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A typical physician’s job is much more than just seeing patients. In fact, most doctors spend hours every week outside of clinic hours catching up on typing notes and getting visits and treatments cleared with insurance providers. As a practicing cardiologist, Shiv Rao had gotten used to doing this work late at night. Thats why he launched Abridge, an AI platform that can turn conversations between doctors and patients into clinical notes in real time. So far, Abridge has raised $780 million from the likes of Andreessen Horowitz, Elad Gil, and Khosla Ventures, and struck up partnerships with more than 150 health systems nationwide. I recently sat down with Rao, and we discussed: How Abridges ability to understand and transcribe nearly 100 languages tranforms patient visits into clinical notes and billing codes to save physicians time What the 7-year-old company brings to health systems of different sizes, such as Kaiser Permanente and Johns Hopkins Medicine Why AIs real potential in healthcare isnt replacing doctors and nurses, but making their jobs easier and time with patients more impactful This interview has been edited and condensed. Abridge was founded in 2018, before most of us learned what generative AI was when OpenAI launched ChatGPT. When did you see the potential of machine learning in a clinical setting? In the 2010s, deep learning was really starting to take off. We were all on notice as doctors that machine learning was about to do something really interesting in terms of assisting, augmenting, or even automating workflows. Deep learning in medicine started in the computer vision spaceradiologists were the ones who were championing this technology. I remember as an investor, we got to put a good amount of capital into Carnegie Mellon University. We started a machine learning and health program. That’s where I met my cofounder, chief technology officer Zack Lipton. He’s an associate professor over there. Over the years, I got to stay close and have a finger on the pulse of what was happening with all things related to machine learning and AI. In late 2017, it was clear that things were about to really change. We started our company in March 2018that was what just a few months after Google Research had published that paper, Attention Is All You Need. And that was the paper that sort of blew up the spot in relation to all things transformerthe T in GPT. We started building Abridge with pretrained models like Bert and Firebirdbasically different types of pretrained models that predated LLMs. When LLMs came out, we had a first-mover advantage. You have your own LLMs now. Why did you take that approach? We see ourselves as an AI-native company. That means were a company that’s focused on one vertical industry, and we just try to go millions of miles deep on the challenges in healthcare that we’re trying to solve. So we can reach down one or two layers deeper into the stack than I think most companies, we can fine-tune models, we can train our own models where it makes sense, and we can also do what researchers call post-train. That means we can leverage all of the edits that our users are giving us on a daily basismillions of edits every weekand all those edits can feed our models to be that much better all the time. What we’ve learned over time is that the difference between a party trick and an enterprise-grade platform is the ability to hit maybe 15 to 20 LLMs to create one piece of output, and maybe 14 of those LMS are your own proprietary fine-tuned models. Being able to think maximally can make a huge difference. What are your models trained on? I imagine most medical conversations are private. These conversations are sacrosanct. De-identification in healthcare is so important. Every single day we are able to, with a good amount of our health systems, leverage edits that people are making to fine-tune our models to actually train our models to be that much better Could giant LLMs like GPT or Gemini, eventually become so good that they can compete with what you’ve built? It’s a great question. I remember there was a Sam Altman quote where he said that if a new model, a new web scale model comes out from an OpenAI or Anthropic or Google, and you celebrate the new benchmark, the new discoveries, the new performance, then you’re going to ride incredible waves. However, if the new model comes out and you’re scared, if for some reason you’re nervous about how the floor has risen, you might be screwed. Thats a very convenient perspective for him to have. Yeah, totally. But there is something to be said about that perspective because the ground is shifting so quickly. Things are changing all of the time. I think across different verticals or industries, there are some specific use cases and specific problems where you’re never going to be perfect and you’ll always be able to be less than perfect. You’ll always be able to go even deeper. Those are the opportunities where you can create real value. You can build a company that can create incredible impact. How much of a medical professionals job can Abridge do? Over the next five to 10 years, we’re not going to be able to fully automate a doctor or nurse. The folks that are out there saying that we can don’t really understand all the things that they do. I say that with all the bias in the world as a practicing cardiologist. There was an American Journal of General Internal Medicine article that was published a few years ago that suggested that doctors need 30 hours a day to get all of their work done. What we’re all about at Abridge is trying to find a way to unburden them as much as possible from all the clerical work that crushes their souls at night. Our platform can leverage conversations to get at all of these different tasks and jobs and clinical documentation done. Abridge is valued at $5.3 billion. You’ve raised almost $780 million from the likes of a16z and Khosla Ventures. Why did you need to raise so much money? It all comes down to what we’re working backwards from. We’ve burned all of our boats. We’re here to build and be on a decades-long journey with all of our health system customers. We believe we can get into value creation across any number of use cases that help the clinician, that help the patient, and also help the system. To give you