An Ode to PowerScribe 360
Disclosure: I co-founded Montage Healthcare Solutions, which Nuance acquired in 2016, where I became CMIO. I later co-founded Equium Intelligence, which Rad AI acquired in 2022; there, John Paulett and I built what became Rad AI Reporting. I remain a Rad AI shareholder. I now build Presto at HOPPR. I have opinions and conflicts. And I present this to you with extreme prejudice.
I took my first overnight call with Talk Tech. I signed my first report as an attending with Commissure RadWhere. Yesterday, I signed over 80 CT reports with PowerScribe 360.
My entire career as a radiologist has been on a single person's products. I didn't realize it until I wrote that first paragraph.
Michael Mardini founded Talk Technology in 1993, sold it to Agfa, then started Commissure and built RadWhere. Nuance acquired Commissure in 2007, and RadWhere became the foundation of PowerScribe 360. Talk Tech, RadWhere, PS360: all him. What a legend.
PS360 went on to become the reporting platform behind roughly three-quarters of all radiology studies in the U.S. Hundreds of millions of reports are signed with it every year. One of the most successful clinical software products ever built.
And soon it will be end of life.
Microsoft, which acquired Nuance for $19.7 billion in 2022, sent end-of-life letters to customers in late February 2026. Renewal and maintenance end August 31, 2026. Full support ceases in 2027.
What PS360 Got Right
Everyone complains about PS360. I complain about PS360. The startup time. The random crashes. The interface that hasn't changed in a decade and a half.
But here's what doesn't get said enough: it works.
Every day, across thousands of hospitals and imaging centers, radiologists open PowerScribe, dictate their findings, and sign reports that drive patient care. For nearly two decades, through acquisitions and corporate transitions and an entire pandemic, 360 was there getting the job done.
That reliability is what makes it the default. Nuance had one hell of a sales team, but what keeps PS360 on every workstation is simpler than that. When you sit down at 6 AM to start reading, it's there, and it works. That's a higher bar than most software ever clears.
The Forced Migration
The end-of-life announcement changes everything for radiology groups that have spent nearly two decades building workflows, templates, macros, and muscle memory around PS360.
This isn't a voluntary upgrade. This is a forced migration with a deadline.
The natural path is PowerScribe One, which Microsoft has been trying to roll out since 2019. For large institutions with existing Microsoft contracts, it will be the obvious choice. The rollout was rough for a long time. Stability, pricing, and performance were friction points for years, and many practices resisted the transition. To their credit, the team has hit their stride over the last year or so. But the PS360 end-of-life still removes the option to wait and see.
The Landscape Has Changed
What's different about this migration is that radiology groups aren't choosing between PowerScribe and nothing. The field looks completely different than it did five years ago.
Jacobian (the merger of Fluency and Smart Reporting) has been ranked #1 in KLAS for speech recognition in front-end imaging for five years running. They're the safe, proven alternative, and for a lot of groups, that matters more than anything.
Radiology Partners built Mosaic Clinical Technologies, acquired Cognita Imaging for its vision-language models, and partnered with RadPair for generative AI reporting. Cognita's chest X-ray VLM got FDA Breakthrough Device Designation in March 2026. The draft reporting work they've published is real. But RP has 4,000 radiologists and 55 million annual studies of its own. Mosaic is built for that captive audience first.
Sirona Medical and New Lantern represent a new generation of all-in-one platforms that combine PACS, viewer, worklist, and reporting into a single cloud-native system. Sirona raised $42 million and their CPO, Kate Kovalenko, came from the Nuance PowerScribe team. She knows where the bodies are buried. New Lantern's AI drafts reports that learn each radiologist's dictation style. Both are betting that the future of radiology IT isn't stitching together best-of-breed tools, it's replacing the whole stack.
Rad AI Reporting? You already read the disclosure. John Paulett and I built it after Rad AI acquired our company in 2022. It won AuntMinnie's Best New Radiology Software in 2023, and no, I will never stop mentioning that.
And there are others. For the first time in a long time, the reporting platform market is actually competitive. That's good for radiologists.
The Bigger Question
Every radiology group in the country is about to spend significant time, money, and political capital choosing a new reporting platform. That decision will consume IT departments, practice managers, and radiologist champions for the next twelve to eighteen months.
But the reporting platform is not the only decision that matters. It may not even be the most important one.
The question isn't just "which platform do I migrate to?" It's "how do I bring AI into my reporting workflow?"
A reporting platform is infrastructure. It's where your voice becomes text and your text becomes a signed report. That matters. But the AI layer is what will determine whether your radiologists are more productive in 2027 than they are today.
And that layer doesn't have to come from your reporting platform vendor.
What I'm Building
People ask me what Presto is. Is it another reporting solution?
No.
We are not building another reporting platform. We are building a way to bring AI into all reporting platforms.
Commissure's philosophy twenty years ago was to "embrace — not replace — existing products." That idea shaped how I think about this problem. The reporting platform you choose matters. But the AI that makes your radiologists more productive shouldn't be locked to one vendor's ecosystem.
The migration from PowerScribe 360 is a moment to rethink everything. Not just which vendor gets your reporting contract, but how AI fits into the workflow you're building for the next decade.
Whatever platform you choose, PowerScribe One, Jacobian, Sirona, Rad AI (hint hint!!), or something else entirely, the question of how AI reaches your radiologists is worth answering separately. That's what we're building at HOPPR with Presto.
The end of PowerScribe 360 is the end of an era. For radiology reporting, the next one has already started.
William Boonn, MD is a cardiovascular radiologist at Penn Medicine and Chief Medical Officer at HOPPR, where he co-created Presto with John Paulett, Woojin Kim, MD, and Brandon Smith.