The leaders of the two largest hospital EHR vendors agree that AI will remake the medical record. Where they part ways is on what that AI should be built from, who should own the data underneath it and how health systems should pay for it.
Epic, led by founder and CEO Judy Faulkner, is building AI on top of assets it already controls: the EHR with the largest share of the U.S. hospital market and Cosmos, a research database that now holds data from 320 million deidentified patients across 23 billion encounters. Oracle, where co-founder Larry Ellison serves as executive chair and chief technology officer, is rebuilding Oracle Health’s EHR around AI on new cloud infrastructure, separate from the legacy Cerner platform.
Ms. Faulkner introduced her company’s framing for the technology at Epic’s August 2025 Users Group Meeting.
“We are combining the intelligence and curiosity of the human being with the investigative capabilities of gen AI,” she said. “And instead of calling it artificial intelligence, we’re calling it healthcare intelligence.”
At the 2026 meeting in August, Epic rolled out that concept under the name Ergo, and most of the new clinical tools drew on Cosmos. A “lookalikes” feature that checks whether a patient’s case is unusual by comparing it against similar cases was used 25,000 times in the past year. A forthcoming predictive tool called Curiosity learns directly from patient charts in Cosmos rather than from published studies, and it will be available to organizations that contribute data to the database.
Oracle’s new EHR launched for U.S. ambulatory providers in August 2025, built on Oracle Cloud Infrastructure with voice commands and AI agents, and with acute care capabilities slated to follow. Oracle layers outside large language models on top of its own software, as Mr. Ellison laid out in a June 2025 earnings call.
“We use the most modern application generators and AI database technology to build our application suite,” he said. “And then we add AI and analytics using OpenAI, xAI, Google, Llama and other popular LLMs on top of that application data. No other company is even attempting to build the depth and breadth of AI-based applications that we have already built.”
On documentation, the two companies have landed in similar places. Epic’s native AI charting tool, Chart with Art, now generates visit notes automatically, and Art-generated summaries are in use at more than 300 healthcare organizations. Oracle expanded its Clinical AI Agent in August 2026 with automated professional fee coding, AI-powered chart review and clinician-controlled dictation, then added a version for nurses in September.
Mr. Ellison framed the goal at Oracle’s Health and Life Sciences Summit on Sept. 23.
“We shouldn’t have doctors sitting behind keyboards typing in and updating their electronic health records,” he said.
Ms. Faulkner’s public comments have centered less on the keyboard than on the clinician’s judgment. In a June 23 interview at Aspen Ideas: Health, Jon LaPook, MD, of CBS News asked her what it will mean to be a clinician in five years, pointing to research suggesting AI can already outperform physicians at diagnosis.
“What we hear people say is that the physician plus the AI is better than either of them alone,” Ms. Faulkner said.
She later described a night when her Tesla, driving on autopilot, slowed for a police car she had not seen in the dark.
“I thought that’s going to be what happens with the doctors and the AI,” she said. “The AI will figure things out that the doctor would not have been aware of, like with sepsis … and that will help the doctor.”
The split is sharpest on the data itself. Cosmos is pooled from Epic customers, and its value grows with Epic’s footprint. Oracle has built its next-generation patient portal to consolidate a patient’s history regardless of how many EHRs, hospitals or providers contributed to it.
“That record doesn’t belong to the hospital, that record belongs to the patient, and the patient needs a full longitudinal record, regardless of whether it’s in Epic format or in a Cerner format or an Allscripts format,” Mr. Ellison said at the September summit.
The vendors also diverge on how AI is priced. At its 2025 meeting, Epic introduced an AI suite to go along with its pay-as-you-go model. A year earlier, in a September 2024 earnings call, an analyst asked Mr. Ellison how generative AI app developers can monetize the software.
“And I hear a bunch of applications companies say, ‘Oh, we’ve now got AI agents. We’ll charge for it separately.’ Our applications are going to be primarily AI applications — everything,” he said. “How do you charge separately for everything? I find it bewildering when I listen to them talk. I don’t understand what they’re saying.”
So far, the market has not moved toward Oracle. Epic held 43.7% of the acute care hospital EHR market at the end of 2025, compared with 21.9% for Oracle Health, according to KLAS Research data reported by Becker’s. About 30% of sampled Oracle Health customers told KLAS the platform is not part of their long-term plans, and KLAS described 2026 as a pivotal year for the vendor as it rolls out its AI-enabled EHR. Oracle has said it expects Oracle Health to post double-digit revenue growth in fiscal 2027, fueled by an AI-driven modernization of the Cerner platform.
Epic, for its part, pointed to its track record. Of 167 projects mentioned at its 2025 meeting, 84 were completed on time, seven were completed or nearly completed, and 76 were in progress and on track, Ms. Faulkner said.
“What you hear here is very likely to happen,” she said.
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