a sense of what I mean by that: in this country, we’re not compensated for the care that we deliver, we’re compensated for the care that we document that we deliver. All these notes Abridge captures are actually bills. So what we’re doing is taking our models to revenue cycle school. We’re taking our models to what’s called risk adjustment school as well, because in this country, you’re also compensated for the quality of care that you deliver, what those outcomes look like, and how well your patient does over time. These notes end up being the artifacts that have to capture all of that information at a level of detail and fidelity that Medicare would accept. When is Abridge going to be profitable? That’s certainly not our objective function right now. Right now its jst growth. As much distribution as we’ve got, there’s still any number of clinicians who don’t have this technology. And so being able to grow right now is a top priority, but also being able to innovate at the same time and get into these new use cases, these new features and experiences, is a big deal. Youve also grown a lot, which requires a lot of capital. The last few years haven’t been hockey stick growth. I think they’ve been more akin to telephone pole growth. The ChatGPT moment just absolutely opened up the skies for us in a way. What I didn’t realize is that three years before that, or even four years before that, is that we were pre-selling. We were seeding the market. We were using these models that predated LLMs, and we were talking about generative AI and people didn’t have the words yet. When Chat GPT came out, it blew all of these executives minds. It also got clinicians wondering what this technology could do for them. I spent so much time in 2021 and 2022 doing demos on Zooms where prospective clients would ask me to put my hands up [idk what this means]. They couldn’t believe what we were doing. I could tell that it was novel and it was fun for them to see this demo, but it wasn’t something that they were seriously considering. It seems like they were incredulous about the technology you built, but did they see a need for it at the time? I think where a lot of stars had to align is that there’s a public health emergency in the United States where two out of five doctors don’t want to be doctors in the next two to three years. And up to 30% of nurses don’t want to be nurses in the next 12 months. So many of them are trying to solve their own problems, but I think for me, this was just one of those moments where we need technology. If we don’t find a way to unburden them, if we don’t find a way to automate the things that we can automate and assist them where we can with technology, then we’re going to be in a world of hurt. This is one of those moments where a market and a challenge and a technology just perfectly fit. There are so many challenges when it comes to recording doctor-patient communication. What are you prioritizing? In terms of languages, what’s different about this world of conversations and dialogue is that you have to meet the patient where they are. I might see a patient who speaks Nepalese, and I don’t speak Nepalese, and so I need an interpreter in the room. That’s the kind of complexity that our technology needs to be able to lean into. We need to be able to build technologies that don’t get tripped up when there’s multiple voices in the room. We need to make sure that our technology can understand and translate different languages. We could probably support well over 90 languages today. Are patients wary of AI being used in a clinical setting? Consent is critical and healthcare data is so private and personal. So they absolutely have to be aware. What’s been fascinating too over these last five years is that the zeitgeist has shifted. People know what AI is. People are using this technology increasingly in their daily lives. And so when the clinician says, Hey, can I use this technology? It’s going to help me focus on you, instead of all the distractions that get in the way, they get it. That value proposition around helping people be more present with each other, I think is arguably the most profound impact that we’re having right now. There are other companies in your space, I’m thinking of Microsoft-owned Nuance, for instance. How do you compete with them? The healthcare system is not homogenous. On one end of the spectrum, there might be an independent primary care doctor or a concierge medicine clinician who’s taking cash payment out of pocket. On the other end of the spectrum, there are the large health systems, and if anything, we’re going to see more and more clinicians affiliated in some way with one of these large health systems. At this point in time, about 75% of the doctors in this country are affiliated with a large health system. The latter end of the spectrum is where Nuance focuses, and that’s where we focus. Nuance is owned by Microsoft, and obviously Microsoft is everywhere. We’ve been in this David and Goliath sort of situation Whats on the road map in the next year? When you hit stop and you look down at your phone, we can give you a quick tip or give you a cue. In the now terms, what it looks like and what we’re about to talk a lot about is something like prior authorization. Let’s say I see you in the clinic and I prescribe you a cardiac MRI. Sometimes I place that order and it takes weeks, sometimes months to get that cardiac MRI done. You might have a specific insurance plan and a specific geography that requires six specific things to get documented to be addressed. It’s impossible for any clinician to keep up with all this stuff. So this is a really good spot for AI. So our AI is trying topun intendedbuild a bridge between providers and payers. It is listening to the conversation so payers can make sure that the clinician was thoughtful. So we might be in conversation, and when we stop talking I could look at my phone and get a notification saying, Hey Shiv, you have to ask Yaz these six questions. You asked five . . . do you want to ask that last question? You are a physician in Pittsburgh. Have you watched HBOs The Pitt? Is it accurate? That show is really accurate. This is one of those shows that I think has helped a lot of doctors feel really seen. The way characters react and the way they practice medicine is absolutely accurate.
