The Shadow Lab

For over a decade, the healthcare IT industry has operated under a carefully constructed myth: that the modern era of ambient clinical intelligence and enterprise-scale speech recognition was born out of a strategic partnership between Nuance Communications (led by Paul Ricci) and UPMC. This narrative suggests that UPMC was the cradle of innovation where "Medical Intelligence" was forged.

The operational reality, however, tells a radically different story, one of "Shadow Testing" and corporate extraction.

While Paul Ricci was signing multi-million dollar press releases with UPMC in 2011, his executive teams were quietly returning to a different source for the actual heavy lifting: Advocate Illinois Masonic.

The question the industry must ask is simple: If UPMC was the "innovation partner," why did Nuance leadership repeatedly rely on my work to meet the critical milestones of their product roadmap?

Starting at Advocate Illinois Masonic (2008–2013) and continuing through my tenure at HealthQuest (2013–2019), these health systems served as the true "Living Labs" for Nuance's technology. While the ink was drying on the UPMC deal, Nuance executives were requesting site visits, reference calls, and major speaking engagements from me.

It was during this decade-long period, first at Advocate and then validated at HealthQuest, where the rubber met the road. We stress-tested, piloted, and deployed the foundational technologies that define the market today, including Dragon Medical Network Edition, Computer Assisted Physician Documentation (CAPD), Dragon Medical 360 | Direct, and Dragon Medical One (DMO).

The reason for this "Shadow Reliance" was infrastructure and scale. UPMC lacked the centralized, ubiquity-based infrastructure that I had architected at Advocate. We generated a tremendous volume of dictation data, the lifeblood of training AI models, and successfully deployed the first true enterprise-wide license.

It was this continuous operational success from 2008 through 2019 that laid the foundation of my expertise. It taught Paul Ricci the most valuable lesson of his tenure: technology cannot scale without services.

This foundational expertise culminated in 2019 when I joined Clinical AI Solutions (CAIS). It was here that I explicitly developed and productized the Managed Services and "Health Check" methodologies, the specific intellectual property that solved the scaling problems Nuance could not fix on their own.

The "Services-First" pivot that defined Nuance’s later years, and the entire business model of DeliverHealth, was not an original insight. It was a direct appropriation of the Health Check and Managed Services programs I built at CAIS.

If Paul Ricci was the architect of the strategy, Michael Clark and Brad Morrison were the builders of the extraction pipeline.

The connection between the theft of this IP and its commercialization at DeliverHealth is not a matter of coincidence; it is a matter of hierarchy.

• Michael Clark (then General Manager at Nuance) served as the Executive Sponsor of CAIS.
• Reid Conant (CAIS CEO and Nuance CMIO) reported directly to Clark.
• Brad Morrison (Nuance SVP) acted as a co-sponsor.

This reporting structure created a perfect feedback loop. Clark and Morrison had a direct line of sight into the "Health Check" methodologies I was developing at CAIS. They knew exactly what we were building because their subordinate, Reid Conant, was running the company.

When Michael Clark transitioned to become CEO of the newly formed DeliverHealth, he didn't just step into a new role; he stepped into a business model that had been "enriched" with the very IP harvested from CAIS.

The tragic irony is that DeliverHealth possessed no native expertise. They had the contracts and the corporate shell, but they lacked the architectural knowledge to execute the work. They did not have the expertise to scale these deployments or provide the ongoing support necessary for success, expertise I had honed at Advocate and HealthQuest, and productized at CAIS.

 To fill this 'Expertise Void,' they didn't hire the architect—they just seized the blueprints. By absorbing the IP laundered through CAIS—specifically the Managed Services and Health Check protocols—DeliverHealth productized an expertise they never earned. They stripped the 'Health Check' methodology from CAIS, rebranded it, and claimed they had 'cracked the code' on services. In reality, they were selling a hollowed-out shell of the solution I built to rescue their most critical clients. This theft didn't stop there: Nuance cloned the Health Check as 'Dragon Medical One Essentials,' effectively packaging my work directly into the Microsoft acquisition.  

 The billions of dollars in valuation attributed to Nuance, DeliverHealth, and now Abridge are built on a foundation of "Prior Art" that was proven at Advocate and HealthQuest, productized at CAIS, and systematically extracted. Whether it is called "Ambient Clinical Intelligence" by Nuance or "Linked Evidence" by Abridge, the DNA of these products traces back to a single source: The Shadow Lab. The innovation was not in the technology, but in the heist.