When UCI Health in Orange, Calif., bought four Southern California hospitals from Tenet Healthcare in 2024, it already knew what would happen to their EHR. President and CEO Chad Lefteris told Becker’s the hospitals would move off Cerner.
“[The hospitals] are on a different EMR than UCI Health is, so we already have plans in place to update them to our Epic system,” Mr. Lefteris said.
That sequence, in which Epic arrives once a nonprofit takes over, reflects a broader split in the EHR market. Most of the country’s largest health systems use Epic, which held 43.7% of the acute care hospital EHR market in 2025, according to KLAS Research. Big for-profit systems are the notable exception.
When Becker’s compiled a list of the largest health systems not on Epic in October, the most prominent names were for-profit operators. Nashville, Tenn.-based HCA Healthcare is moving its roughly 190 hospitals to Meditech. Dallas-based Tenet and King of Prussia, Pa.-based Universal Health Services run Oracle Health. Franklin, Tenn.-based Community Health Systems uses Oracle Health, Athenahealth and Medhost, and Brentwood, Tenn.-based Lifepoint Health runs a wide mix of EHRs. HCA, Tenet, CHS, UHS and Lifepoint declined or did not respond to Becker’s requests for comment.
There are exceptions. Brentwood, Tenn.-based Ardent Health is rolling out Epic, and Ontario, Calif.-based Prime Healthcare planned to convert nine Illinois hospitals it agreed to buy from St. Louis-based Ascension in 2024 to its own version of Epic.
The biggest difference may be geography. Much of Epic’s pull comes from physicians who practice at several hospitals in the same market and don’t want to learn a new system at each one. Mark Gilliam, CIO of Louisville, Ky.-based ScionHealth, a for-profit that also runs multiple EHRs, said that pressure is real for hospitals competing to recruit and credential physicians.
“The last thing you want a physician to do is have to use four different systems depending on where they provide their [services],” Mr. Gilliam told Becker’s. “So some of that comes into play. I’m not saying it’s major, but you can’t ignore it. So it depends on the market you’re in.”
Many large nonprofit systems tend to be concentrated in one region, where those physician networks overlap. The big for-profit chains are spread across dozens of states. Al Smith, Lifepoint’s CIO at the time, described what that means for interoperability in September 2022.
“Because we’re in so many different states, I don’t have to be super interoperable,” Mr. Smith said. “There are not a lot of patient referral patterns from Idaho to South Carolina for a small community hospital.”
How the chains are built adds to the patchwork. For-profits grow and shrink through acquisitions, divestitures and spinoffs, and each deal brings in hospitals running whatever EHR they already had. Lifepoint was spun off from HCA, Quorum Health from CHS, and ScionHealth was formed in 2021 from Lifepoint community hospitals and Kindred Healthcare’s long-term acute care hospitals.
“Really the strategy here, or the landscape here, is result of how Scion became as a company, which was through the acquisition of Kindred Health and the spinoff from Lifepoint,” Mr. Gilliam said.
ScionHealth’s community hospitals run two versions of Meditech, Medhost and Oracle Health, and its long-term acute care hospitals use a legacy Kindred system. Even if the company consolidates, Mr. Gilliam said one EHR wouldn’t fit both: A system built for community hospitals would be overkill for long-term acute care, and one built for long-term acute care wouldn’t be sophisticated enough for community hospitals.
“So we’ll probably have to, if we go down that path, it would probably be two different flavors. At least we’d have two instead of five,” he said.
Then there is the price. Large nonprofit systems have disclosed Epic installs costing $800 million at Livonia, Mich.-based Trinity Health and Renton, Wash.-based Providence, $1.2 billion at New Hyde Park, N.Y.-based Northwell Health and $1.5 billion at Rochester, Minn.-based Mayo Clinic. When Becker’s asked the largest systems about their EHR costs in December 2024, HCA declined, and Tenet, CHS and UHS did not respond.
“I can’t fathom how you make the financials with some of the numbers you see for some of these play out,” Mr. Gilliam said.
Some for-profits have instead deepened long vendor relationships. HCA, which has worked with Meditech for more than 30 years, took 43 hospitals live on Meditech Expanse early this year and added 34 more in September. Jake O’Shea, MD, HCA’s vice president and chief health information officer, framed the decision in February.
“Expanse allows us to modernize our EHR environment while building on a deep strategic partnership with Meditech,” Dr. O’Shea said.
UHS has used Oracle Health, formerly Cerner, as its primary EHR since 2009. CIO Eric Goodwin explained in February 2024 why it had not followed other large systems to Epic.
“UHS’ view is that success with the EHR is driven by how the systems are tailored and adopted within the hospitals,” Mr. Goodwin said.
ScionHealth is still weighing whether to consolidate its own systems.
“I think you just got to be judicious in how you look at it. It’s not one size fits all,” Mr. Gilliam said.
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