EHRs are among the largest investments health systems will ever make, with some reaching into the billions — and, in one case, tens of billions — of dollars.
Here are the priciest EHR installations on record, according to Becker’s reporting and other publicly available sources detailing projects that cost $500 million or more (this list contains ties):
1. U.S. Department of Veterans Affairs (Washington, D.C.): About $37 billion (Oracle Health). A revised lifecycle cost estimate given to lawmakers in December 2025 put the modernization at roughly $37 billion, up from the original $16 billion contract signed with Cerner (now Oracle Health) in 2018. After a three-year pause over safety and usability concerns, the VA resumed deployments in April 2026 at four Michigan sites, with about 13 facilities expected to be live by the end of the year and full rollout to all of its medical centers targeted as soon as 2031.
2. Military Health System (Washington, D.C.): $5.5 billion (Oracle Health). The Defense Department’s Oracle Health-based MHS Genesis system has been deployed across military hospitals and clinics in the U.S. and overseas as part of an effort to unify medical and dental records with the VA’s system.
3. Kaiser Permanente (Oakland, Calif.): $4 billion (Epic). The integrated system’s Epic-based HealthConnect platform links records across its hospitals, medical groups and health plan, serving nearly 13 million members.
4 (tie). Catholic Health Initiatives (Englewood, Colo.): $1.5 billion (Cerner and Meditech). The Catholic system planned to invest the figure in EHRs and other IT systems between 2010 and 2015, using Cerner in its larger markets and Meditech in smaller ones, ahead of CHI’s 2019 merger with Dignity Health to form Chicago-based CommonSpirit Health.
4 (tie). Mayo Clinic (Rochester, Minn.): $1.5 billion (Epic). The system’s multiyear Epic rollout unified records across its Minnesota, Arizona and Florida campuses along with its community hospital network.
6 (tie). Mass General Brigham (Somerville, Mass.): $1.2 billion (Epic). The system’s Epic build, launched under its former name, Partners HealthCare, unified records across its hospitals and physician network.
6 (tie). Northwell Health (New Hyde Park, N.Y.): $1.2 billion (Epic). New York’s largest health system is in the midst of a phased, region-by-region Epic migration meant to unify more than 30 legacy EHRs across its 28 hospitals. Its first major go-live wave covered the Western region in November 2025, with more waves to follow.
8 (tie). Dignity Health (San Francisco): $1 billion (Cerner and Meditech). The system, then known as Catholic Healthcare West, raised its EHR investment to $1 billion as it expanded its rollout across its hospitals before rebranding as Dignity Health and later merging with CHI to form CommonSpirit Health.
8 (tie). NYC Health + Hospitals (New York City): $1 billion (Epic). The public safety-net system’s Epic rollout unified records across its network of hospitals, post-acute facilities and community clinics.
8 (tie). Sutter Health (Sacramento, Calif.): $1 billion (Epic). The system’s Epic implementation, which drew scrutiny after high-profile outages, has since been completed across its Northern California hospitals and medical groups.
11. NewYork-Presbyterian (New York City): $964 million (Epic). The cost figure, cited in a Fitch Ratings credit analysis, covers the system’s Epic build across its hospital campuses and physician network.
12 (tie). Providence (Renton, Wash.): $800 million (Epic). The system completed an Epic rollout across its hospitals spanning Washington, Oregon, California, Montana, New Mexico, Alaska and Texas.
12 (tie). Trinity Health (Livonia, Mich.): $800 million (Epic). The 92-hospital Catholic system is nearing completion of its enterprise Epic rollout and expects to become the largest single-instance Epic user in the country.
14 (tie). Duke University Health System (Durham, N.C.): $700 million (Epic). The system’s Epic implementation unified records across its three hospitals and physician network.
14 (tie). UMass Memorial Health (Worcester, Mass.): $700 million (Epic). The system’s CFO described the figure as a full total-cost-of-ownership estimate spanning a decadelong commitment that began in 2017. UMass Memorial has since reached Epic’s Gold Stars Level 10 recognition, putting it in the top 4% of Epic users nationally.
16. AdventHealth (Altamonte Springs, Fla.): $660 million (Epic). The system completed a systemwide Epic rollout across its hospitals in nine states.
17. Memorial Hermann Health System (Houston): $500 million (Epic). The system’s Epic overhaul consolidated records across its hospital network in the greater Houston area.
NOTE: This is not an exhaustive list. If you know of other EHR projects to include, please email gbruce@beckershealthcare.com.
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