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E-Commerce
Shares in Cracker Barrel Old Country Store, Inc. (Nasdaq: CBRL) arent reacting as much as the company had probably hoped on Tuesday after the beloved country-style restaurant chain apologized over a logo redesign it rolled out last week. The backlash highlights the level of emotional attachment that customers have to a brands identity. Heres what you need to know about the Cracker Barrel logo redesign, apology, and the effect on CBRL stock. What happened? On August 19, Cracker Barrel announced that it was launching a redesigned logo. Gone was the old-timey Cracker Barrel Old Country Store logo, which featured the laid-back old timer Uncle Herschel sitting in a chair, resting his arm over a wooden barrel. It was replaced with a more modern, minimalistic logo that consisted of nothing more than the name Cracker Barrel set on top of a rough outline of a two-dimensional shape resembling a barrel. In a press release announcing the change, Cracker Barrel said that the new logo is now rooted even more closely to the iconic barrel shape and word mark that started it all. But that wasnt how some Cracker Barrel fans saw things. Stock price drops after backlash After the new Cracker Barrel logo was unveiled, fans of the restaurant chain, which currently operates over 600 locations across America, took to social media to vent their frustrations. Generic, soulless, and bland were some of the most common words used to describe the redesigned logo, notes CNBC. From a financial standpoint, things got worse for Cracker Barrel. As noted by CBS, last Thursday, after public blowback to the logo went viral, Cracker Barrel saw almost $100 million wiped from its market cap as investors sold the stock. It ended up down about 7.2% for the day to $54.80. Before the logo discourse began, Cracker Barrel shares had been on an upswing. In March, the company increased its financial outlook for the year, projecting revenue of $3.45 billion to $3.50 billion, up from an earlier outlook of $3.4 billion to $3.5 billion. Cracker Barrel apologizes for logo redesign Since the redesign-induced stock slump, CBRL shares have remained depressed, which is likely one of the reasons that the company has decided to publicly apologize for the logo change. Yesterday, the company put out a statement saying that it could’ve done a better job sharing who we are and who we’ll always be. It also reiterated that despite the redesign, the things people love most about our stores aren’t going anywhere. Those things include rocking chairs on the porch, a warm fire in the hearth, peg games on the table, unique treasures in our gift shop, and vintage Americana with antiques pulled straight from our warehouse in Lebanon. The chain also clarified that while Uncle Herschel is no longer on the new logo, the character will remain in other places in the companys branding. “We love seeing how much you care about our old timer. We love him too, the company wrote. Uncle Herschel will still be on our menu (welcome back Uncle Herschel’s Favorite Breakfast Platter), on our road signs and featured in our country store. He’s not going anywhere – he’s family. Still, while Cracker Barrel may quell some of the backlash, the statement has so far done little to reverse the companys decline in stock price. As of the time of this writing, CBRL shares are virtually unchanged in premarket trading. Currently, shares are down about half a percent to $54.01 per share. Over the past five days, CBRL shares have lost nearly 11% of their value.
