How OneCare Vermont is giving rural primary care clinicians their evenings back
How OneCare Vermont is giving rural primary care clinicians their evenings back
Heidi Team
April 6, 2026•11 min read
Preview of outcomes:
77% adoption rate across the OneCare Vermont network
30–40 minutes of documentation time saved per day
Notes arriving at approximately 75% complete before editing
Reduced weekend and off-day catch-up documentation
Improved accuracy for delayed notes
Greater clinician presence during emotionally complex visits
Background
OneCare Vermont is a nonprofit Accountable Care Organization and part of the University of Vermont Health Network. They partner with over 5,000 healthcare providers across the state to improve quality, coordination, and community-based care, with a particular focus on independent practices serving Vermont's most rural communities. Their mission is to improve the health and wellbeing of all Vermonters, especially in the places where access to care is hardest to come by.
Community Health Center of Rutland Region (CHCRR) is one of those places. An FQHC with five offices across the region, CHCRR sits at the intersection of agricultural Vermont and the Dorset-Manchester corridor. The patient panel reflects that: slate quarry workers who walk in after a shift with lacerations needing stitching, uninsured families, Medicare and Medicaid patients, and long-time community members who have been coming to the same clinic for decades.
Dr. Job Larson has been a family medicine physician at CHCRR for three years. He grew up less than two miles from the clinic. After training at UVM and spending eight years as a physician in the Navy, coming back to practice in his hometown was always the plan. It worked out.
Before Heidi
The day didn't end when the clinic closed
Dr. Larson had made a deliberate choice: he didn't type during visits. He wanted to be present with patients, not behind a screen. But that choice had a cost. He would scribble handwritten notes, steal minutes between patients, work through lunch, and then stay two hours after the clinic ended. On weekends too. On his days off.
"I stay late — probably two hours after my clinic ends — and then spend a few hours on either my off day or the weekends to catch up on it. So it never ends."
With 15 to 25 patients per day across a genuinely complex panel, the stakes of delayed documentation were real. Notes written hours after a visit are notes written from memory. And memory is not a reliable system.
Accuracy suffers when documentation is delayed
Dr. Larson used Dragon Dictation to help with the pace of typing. It helped with speed, but it did not solve the underlying problem. When you sit down to chart at 7pm after seeing 25 patients, you are reconstructing conversations from fragments. For a practice where a single visit might cover chronic disease management, a walk-in injury, mental health, and a patient who just lost a family member, that matters.
"Anybody who's in primary care is doing delayed documentation. We all do. And that's a big problem — the accuracy of those notes declines rapidly after about two hours."
The quiet anxiety of not being sure
Dr. Larson was not typing during visits. But he was still carrying something into every room: the low-level worry that he might forget something. A test he promised to order. A follow-up he said he'd schedule. A detail the patient mentioned that would matter at the next visit. He chose presence, but presence came with anxiety.
CHCRR sees between 15 and 25 patients per clinic day across three physicians and three NPs and PAs. Across the broader OneCare network, the picture is larger still: 242 monthly active users, 1.8 million minutes transcribed, over 75,000 sessions, and 88,000 notes and documents generated.
It was CHCRR's Chief Medical Officer who first raised the idea. Dr. Larson happened to be at his desk late when the conversation came up.
"It was one of those nights where it's like, you know, it's 6:30 and here I am writing notes in clinic. I just told him I would be happy to be part of that pilot."
Moving on to Heidi
In September 2025, OneCare Vermont and Heidi Health announced a partnership backed by a $320,000 investment from OneCare's ACO to help independent practices and FQHCs across Vermont adopt AI scribe tools. For clinics like CHCRR, organizational support like this was what made adoption possible.
Dr. Larson joined the pilot and found that Heidi worked around his existing workflow rather than demanding he rebuild it. CHCRR uses Medent, an EMR that does not currently integrate directly with Heidi. As it turned out, that suited him fine.
"It doesn't [integrate] with our EMR. That actually works better for me the way I structure my notes."
His setup is simple. He runs Heidi on his phone. At the start of a visit, if the patient consents, he places his phone on the counter. Nothing else changes. He talks to his patient the same way he always has. After the visit, he stops the recording, reviews the note, copies the relevant sections into the EMR, edits as needed, then deletes the note from Heidi.
