University of Iowa Health Care surveyed clinicians in 2023 to assess their documentation experience, finding that most viewed clinical documentation as a barrier to efficiency and patient care. In response, the 862-bed academic medical center sought an ambient documentation tool to reduce administrative burden and decrease “pajama time”—the unpaid hours clinicians spend on paperwork after shifts.
Adopting an Ambient Solution
After piloting Nabla in 2024, UI Health Care implemented the technology systemwide rather than in limited deployments, a strategy Dr. James Blum, chief health information officer, described as critical for success. The vendor’s cloud-based platform integrated with Epic via a small HL7 feed, allowing the health system to be operational in days with minimal IT changes. A key requirement was that the vendor not train models on UI Health Care’s data, which narrowed the field of potential partners.
User-friendliness and adaptability were decisive factors in choosing Nabla. The solution’s lightweight design enabled rapid adoption, and its potential for broader use beyond clinicians, such as physical therapists, aligned with UI Health Care’s long-term goals. Blum emphasized that the vendor’s willingness to grow with the organization was essential as healthcare systems increasingly rely on ambient tools to meet clinician expectations.
Results and Evolving Governance
A 2025 follow-up survey revealed a 26% reduction in burnout and a 14% increase in satisfaction with the electronic health records system after adopting the ambient tool, findings published in a KLAS Arch Collaborative case study. Blum noted that the adoption rate for such technologies has outpaced even EHR rollouts, describing it as the fastest technology implementation he’d witnessed.
Recognizing the need for robust oversight, UI Health Care established a multidisciplinary group with AI expertise before the generative AI boom. This team evaluated vendors by scrutinizing model training, performance, and dataset limitations, ensuring solutions were not tailored to narrow hospital-specific data. As the health system evolves, it is shifting from point solutions to platform-based approaches, focusing on model drift and utilization metrics to refine its governance strategy over the next 12 to 18 months.
The vendor environment has shifted dramatically since 2022, when Microsoft completed its acquisition of leading ambient solution provider Nuance Communications and ChatGPT later launched to the public. Native generative AI features in EHR platforms like Epic and Oracle Health have since become standard offerings, prompting providers to rapidly adapt their procurement strategies. Blum highlighted that UI Health Care’s early preparation positioned it well amid this transformation, where compliance concerns and evolving capabilities now dominate vendor selection criteria.
Expanding Governance Focus
UI Health Care’s governance strategy now prioritizes platform-based solutions over isolated tools. The multidisciplinary team, formed ahead of the generative AI surge, continues evaluating vendors through rigorous scrutiny of model training and dataset scope. Blum noted that models trained on narrow, hospital-specific data often fail to meet the system’s standards, prompting ongoing adjustments to acquisition protocols. As the health system refines its approach, it emphasizes monitoring model drift and utilization metrics to ensure sustained performance.
Looking Ahead: AI in Broader Applications
Blum expressed optimism about AI’s potential in administrative tasks such as claims processing and patient outreach. He noted that UI Health Care’s exploration of native AI features within EHR platforms like Epic and Oracle Health shows its commitment to staying ahead of industry shifts. Blum stressed that early preparation positions the organization to adapt to rapid technological changes, ensuring clinicians retain access to tools that enhance efficiency and care quality.
The health system’s proactive stance, he noted, mirrors the transformative role of ultrasound in anesthesiology, where new technologies redefine clinical expectations and outcomes. “Folks who don’t necessarily have the technical skill can still build out prototypes, and I think that will enable an era of innovation in healthcare that we haven’t seen in probably 20 years because, as provider organizations, we’re so often reliant on vendors,” Blum said. The bottom line is that healthcare organizations can’t shy away from adopting new technologies because the next generation of clinicians will expect to have these tools at their disposal.