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For understandable reasons, most technology coverage tends to focus more on the physical or visual elements of new devices than their audio signature. Its much easier to show and tell audiences how great a new screen is or how thin a new phone is than to explain the experience theyll get from its sound effects. But that doesnt mean audio cant be just as memorable, or as important to the companies that design it. Here are 10 of the most impactful, unforgettable sounds and effects from the past few decades in tech. Mac startup chime Frustrated by the previous tri-tone sound that accompanied the frequent Mac crashes of the ’90s, Apple sound designer Jim Reekes took it upon himself to create an iconic chime that remains an indelible part of the Mac experiencealthough we dont need to reboot our computers so often these days. The current chime, introduced in 1998 on the iMac G3, was inspired by The Beatles A Day in the Life and makes for a much more calming, optimistic way to start your work. {"blockType":"creator-network-promo","data":{"mediaUrl":"https:\/\/images.fastcompany.com\/image\/upload\/f_webp,q_auto,c_fit\/wp-cms-2\/2025\/03\/multicore_logo.jpg","headline":"Multicore","description":"Multicore is about technology hardware and design. It's written from Tokyo by Sam Byford. To learn more visit multicore.blog","substackDomain":"https:\/\/www.multicore.blog","colorTheme":"salmon","redirectUrl":""}} It says a lot that of all the issues introduced alongside the controversial 2016 MacBook Pro lineupincluding the unpopular USB-C-only port setup and the fragile butterfly keyboardthe lack of a startup chime managed to cause a similar level of uproar online among Mac diehards. The chime was restored in 2020 and has remained on Mac computers ever since. Windows 95 startup sound While the Mac startup chime came from a single employees personal inspiration, Microsofts equally iconic counterpart came about through sheer corporate willpower. To create a sound that would define the Windows 95 experience, the companys marketing agency decided to leverage the talents of legendary record producer and ambient music pioneer Brian Eno. The thing from the agency said, We want a piece of music that is inspiring, universal, blah-blah, da-da-da, optimistic, futuristic, sentimental, emotional, this whole list of adjectives, Eno told SFGate in 1996. And then at the bottom it said and it must be 3 1/4 seconds long. Eno may have failed the brief, because the resulting sound is actually more like six seconds. But it does a lot with its running time; a lush, rising arpeggio gives way to fading crystalline notes, managing to sound at once warm and futuristic. It was the perfect match for Windows 95, which drove an explosion in the accessibility of personal computers. Dial-up modem handshake The other inescapable sound associated with PCs of that era could not have been more different to Enos delicate precision. The screeching handshake as a dial-up modem connected to an internet service provider was not exactly a single sound effect, but the raw, analog result of machines talking to each other. Although it sounded like random static, it reflected a precise negotiation on the part of the modem. Each bleep and hiss served a purpose, from the tones that disabled voice-line processing to the test chirps that probed for speed and stability. No one would ever have described the eventual noise as pleasant, and it was frustrating to have to sit through it every time. But there is a certain beauty in how such a chaotic signature came to symbolize getting online in the early days of the web. Logging onto the internet each evening felt like tapping into a fragile new frontier held together with string. Of course, that wasnt too far from the truth. DROOOID This was the mechanical sound that first signaled to American consumers that Apple might have some serious competition. While Android had been around for a couple of years, it was still a Wild West of janky hardware and convoluted software from a variety of providers, with no one quite managing to break through. But by pairing the aggressive, sci-fi Droid brandinglicensed from Star Wars owner Lucasfilmwith some impressive keyboard-equipped hardware from Motorola, Verizon managed to define an identity for Android that stood in direct opposition to Apple. The Droooid audio tag not only appeared at the end of TV commercials, it was the notification sound on Verizon phones at a time when people didnt live on Do not Disturb (DND). Sat next to a Verizon customer on the subway who justgot an alert? Droooid. Looking back at Droooid today, it comes off as deeply silly. The techy, self-consciously masculine branding swiftly descended into parody, with some truly ridiculous products like the Droid Xyboard tablet. But its impact on the mobile ecosystem cant be underestimated. It was so successful as a branding exercise, in fact, that for years many people would refer to any Android phone as a Droid regardless of whether it came from Verizon or Motorola. Nintendo Game Boy startup The simple, two-note Game Boy bling was an exercise in delayed gratification. Flip the switch with a game cartridge inserted and youd see the monochrome Nintendo logo slowly descend from the top of the screen; if everything was in order, youd hear the satisfying da-ding. What made it so effective was that often enough, everything would not be in order. Often because of dirty cartridge contacts, one way or another most original Game Boy owners would eventually run into what happened when the console couldnt communicate properly with the game: A garbled, pixelated Nintendo logo would be shown instead, and the sound would either be incomplete or not