, the AI-to-EHR boundary control point. · On the roadmap: the Living EHR, the full platform described below.
What if your EHR made you money instead of costing you money?
Every other EHR is an expense. Open C's Living EHR is designed as a revenue engine.
Built by a clinician at the bedside. The Living EHR is the long-term Open C platform. The launch product, , is an independent governance layer at the AI-to-EHR boundary, in active build with a design partner cohort open.
is probably leaving on the table
Your EHR was supposed to help. It made everything worse.
Documentation and charting now rank as the number one driver of physician burnout. For every hour of direct patient care, physicians spend nearly two additional hours on EHR and desk work.
Documentation Eats Your Day
86 minutes of after-hours EHR work per day. A third of residents chart 3+ hours every night.
You Leave Money on the Table
33-45% of visits undercoded. $564M in 99214 coding errors alone. Your chart doesn't prove what you did.
Your People Are Burning Out
138,000 nurses left since 2022. Replacing one physician costs $500K-$1M. Burnout turnover costs $4.6B/year.
AI With No Accountability
Your vendor is adding AI that writes notes. Ask what data it used or why. Nobody can tell you.
Your EHR should work for you.
Not the other way around.
Five instruments. One platform.
- Listens to the encounter and writes the clinical note automatically
- Every sentence traces back to the exact moment in the conversation
- If Scribe makes an error, you can find exactly where the misinterpretation occurred
- No more typing, clicking, or pajama time
- Pull up patient history with a specific medication instantly
- Compare this visit's labs to last quarter
- Walk through differential diagnoses with sourced evidence
- Does not hand you answers. Walks through the reasoning with you.
- Flags safety concerns before they become patient harm
- Streams content to CEE so the copilot follows the conversation in context
- All governed, all transparent, all receipted
- Clinical guidelines, drug references, and protocols connected to the patient in front of you
- Right information, right time, right source
- Not a search engine. A governed knowledge layer.
- Every encounter, device reading, and AI interaction feeds a living document
- Designed for continuity of care across providers, settings, and time
- Includes prospective decision-support modeling for clinical scenarios under clinician review
Every AI action carries a receipt.
Every recommendation shows exactly what data the AI used, which model version processed it, what rules it followed, and what it recommended. No unaudited AI actions.
Stop paying for your EHR. Make it pay for you.
How your revenue grows
The ACCESS Model (Medicare Part B)
CMS launched a 10-year outcome-based payment program on July 5, 2026. 150+ organizations already accepted. Pays for managing chronic diseases based on results, not activities. Open C automates the outcome tracking, patient engagement, and FHIR reporting it requires. Most legacy EHRs were not designed around real-time AI governance, attestation receipts, and clinician-reviewed automation. Open C has over 150 patents pending that protect the governed AI infrastructure ACCESS demands.
The math: 500 Medicare patients across multiple tracks.
A practice managing 500 qualifying Medicare patients across ACCESS tracks could generate $90,000 to $210,000 per year in new revenue on top of normal E&M billing. CMS set the Outcome Attainment Threshold at 50% for the first performance period. The platform handles all outcome tracking, patient engagement, and quarterly FHIR reporting.
For practices that do not want to participate directly: You can refer chronic disease patients to an ACCESS organization and bill a co-management code (~$30 per documented review).
14 major private insurance companies covering 165 million lives have pledged to adopt ACCESS-style outcome-based payment by 2028. This is not just Medicare. This is where the entire industry is heading.
Built by someone who is a board-certified Family Nurse Practitioner with psychiatric-mental health nurse practitioner training.
Open C is designed by a board-certified family nurse practitioner (FNP-BC, FNP-C) with psychiatric mental health training (PMHNP candidate, board eligible). The product is shaped by clinical practice, not by assumptions about it.
Why this matters for your practice
Nearly 60% of patients who receive mental health treatment get it from their PCP, because over 150 million Americans live in mental health shortage areas. Open C is designed to support behavioral health screening, measurement-based care, documentation, referral prompts, and clinician-reviewed decision support.
- PHQ-9 and GAD-7 tracking built into the Living EHR
- Evidence-based medication algorithms through Alexandria
- Monitors treatment response and flags patients who need specialist referral
- ACCESS Model behavioral health track means additional revenue per patient
CEE is designed to surface referral considerations for clinician review: severe psychiatric illness, active suicidal ideation, treatment-resistant depression, bipolar disorder, psychosis. The governance layer flags these cases rather than letting a PCP manage beyond their comfort zone.
Built by a clinician. Governed by design. Safe by architecture.
Hey, look. Your stethoscope can chart for you now.
Each tool drops findings straight into the Living EHR. Each reading comes with a receipt. The bundle plugs into Medicare codes you already bill, and patient-side pieces are FSA and HSA eligible.
