The relationship between Abridge, one of healthcare’s most promising AI startups, and Epic Systems, the dominant electronic medical records provider, has taken a dramatic turn. Once a strategic partnership that propelled Abridge to prominence, the alliance is now complicated by Epic’s own aggressive entry into the AI scribing market—a move that threatens to undermine the very business Abridge built. In 2023, Abridge struck a landmark deal with Epic, integrating its AI-powered medical scribing technology directly into Epic’s electronic health record system. The partnership was a game-changer. It gave Abridge access to Epic’s vast network of hospitals, including major institutions like Kaiser Permanente, Mayo Clinic, and Johns Hopkins. That access helped Abridge raise over $700 million from top-tier investors like Andreessen Horowitz and Khosla Ventures, reach a $5.3 billion valuation, and secure more than 150 hospital clients. At the time, Epic acquired a single-digit stake in Abridge, which, at current valuation levels, would be worth hundreds of millions. Multiple sources confirm that Epic sold those shares earlier this year, signaling a shift in strategy. Now, Epic has announced plans to launch its own AI tools to automate patient visit documentation—directly competing with Abridge’s core product. This move follows a pattern seen across tech: incumbents who once welcomed startups as partners later replicate their innovations to eliminate external competition. Microsoft’s relationship with OpenAI and Google’s ties to Anthropic are similar examples. Abridge’s challenge is acute. It remains dependent on Epic for distribution and revenue, yet must now compete with the same company that once helped it grow. The startup insists the integration with Epic will continue, and executives have maintained a friendly public posture. Abridge’s CTO, Zachary Lipton, has repeatedly emphasized that the company has no interest in replacing Epic’s system—only in enhancing it. Still, the reality is tense. Epic’s deep pockets, unmatched market share—about 42% of U.S. hospitals—and ability to bundle AI features with existing software make it a formidable rival. Hospitals may prefer a single vendor for their entire tech stack, especially if Epic offers AI tools at a lower cost or with better integration. Abridge is responding by expanding beyond Epic. It’s investing in new areas like revenue cycle management and working to integrate with rival EHRs such as Cerner, Athenahealth, and Meditech. The company is also exploring acquisitions to accelerate growth, with CEO Dr. Shiv Rao confirming that M&A is on the table. Meanwhile, Epic faces growing scrutiny. Two antitrust lawsuits—by Particle Health and CureIS—allege the company has stifled competition by blocking or undercutting third-party innovations. These legal pressures add another layer of complexity to the evolving dynamic. Despite the risks, Abridge’s investors remain cautiously optimistic. They believe the startup’s technology is too far ahead for Epic to catch quickly. “They’ve got work to do,” said Bryan Roberts of Venrock. “But they can’t milk the Epic cow forever.” Still, many observers doubt the friendship will last. “Epic wants every health system using Epic to use their AI scribe, not Abridge,” Roberts said. “That has to be true.” For now, Abridge walks a tightrope—maintaining cooperation with Epic while preparing for a future where the two are no longer allies. The outcome will likely shape the future of AI in healthcare.