play at all. The solution? You guessed ittake the cartridge out and blow on it. Nintendo has never officially endorsed this technique, but the proof of its effectiveness was right there in the restoration of the chime. The anticipation of hearing it play as the correctly displayed Nintendo logo moved down the screen made the struggle worth it. Sony PlayStation startup The original PlayStation went for something functionally similar to the Game Boy, but with a much more maximalist approach. The booming, cinematic drone that accompanied the gold Sony Computer Entertainment logo on a white background would, if a readable game CD was inserted, give way to a black screen that featured the iconic four-color PS logo accompanied by a cascade of shimmering chimes. The startup sequence was created by Sony sound designer Takafumi Fujisawa. My aim is to lead the sense of security when the console is turned on to the excitement after, he said in a 2019 interview. I kept thinking from the start that I wanted the sound image to be something exciting, like that feeling when you walk into a cinema. I really wanted to communicate and reinforce that something fun is going to happen. Sony brought back the PS1 boot animation and sound as part of a nostalgic 30th-anniversary theme update for the PS5, but unfortunately it was a limited-time addition. While subsequent PlayStation startup sounds have been similarly classyin particular the PS3s orchestra tune-upits hard to beat the original. THX Deep Note Audio company THX is known for its quality assurance rather than any particular products of its own. But if you ever watched a movie in a THX-certified theater, you wont have forgotten the Deep Note, a swelling synthesized crescendo that serves two purposes: demonstrating the sound systems capabilities, and convincing you that youre about to be blown away by some serious audio. Starting from a low rumble in narrow frequencies and expanding to pitches that span three octaves, the THX Deep Note is an ode to the concept of dynamic range. THX has bounced around various owners since being spun off from Lucasfilm, and the Deep Note is not as ubiquitous a fixture of the cinema experience. But there might never have been a more powerful sound in technology. Cherry MX Blue switch If youre not into mechanical keyboards but you think you know what mechanical keyboards sound like, youre probably thinking of the Cherry MX Blue switch. Cherrys pioneering range of switch designs includes several with quieter feedback, but the Blue is best known for its ultra-tactile, intentionally clicky response. The sound is not necessarily the point of the design, which most appeals to writers for its deep travel and satisfyingly physical click. But the experience of typing on a keyboard with Blue switches is multisensory and, for many, addictive to the point of no return. Between the way you feel the key travel past the bump of the actuation point and the sound you get when the switch is activated in response, you really know when youve successfully typed each and every letter. Is this a problem that non-converts ever think about? Not really. But in the same way that watch enthusiasts obsess over legibility or font experts demand readability, the sound of a Cherry MX Blue switch is a testament to crunchy, inimitable typeability. Xbox 360 ‘blades’ Microsoft has never been abe to make its mind up about Xbox software design, and no iteration was more beloved than the Blades interface that launched with the Xbox 360 in 2005. Though simple by todays standards, and a little visually gauche even at the time, the key feature was the ability to swipe between pagesgames, hardware, media and so onwith the bumper buttons on the controller. The interface was fast and responsive, but it was the audio that elevated it into such a satisfying experience. Switching between each Blade was accompanied by a crisp, directional swooshing noise, giving you a sense of place in the UI and encouraging you to explore more. The Xbox 360s Blades were designed in an age of physical media, where access to Netflix involved pressing the eject button on the console itself. Its no wonder that Microsoft eventually decided that the UI would require a total overhaul. But that doesnt mean Xbox fans to this day dont miss the precise, razor-sharp swoosh that came when they swiped over to play a video from a USB stick. iPod Click Wheel clicks Apple knew it had a hit on its hand with the iPod, and a big part of it was the wheel-driven interface that made scrolling through long lists of music effortless. But when the company moved to touch-sensitive capacitive scrolling wheels, it needed something to replace the sense of tactile feedback that came from the older mechanical wheels physical detents. With the Click Wheel, introduced with the iPod mini, Apple hit on an ingenious solution: sound. Whether played through headphones or a tiny onboard piezoelectric speaker, the subtle ticks you could hear created the illusion of a physical bump behind every item in the list-based interface. Between the synthetic ticks and the way the Click Wheel incorporated physical buttons for controls like skipping and play/pause, Apple designed a more convincingly tactile experience while actually reducing the moving parts. {"blockType":"creator-network-promo","data":{"mediaUrl":"https:\/\/images.fastcompany.com\/image\/upload\/f_webp,q_auto,c_fit\/wp-cms-2\/2025\/03\/multicore_logo.jpg","headline":"Multicore","description":"Multicore is about technology hardware and design. It's written from Tokyo by Sam Byford. To learn more visit multicore.blog","substackDomain":"https:\/\/www.multicore.blog","colorTheme":"salmon","redirectUrl":""}}
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