Intelligent Stethoscope* In Development
- Full-spectrum auscultation
- Replay anywhere
- Cryptographic provenance per recording
Visual Diagnostic Instruments* Future Integration
- Otoscope, ophthalmoscope, dermatoscope
- Clinician-reviewed annotation
- Longitudinal review across visits
Vital Sign Integration* Future Integration
- Continuous and intermittent vitals
- One clinician-reviewed timeline
- Context-aware alerting
Mobile Acoustic Capture* Future Integration
- Clinical-grade audio from your phone
- No extra hardware
- Patent-pending acoustic pipeline
* Investigational, clinician-supervised instruments. Not FDA-cleared. Performance described reflects design intent and prototype testing; commercial availability is subject to ongoing development and regulatory review. Not intended for diagnosis or treatment without clinician validation.
Medicare Part B, built in
The kit feeds the codes you already bill:
- CCM: Chronic Care Management
- RPM: Remote Patient Monitoring
- RTM: Remote Therapeutic Monitoring
- BHI: Behavioral Health Integration
- ACCESS Model: eCKM, CKM, MSK, BH
More codes captured. Less revenue left on the table.
FSA & HSA eligible
Patient-side devices count as medical equipment.
Patients pay with FSA and HSA money. Tax-free dollars set aside for medical care.
Lower out-of-pocket. More patients say yes.
Every instrument is governed.
No finding enters the chart without provenance. Every AI classification includes confidence scoring. If the AI is not confident enough, it tells you instead of guessing.
Built for real clinical workflows. Coming soon.
Interactive walkthroughs showing how Open C works in the scenarios you deal with every day. Split-screen view: clinical encounter on the left, Open C governance on the right.
Chest Pain Interview with Copilot
Watch CEE work alongside a provider in real time. The copilot cues questions, builds the differential, and suggests a plan as the conversation unfolds.
Paramedic to Charge Nurse to Physician Handoff
A 67-year-old male with dyspnea and altered mental status arrives by ambulance. Follow the handoff with real-time agentic updates at every transition.
Nurse-to-Nurse 12-Hour Report
What changed, what is pending, what needs follow-up, and what cannot be closed until specific conditions are met.
Hospital to PCP Transition
Your patient was admitted, had surgery, and is coming home with new medications. See exactly what changed and what you need to do next.
Additional demos coming soon: Autonomy Levels 1-10, Agentic ER for Low-Acuity Visits, Cost Savings Calculator, Neuromorphic Device Integration
Run your own numbers.
This does not include RPM, BHI, APCM, or ACCESS Model revenue, which can layer on top of CCM. Actual reimbursement varies by geographic location.
Every day without the right platform costs you money, people, and patients.
Open C was built to stop every one of these losses.
Ambient documentation eliminates pajama time. Automatic coding captures full visit complexity. The Living EHR tracks every billable activity so you capture every dollar you earn.
Your practice deserves better than a billing tool that calls itself an EHR.
is shipping today as the AI safety layer for your existing EHR. The broader Living EHR is on the roadmap. Start with what's ready now.
1. Holmgren AJ, Sinsky CA, Rotenstein L, Apathy NC. "National Comparison of Ambulatory Physician Electronic Health Record Use Across Specialties." Journal of General Internal Medicine, 2024;39:2868-2870. Sample: 200,081 physicians, 396 organizations using Epic Systems EHR. Published via the AMA Electronic Health Record Use Research Grant Program.
2. Sinsky C, Colligan L, Li L, et al. "Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties." Annals of Internal Medicine, 2016;165:753-760. Funded by the American Medical Association.
3. American Medical Association. National Physician Comparison Report (Organizational Biopsy), 2024. Nearly 18,000 responses from physicians across 43 states and more than 100 health systems.
4. 2026 CMS Medicare Physician Fee Schedule. CPT 99213 national average: ~$91.85. CPT 99214 national average: ~$135.60. Conversion factor: $33.40.
5. 2026 CMS Medicare Physician Fee Schedule. CPT 99490 (base CCM, 20 minutes): ~$66.30/month national average. 10% increase finalized in 2026 Final Rule (CircleLink Health analysis, November 2025).
6. CMS Innovation Center. ACCESS Model Request for Applications, December 2025. Payment amounts: eCKM $360/year, CKM $420/year, MSK $180/year, BH $180/year. Outcome Attainment Threshold: 50% for first performance period.
7. CMS Innovation Center. "ACCESS Model Accepted Applicants," April 13, 2026. 150+ organizations accepted. Application deadline extended to May 15, 2026.
8. CMS Innovation Center. ACCESS Payer Pledge, February 12, 2026. 14 health plans representing 165 million members committed to adopting outcome-aligned payment by 2028.
