At the VA, the case for ambient AI is being made at scale — and the bar for what works is unlike anywhere else.
The U.S. health system that does more than any other has a paradoxically brief, well-known two-letter name: the VA.
The U.S. Department of Veterans Affairs serves roughly 9 million enrolled veterans across a longitudinal care model that follows patients from active duty through end of life. It is also the nation’s largest educator of medical professionals and a major engine of clinical research. The country’s largest healthcare operation is also its most mission-driven.
Few, if any, health systems are asked to do as much for as many people. In as many settings. All at once.
And, more recently, with less. In fiscal year 2025, the VA shed nearly 30,000 employees — thousands of nurses, physicians and mental health workers among them — through attrition, deferred resignations and a hiring freeze. The VA Office of Inspector General reported 4,434 occupational vacancies across Veterans Health Administration facilities in 2025, a 50% jump from the year prior.
The documentation burden on VA clinicians predates these losses. Providers were already spending significant time charting at the expense of patient-facing care or their own wellbeing. Add veteran care’s clinical reality, with co-occurring mental health conditions, polytrauma and chronic disease, and each encounter becomes significantly more complex to document accurately.
This is the pressure test that ambient AI is taking on. The technology drafts clinical notes from the conversation itself, lifting providers off the keyboard and putting time back in front of the patient. At the VA, that small shift carries outsized weight — for clinicians under strain, for veterans seeking presence in the exam room and for the care relationships that take careers to build.
The VA is where the case for ambient AI gets made at full scale and in full complexity. What the technology is delivering inside the country’s largest health system, and what it will take to bring across the rest, is the story that follows.
‘Something really rare in medicine’
The VA’s documentation challenges only come into focus once you understand what its clinicians are asked to absorb. That part of the picture is too often missed. Chuck Ritter, partner success director for federal accounts at Abridge, says the system is routinely underestimated, even by experienced healthcare leaders.
“It really is one of the most vital and comprehensive health institutions in all of U.S. medicine,” he said.
Veteran care begins almost immediately after service ends, with care teams “oftentimes meeting veterans literally coming off the plane from their deployment,” Mr. Ritter said. “It’s there from every milestone that follows them all the way to the end of life.”
In between, the VA covers a remarkably broad set of needs under one roof: primary care, specialty care, rehab, mental health, dental, home health, housing support, and a nationwide telehealth system. “I just don’t think any other health system in the country is asked to do anything even close to that,” Mr. Ritter said.
The range of people served is equally far-reaching. On any given day, a clinician might see a 25-year-old amputee transitioning out of military service and, an hour later, a patient in end-of-life care managing dementia, PTSD and the cumulative health effects of decades of service.
“The VA meets each of them with the same commitment, same benefits, and the same standard of care, whether they live in rural Wyoming or in the heart of Boston,” Mr. Ritter said. “That equity alone is just a remarkable achievement.”
All of it lands in the chart. High-volume encounters across a distributed system, layered comorbidities, longitudinal histories, and significant administrative and compliance requirements compound inside every note. As positions go unfilled, remaining staff absorb added responsibilities, widening the documentation burden on an already strained team.
The downstream effects are familiar: rising cognitive load, after-hours charting, less time for direct patient interaction. The cost is operational, but also relational. At the VA’s scale, reducing documentation burden becomes less about efficiency and more about preserving clinician attention for complex patient care.
“At its core, VA is built around its mission,” Mr. Ritter said. “And at the core of that is something really rare in medicine — care teams building lifelong, meaningful relationships with veterans and their families throughout their lifetime.”
Built for every veteran. Not every technology.
Ambient AI captures and structures clinical conversations in real time, generating a draft note from the natural dialogue between clinician and patient. The technology has matured quickly. More advanced ambient AI systems are beginning to move beyond transcription alone, incorporating clinical context and longitudinal patient information to support more accurate documentation — capabilities particularly well suited to complex care environments like the VA.
