Health systems delay EHR purchases amid uncertainty, rising AI investment

Health systems pulled back on acute care EHR purchasing in 2025 as organizations became more selective about large-scale replacement decisions, according to the US Acute Care EHR Market Share 2026 report from KLAS Research.

The report found the number of hospitals making EHR purchase decisions dropped 40% compared with 2024 and nearly 50% compared with 2023, which KLAS attributed to policy uncertainty and shifting technology priorities. Organizations increasingly favored investments with more immediate financial returns -- including AI and operational efficiency tools -- over large-scale EHR replacement projects. The slowdown was especially pronounced among larger organizations. Only two health systems with more than 10 hospitals made enterprise-wide EHR purchase decisions in 2025. Both selected Epic Systems.

Overall, Epic held 43.7% of the acute care hospital market in 2025, compared with 21.9% for Oracle Health and 14.7% for MEDITECH. While Epic continued to expand its footprint, KLAS said Oracle Health faces mounting pressure to restore customer confidence. The firm said 2026 will be a critical year for Oracle Health as the vendor rolls out its new AI-enabled EHR platform amid continued customer uncertainty.

The uncertainty among Oracle Health customers, results from repeated layoffs, restructures and focus shifts since Oracle acquired Cerner in 2022. KLAS said many Oracle Health customers deferred purchasing decisions while awaiting greater clarity around the vendor's long-term direction and new AI-enabled EHR.

Customer satisfaction with Oracle Health's Millennium EHR platform also continued to decline, according to the report. KLAS found nearly one-third of sampled customers said the platform was not part of their long-term plans, while another third said they might leave or wanted to leave the vendor but could not.

KLAS noted that Oracle Health did not provide new contract data for 2025 decisions. The firm said Oracle Health's data was compiled through internal research methods and publicly available information.

Though overall purchasing slowed,  purchasing activity in 2025 favored Epic. The vendor added a net of 77 hospitals in 2025, while Oracle Health lost a net of 56 hospitals. According to the report, Epic's gains were driven largely by smaller health systems and midsize standalone hospitals. Many of those wins came from organizations leaving Oracle Health.

KLAS said organizations selecting Epic frequently cited the ability to more easily exchange data with regional partners, along with platform standardization and vendor partnership. Epic also continued expanding its reach among smaller standalone hospitals through Community Connect, which allows smaller organizations to align with larger health systems already using Epic. Seven standalone hospitals with fewer than 200 beds selected Community Connect in 2025.

The report further highlighted continued activity among smaller and legacy-focused vendors. Though purchasing of solutions from these vendors by standalone hospitals also slowed, MEDITECH recorded its strongest retention of legacy customers to date. Most (84%) of MEDITECH's legacy customers chose to migrate to the vendor's Expanse platform rather than seek out a different vendor for an upgrade in 2025. MEDITECH maintains the third-largest acute care EHR customer base in the US, with about 45% of those acute care hospitals still using legacy platforms.

According to KLAS, MEDITECH customers and prospective buyers have continued to raise concerns about interoperability and the need for broader platform capabilities that could reduce reliance on third-party tools.

Elizabeth Stricker, BSN, RN, comes from a nursing and healthcare leadership background, and covers health technology and leadership trends for B2B audiences.