How OpenEvidence compliantly and effectively scaled to $50M ARR without BAAs or EHR integration: How their unique business model drove hyper-scaling metrics previously considered impossible in health.

DISCLAIMER: The views and opinions expressed in this essay are solely my own and do not reflect the views, opinions, or positions of my employer or any organizations with which I am affiliated.

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ABSTRACT

OpenEvidence achieved what most healthcare software companies thought impossible: fifty million in annual recurring revenue within roughly two years of product launch, capturing forty percent of US physicians without requiring business associate agreements or EHR integration during its critical growth phase. The company’s trajectory from zero to half a billion in funding and a six billion dollar valuation happened because they understood a subtle regulatory distinction that let them scale like consumer software while everyone else was stuck in enterprise sales cycles. This essay examines the specific mechanics of how they did it, why the approach worked, and why it probably won’t work again.

TABLE OF CONTENTS

The Problem With Healthcare Software Distribution

What HIPAA Actually Requires Versus What Everyone Thinks It Requires

The EHR Integration Tax

How OpenEvidence Structured Their Product to Avoid Both Barriers

The Growth Numbers and What They Mean

Why This Window Has Closed

Implications for Healthcare Software Strategy

The Problem With Healthcare Software Distribution

Healthcare software has a distribution problem that’s fundamentally different from other enterprise software categories. The root issue isn’t that healthcare buyers are conservative or slow, though they are. The issue is that clinical software usually requires two things that create massive friction: business associate agreements under HIPAA and integration with electronic health record systems. These requirements turn what could be fast product-led growth into multi-year enterprise sales cycles.

The typical path looks brutal. You build clinical decision support software that helps doctors make better treatment decisions. To be useful, it needs patient data from the EHR, which means technical integration work. Epic’s app orchard review process takes six to nine months just to get listed. Then each health system needs to enable your app, which requires IT approval. Once you’re dealing with patient data, you’re handling PHI, which means every health system needs their legal team to review and sign your BAA. Their information security team does a vendor assessment. Their clinical leadership needs to see evidence that doctors will actually use it. The whole process takes twelve to twenty four months per health system, and at the end you might have a few hundred physicians using your software.

This explains why healthcare software companies typically raise a Series A to hire enterprise sales teams before they have real revenue. They spend millions on compliance infrastructure before they know if doctors actually want the product. They modify features based on what hospital administrators think doctors need rather than what doctors actually need. The result is that most healthcare software companies are still trying to close their tenth customer three years after founding. The ones that succeed usually do it by grinding through enterprise sales, not by achieving viral adoption.

OpenEvidence just bypassed this entire machinery and got to fifty million in ARR in roughly two years.

What HIPAA Actually Requires Versus What Everyone Thinks It Requires