The technology is also gaining traction across some of healthcare’s most operationally demanding settings— academic medical centers, comprehensive cancer centers and FQHCs — giving health systems evidence that the technology can perform at enterprise scale.
The VA use case is distinctive, Mr. Ritter said, because of the documentation it generates. “No other health system in the country serves a population this broad, this complex, and across such a broad geographic range,” he said. “That kind of care generates documentation at a scale and complexity that, in my opinion, does not exist in any other health system. Since VA encounters routinely span behavioral health, chronic disease, trauma histories and decades of longitudinal care, documentation accuracy becomes more than operational, it becomes foundational to continuity of care. And because so much of that care happens within a single integrated system, the interdisciplinary nature of that documentation compounds across nearly every encounter that clinicians have with veterans.”
That reality raises the bar for how ambient AI must function inside the VA. Set against fiscal constraints, recruiting challenges and one of the largest eligibility expansions in VA history — Mr. Ritter cited roughly 900,000 new veterans enrolled through the PACT Act alone — ambient AI shifts from productivity tool to something closer to critical infrastructure.
For clinicians, the immediate change with the technology is less documentation time during and after visits — a shift that lowers cognitive burden, reduces after-hours charting, and gives providers a real chance at finishing the workday within the workday. Over time, those gains translate into improved job satisfaction and retention, both scarce currencies in a workforce under as much pressure as the VA’s.
For veterans, the difference shows up as presence. “Every minute saved for VA providers is time given back to veterans that are sitting in the exam room with those clinicians,” Mr. Ritter said. More eye contact, fewer interruptions to type, and clinicians who finish a visit with their head up instead of buried in a keyboard all contribute to stronger communication and deeper trust — the same trust VA care teams have spent careers building.
The care quality implications are just as consequential. More complete, standardized documentation makes complex, longitudinal narratives easier to follow. Mr. Ritter pointed to the VA’s uniquely rich medical record as both an opportunity and an obligation.
“The VA’s got such a deep medical record and such a deep history for every veteran,” he said. “That record really is an asset in healthcare, and the goal should be making it easier to navigate and use, so the value of that record can be fully realized at the point of care.”
Years in the making
By the time ambient AI arrives at the VA, much of the hardest work is already done.
The VA has invested for years in the Summit Data Platform, the Clinical Decision Support Platform, its interoperability pledge and the Lighthouse API framework — infrastructure that other health systems are still trying to build.
That foresight is what makes the moment ambient AI is stepping into so consequential. Technology infrastructure is in place. The next challenge is ensuring AI platforms can adapt to the VA’s operational complexity, clinical workflows and interoperability requirements at enterprise scale.
“The VA’s workflows and mission aren’t like anything else in the private sector,” Mr. Ritter said. “The right partner is one that comes to the table with a willingness to build VA-specific solutions, to learn the VA system, understand the veterans it serves, and adapt accordingly — absolutely not the other way around.”
The partnership has to match the VA’s complexity, too. Ambulatory providers and inpatient teams can’t be using different tools. Nursing and physicians can’t be on different platforms. Mr. Ritter advocated for a single, coherent AI layer that follows the clinician and the veteran across every setting, every specialty, every touchpoint — “consistent, intelligent, and purposely built for VA workflows.”
Reducing administrative burden, at this scale, is more than an efficiency gain. It compounds — across clinician engagement, patient experience and the human shape of veteran care itself. With the foundation in place and the mission clear, Mr. Ritter argues the opportunity to get this right for veterans, clinicians and the future of VA care has “never been greater.”
The measure of success is not in the contract or the platform, after all, but in the encounter.
“When a VA primary care physician in a busy urban medical center and a nurse practitioner running a rural health clinic are both walking into patient encounters with less burden, more presence, and more focus on the person in front of them — that’s when you know the deployment is successful,” he said. “Not because a contract was signed or a platform was installed, but because — somewhere — a veteran felt the difference.”
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