*This is the short version of a full article that’s published on our substack here.
Health tech companies love to talk about their product roadmap. They rarely talk about their adoption roadmap. That’s backwards, and the largest real-world study of AI scribes ever conducted just proved it with hard data.
Across five academic health systems, 1,800 clinicians using ambient documentation saved a modest 16 minutes of charting a day. Unremarkable, on average. But clinicians who used the tool on more than half their visits saved two to three times that — while roughly a third of adopters ever reached that usage level. Separate research found as many as 15% of clinicians assigned a scribe never opened it once.
Same software. Wildly different outcomes. The variable wasn’t the product. It was what happened — or didn’t happen — after the contract was signed.
If you’re building or selling healthcare technology, that should unsettle you more than any competitor announcement. It means the thing your sales team is optimizing for — the signed deal — isn’t the thing that determines whether your product survives its first renewal cycle. Utilization is. And utilization isn’t a product problem. It’s a behavioral one.
Why “build a better product” doesn’t fix it.
The instinct, especially among clinically-trained founders, is to treat low utilization as a signal to improve the product. Worth doing — but it doesn’t touch the actual failure mode: a third of users engaged heavily and the rest didn’t, with the identical software. That’s the intention-action gap at work, a well-documented behavioral economics pattern where every added decision point favors the old habit. This shows up across health tech generally, not just documentation tools — reviews of AI and digital health adoption consistently find trust, not accuracy, is the strongest predictor of whether a rollout survives, and that roughly 70% of health IT projects never reach sustained use.
The behavioral framework.
There’s a simple model behavioral scientists use for designing interventions people actually adopt: make it Easy, Attractive, Social, and Timely. It maps almost exactly onto what separated the heavy adopters from the ghosts in the scribe data — reducing decision points, making the benefit immediate and personal rather than aggregate and delayed, putting visible champions in front of peers, and timing the nudge to the actual moment of decision, not a training email sent the week before.
What it means for go-to-market.
If utilization is the real product, a few things in a typical GTM motion have to change: stop selling the average and sell the ceiling your best users actually hit; redefine your success metric from “activated” to “habituated”; and build a deliberate support motion for the awkward weeks after go-live, not just an onboarding call — because that’s exactly where the intention-action gap does its damage.
Here’s the uncomfortable part: your product’s ceiling is probably already high enough. A third of users are already getting the dramatic outcome. The gap between your average customer and your best one likely isn’t a roadmap problem — it’s a behavioral design problem, and it’s more fixable than most founders assume.
Read the full article here.
The Full Article Goes Further
Substack subscribers got the complete breakdown this week — the full EAST behavioral playbook applied line by line to health tech rollout, the specific GTM and customer-success changes that convert average outcomes into ceiling outcomes, and how to instrument for the silent 15% who never engage before they show up as a lost renewal.
If you build or sell healthcare technology, that playbook is the part worth having.
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