BastionGPT vs Microsoft Copilot: Healthcare AI Comparison for 2026

Built for clinical work, not adapted to it

Microsoft 365 Copilot is a general productivity assistant. It drafts documents in Word, builds formulas in Excel, and summarizes meetings in Teams. It ships with no clinical note templates, no medical scribe, and no healthcare-specific workflows; Microsoft's healthcare documentation products live in a separate division under the Dragon Copilot brand.

BastionGPT was developed by healthcare and cybersecurity professionals for clinical documentation. It produces SOAP, Detailed SOAP, DAP, BIRP, H&P, and progress notes, drafts referral letters, insurance appeal letters, treatment plans, and patient education materials, reviews documentation for incorrect names, pronouns, vague language, and suspected under- or over-coding, and analyzes lab summaries and spreadsheets. BastionGPT achieved 99.3% sentence-level accuracy on clinical documentation tasks from a peer-reviewed study by Baylor College of Medicine and Texas Children's Hospital researchers. Microsoft has published no comparable clinical accuracy study for Microsoft 365 Copilot, and an independent 2025 academic study of a Microsoft 365 Copilot workplace trial reported mixed experiences after initial enthusiasm, including unmet expectations around deeper contextual understanding and workflow integration.

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A medical scribe is included, not a separate product

This is a wide gap between the two platforms. Microsoft 365 Copilot has no medical scribe. Copilot in Teams can recap a Teams meeting, and that is a different job from documenting an in-person patient visit as a structured clinical note. Microsoft's actual scribe, Dragon Copilot, is a separate product with separate licensing, sold through Microsoft representatives and Cloud Solution Provider partners on 12-month terms. Microsoft does not publish Dragon Copilot pricing; independent analyses in 2026 place per-provider licenses at $369 to $830+ per provider per month, and Microsoft's own licensing guidance meters AI-assisted sessions on its Flex and pay-as-you-go models.

BastionGPT includes an unlimited AI Scribe on every plan, starting at $20 per user per month. It transcribes live audio or uploaded recordings for sessions up to 240 minutes, recognizes up to 10 speakers, and automatically labels each speaker's name and role (for example, clinician, patient, or parent) in the transcript. Group therapy, family sessions, and care conferences produce a transcript that reads like a script, and the resulting notes attribute statements to the right person.

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Price

Microsoft 365 Copilot is an add-on, so the sticker price is only part of the cost. The enterprise add-on runs $30 per user per month on an annual term; Microsoft 365 Copilot Business, for organizations under 300 users, runs $21 per user per month ($18 under promotional pricing in 2026). Either way, a qualifying Microsoft 365 base license is required, from Business Standard at $14 per user per month to E5 at $57. Independent licensing analyses put the true all-in cost at roughly $35 to $87 per user per month, and none of that includes clinical scribing.

BastionGPT Professional starts at $20 per user per month, standalone. Professional Plus at $45 adds the full document analysis suite: 10+ simultaneous documents, image and spreadsheet reading, and manual model selection. No base license, no add-on stack, and annual billing includes a free month.

The math for a five-clinician practice that needs both an assistant and a scribe: the Microsoft stack (Business Standard at $14, Copilot Business at $21, and Dragon Copilot at the $369 low end of independently reported pricing) runs about $404 per provider per month, or roughly $24,200 per year. BastionGPT Professional Plus covers both jobs at $45 per provider per month, or $2,700 per year. That is a difference of more than $21,000 per year for a five-clinician practice, before Dragon Copilot implementation fees.

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Compliance that holds from the first prompt

Microsoft supports HIPAA compliance for Microsoft 365 Copilot "for properly configured implementations," and its documentation is explicit about the boundary: HIPAA compliance does not apply to Copilot's web search queries, because web queries sent to Bing are not covered by the Data Protection Addendum or the BAA. Copilot can invoke web search while answering a prompt, so healthcare deployment guides recommend disabling web search tenant-wide, applying sensitivity labels, scoping Graph access, and enabling audit logging before clinicians touch it. Consumer Copilot surfaces (the free copilot.microsoft.com, the personal mobile app) sit entirely outside the BAA, and Microsoft notes that Anthropic models are currently excluded from the EU Data Boundary.

BastionGPT enters a signed Business Associate Agreement with every customer on every plan, including the free trial, and supports HIPAA, 42 CFR Part 2, FERPA, PIPEDA, PHIPA, and Australian APP requirements out of the box, with no configuration project. Data is encrypted with AES-256 at rest and TLS in transit, runs on HITRUST CSF certified and SOC 2 Type II attested Microsoft Azure infrastructure, is independently penetration tested at least annually, and chats and transcripts are wiped after 30 days by default. In three years serving more than 10,000 healthcare organizations, BastionGPT has had zero breaches of protected health information.

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Document analysis depth

On Professional Plus and Ultra plans, BastionGPT reads 10+ documents at once, up to 1,000+ pages of combined context. Supported formats include PDF, Word, Excel, CSV, PowerPoint, HTML, plain text, and JPG or PNG images, including scanned PDFs, charts, and graphs. A clinician can upload a full patient history, a psychological evaluation, and records from multiple providers, then query, summarize, and cross-reference all of it in one conversation.

Microsoft 365 Copilot handles file uploads, and its limits shift by app, license, and tenant configuration. The clearest numbers Microsoft publishes sit in Copilot Notebooks: licensed Microsoft 365 Copilot users can add more than 300 references to a notebook, with the first 300 used to ground responses, while Copilot Chat users can add up to 50. For chat uploads, Microsoft publishes no page capacity, its support guidance recommends shorter documents for best results, and users on Microsoft's own Q&A forums report per-day file caps and document-length constraints that vary between tenants. For a practice whose core task is reviewing long records, that variability is the difference between one conversation and a manual splitting exercise.

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Deployment without an IT project

Deploying Microsoft 365 Copilot for healthcare means an eligible Microsoft 365 tenant, add-on licenses, a permissions audit (Copilot surfaces anything a user technically has access to), sensitivity labels, disabled web search, and audit configuration. Microsoft sells governance tooling under its Copilot Control System banner to address oversharing and insider risk, which signals how much of the rollout work sits with the customer. Microsoft's guidance and independent HIPAA deployment guides describe this as a governance program, and small practices rarely have a compliance engineer on staff.

BastionGPT deploys in minutes from a browser. It works alongside 50+ EMR/EHR systems (Epic, Oracle Health, Athenahealth, eClinicalWorks) through copy-paste and document uploads, requires no Microsoft licensing prerequisites, and includes human support by email, chat, phone, and video on every plan. A Saved Prompts library with folder organization and team sharing lets a practice standardize documentation across providers from day one.

BastionGPT assists with documentation and analysis. Clinicians review and approve all AI-generated output; it does not replace professional judgment.

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