Co-founder Alex LeBrun moves to Executive Chairman and Chief AI Officer.
The founder-to-operator transition is the tell. When the engineering founder steps aside for the sales operator, the product is finished. The distribution isn’t.
🔮 My bet: Ambient scribes are table stakes by 2028. The companies that survive are the ones that expanded beyond documentation — into CDS, into prior auth, into care coordination. Manning’s Bamboo Health background (care coordination) hints at the playbook.
House committee unanimously passes H.R. 3108 — a counterweight to CMS’s RPM vendor ban.
House Ways & Means unanimously passed the Rural Patient Monitoring Access Act, establishing a national floor for RPM reimbursement and eliminating negative payment adjustments.
This is the legislative pushback to CMS’s proposed rule that would bar Medicare payment for third-party RPM vendors. ATA, AHA, and MGMA are all pushing back on the CMS proposal; H.R. 3108 is the Congressional counterweight.
If you’re building RPM tools, the regulatory ground is shifting under both feet. Watch both tracks.
9 teams advance in HHS EHIgnite — a federal competition to make EHR data usable.
ONC named nine Phase 1 winners ($10K each) in its competition to turn dense EHI exports into usable clinician- and patient-facing tools. Phase 2 carries a $400,000 prize pool and concludes March 2027.
💡 80/20: If you’ve ever tried to do anything useful with a FHIR Bulk Data export, this competition is looking for you. Phase 2 applications open soon. The prize money is modest; the ONC-validation stamp on your tool is the real asset.
ACO REACH delivers $706M in gross savings.
8.9% spending decline in the high-needs nursing-home-linked cohort. Community Care Cooperative (C3), the largest FQHC-governed ACO, reported $4.1M in shared savings. LEAD successor model expected next. Builders in value-based care: this is the proof-of-concept data your CFO needs.
🎙️ From the Pods
🎙️ 229 Project — “Clinical AI on Trial: Shadow Tools and Governance Gaps“
Yaw Fellin (UpToDate GM) and Matt Troup (Abridge) surfaced a stat that should stop you: shadow AI is spreading through health systems with no oversight. Clinicians are using ChatGPT, consumer AI tools, and unapproved assistants for clinical tasks — and nobody’s tracking what’s being pasted into those prompts.
The bigger concept: “automaticity bias” — clinicians sign off on AI-generated content without reviewing it because it looks finished. The note is clean, the format is right, the language is polished. So the physician clicks sign.
🔇 Speaker Blindspot: Availability heuristic — they anchored on documentation bias (the visible problem) and didn’t address whether ambient recording itself changes clinical encounters. Do patients modify their history when they know they’re being recorded? That’s the upstream question nobody’s studying.
🎙️ Bob Wachter on Stanford AI Podcast — “Epic Is the Path of Least Resistance”
Dr. Bob Wachter (UCSF Chair of Medicine) said it plainly: nobody is buying 50 point solutions. Epic is the path of least resistance for health system AI. Scribe-only companies — Abridge, Ambience, Suki — are in trouble if documentation is all they do.
The implication: platform wins. Feature loses.
🔇 Speaker Blindspot: Survivorship bias — Wachter profiled the platform strategy (Epic) that’s winning and declared the category. But platform monopoly creates its own failure modes: innovation bottleneck (Epic controls the roadmap), vendor lock-in (switching costs are enormous), and the brain-drain problem sitting in today’s Big Thing. When one company controls the platform AND the AI layer AND the marketplace, the “path of least resistance” is also the path of least optionality.
💡 BTW
💡 BTW: Bob Wachter coined the term “hospitalist” in a 1996 NEJM paper — a word that named a specialty now practiced by 60,000+ physicians. Three decades later, he’s still coining the categories.
What are you building this week? Email and tell me (kevin@clinicians.build) — I read every one.
— Kevin