9. Allzone Medical Solutions. "Navigating the Complexities of Chronic Care Management Codes," April 2025. Analysis of Medicare CCM claims data showing smaller practices less likely to adopt CCM billing.
10. Nsight Health. "Chronic Care Management CPT Codes 2026: Billing and Reimbursement Guide," April 2026. Layered billing analysis: CCM + RPM + BHI = approximately $200-$300+ per patient per month.
11-12. Underlying technical specifications, component selection, and engineering parameters for next-generation acoustic and biosensor capture are confidential trade secrets covered by pending patent applications. Detailed technical disclosures are available to qualified counterparties under NDA during diligence.
13. Arndt BG, Beasley JW, et al. "Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations." Annals of Family Medicine, 2017;15(5):419-426. Family physicians spent 86 minutes per day (1.4 hours) on EHR work after clinic hours.
14. American Board of Family Medicine. National Resident Survey, 2023. Published in Annals of Family Medicine, 2024. One-third of upper-year US family medicine residents report spending 3+ hours per night on after-hours EHR documentation.
15. Tebra Research. "How Documentation Became the Top Cause of Physician Burnout," 2025. Documentation and charting rank as the number one driver of physician burnout, tying with difficult patients and surpassing bureaucratic red tape.
16. Association of American Medical Colleges (AAMC). "A Growing Psychiatrist Shortage and an Enormous Demand for Mental Health Services," 2022. Nearly 60% of patients who receive mental health treatment do so from their PCP. Over 150 million Americans live in federally designated mental health professional shortage areas.
17. American Academy of Family Physicians (AAFP). "Mental and Behavioral Health Care Services by Family Physicians," Position Paper, 2021. 40% of office visits for mental health concerns occur in primary care offices. 47% of prescriptions for any mental illness are written by PCPs.
18. HRSA Bureau of Health Workforce. "Behavioral Health Workforce Brief," 2023. Projected shortages across psychiatrists, psychologists, counselors, and marriage and family therapists. 45% of rural counties had no practicing psychologists in 2021.
19. Steinberg Institute. "Fact Sheet: How Primary Care Providers Can Help Solve Our Psychiatrist Shortage," 2017. 55% of US counties had zero psychiatrists. 77% of counties reported a severe shortage.
20. Sinsky CA, Shanafelt TD, Ristow AM, et al. "Health Care Expenditures Attributable to Primary Care Physician Overall and Burnout-Related Turnover: A Cross-sectional Analysis." Mayo Clinic Proceedings, 2022. Burnout-related PCP turnover costs $260 million per year in excess health care expenditures, and combined with the $4.6 billion in organizational turnover costs, totals nearly $5 billion annually.
21. American Medical Association. Medical billing error analysis, 2018. Billing errors result in an average loss of approximately 7% of a physician's total annual revenue due to inaccurate coding, undercoding, duplicate billing, and unbundling of services.
22. NCSBN. 2024 National Nursing Workforce Study, 800,000 nurses surveyed. 138,000+ nurses left the workforce since 2022. 41.5% cited stress and burnout as the root cause. 39.9% of RNs reported intent to leave or retire within five years.
23. Brinkman JE, Roehl TD, et al. "The Fermi Problem: Estimation of Potential Billing Losses Due to Undercoding of Florida Medicare Data." Exploratory Research in Clinical and Social Pharmacy, PMC, 2023. 33-45% of outpatient visits estimated to be undercoded. 8.9% undercoding rate consistent with CMS CERT findings.
24. AMA STEPS Forward. Cost of Physician Burnout Calculator. Replacing a physician costs $500,000 to over $1 million depending on specialty. At Mayo Clinic, payroll analysis of 2,500 physicians found 30-50% greater likelihood of reduced professional output in the two years following increased burnout.
25. Cross Country Healthcare / Florida Atlantic University. "Beyond the Bedside: The State of Nursing in 2025," 2,600 respondents. 65% of nurses report stress and burnout as the top workplace challenge.
26. AMN Healthcare. 2025 Survey of Registered Nurses, 12,171 respondents. 58% of nurses report feeling burned out most days. Only 39% plan to remain in their current position in 12 months.
27. Li LZ, et al. "Nurse Burnout and Patient Safety, Satisfaction, and Quality of Care: A Systematic Review and Meta-Analysis." JAMA Network Open, 2024. 85 studies, 288,581 nurses. Nurse burnout associated with more nosocomial infections, medication errors, patient falls, adverse events, and lower patient satisfaction.
28. CMS Comprehensive Error Rate Testing (CERT) Program. 63.4% of improper payments associated with E/M code 99214 were due to incorrect coding, totaling $564 million in errors.