For acute, single-issue visits, the assessment and plan comes out clean and largely ready to use. For complex chronic care visits, the transcript becomes a reference: a reliable record of what was discussed, what was promised, and what needs to follow.
"It's very helpful to be able to look back at the transcript and make sure that I'm doing all the things that we talked about at the visit."
He uses one template consistently: a family medicine progress note. It breaks visits into diagnoses, organizes plan components under each one, and handles the multi-complaint nature of primary care without losing the thread.
What Dr. Larson uses Heidi for:
Reviewing transcripts to verify orders and follow-up items discussed during complex visits
Capturing the subjective and objective sections accurately, the part of the note where conversation is longest and memory most fallible
Organizing multi-issue visits by diagnosis with corresponding plan components
Preserving contextual details that would otherwise be lost in delayed documentation
Impact
"It cuts down on maybe 30–40 minutes a day of documentation for me — and it makes it much more accurate, certainly for the subjective portion."
Getting home while it's still light
Dr. Larson has young kids. For a long time, being present at a school event meant rushing out of clinic and carrying the anxiety of unfinished notes behind him. That has changed.
"I'm much more confident leaving and knowing I've got some kind of record where I can go back and make sure I do the things that I said I was going to do."
His eight-year-old daughter noticed before he said anything about it. She came to find him one evening and asked what he was doing home while it was still light out.
Notes that are more accurate, not just faster
The time saving is real. But for Dr. Larson, the more important shift is what happens to note quality when documentation is no longer purely memory-dependent.
He can open a note at the end of the day and find the subjective section already structured, the diagnoses listed accurately, and the plan components organized under each one. What used to be reconstruction is now review.
Full presence when it matters most
One visit captures this well. A patient came in for a routine appointment. She had recently lost her father. The visit went somewhere else entirely. Dr. Larson never touched his computer.
"I was very grateful to not have to even touch my computer that whole encounter — that was not at all what she needed at that point. I really had that freedom to just talk to her and make eye contact and be present with her in the room."
That same quality of presence has been valuable as Dr. Larson absorbs patients from a recently retired local physician who used a paper chart system. These are patients he has never met, with complex histories and records that are difficult to navigate. Being able to listen closely, ask follow-up questions, and trust that an accurate record is being captured has changed how those first visits feel.
"To be able to just be there and listen to them and focus on what they're saying and ask follow-up questions, probing questions to really figure out what their history actually is — and then to have an accurate record of that without having to pay attention to my computer during those visits has been extremely helpful."
An unexpected benefit: peace of mind
The documentation time saved was expected. What surprised Dr. Larson was something quieter.
"I don't know that I was previously forgetting stuff, but I was anxious about it. And now I have that peace of mind — that's a big part of the benefit for me."
Heidi also picks up details he might have let go of in delayed documentation. A patient mentioning that their cat died. A new grandchild. Small things that become meaningful the next time he sees that patient.
"When I see that back in six months, I can address whatever it was."
What's next
As CHCRR continues to absorb patients from retiring community physicians, that kind of historical context could make a real difference to first-visit documentation quality.
The larger opportunity he sees is clinical decision support, using tools like Evidence. A version of Heidi that has access to the same patient data he does, that can flag evidence-based gaps in chronic disease management in real time.
For OneCare Vermont, the Heidi partnership is part of a longer commitment: keeping independent primary care sustainable in one of the most rural states in the country. Vermont lost nearly 2,500 independent physicians between 2019 and 2024. Around 3,300 rural practices shut down in the same period. The pressures are real and ongoing.
With 77% adoption across the network, 1.8 million minutes of clinical conversation transcribed, and clinicians across the state leaving a little earlier than they used to, the foundation is there. The next chapter is about going deeper.
"Having shared some of that same skepticism when I first started using it, I have been really pleasantly surprised by how useful it's been and easy to integrate into my workflow — and I think if anything, it's improved the quality."
"My daughter the other day — she's eight, my youngest — and she was like, 'Dad, what are you doing? It's still light out. What are you doing home?'"
