An EHR transition is one of the most expensive projects a health system takes on, and the costs rarely stop at the purchase price. Training, temporary cuts to clinic volumes and revenue cycle disruption can drag on operating results for quarters after go-live, and systems that inherit another organization’s records platform can pay twice: once to run the old system and again to replace it.
Here are nine health systems that have cited EHR installations or transitions as a factor in operating losses, credit rating downgrades or cash strain, as reported by Becker’s:
1. ACMC Healthcare System (Ashtabula, Ohio): Fitch Ratings downgraded ACMC Healthcare System to “BBB” from “BBB+,” citing a substantial deterioration in liquidity. The system faced revenue cycle disruptions from both the Change Healthcare cyberattack and an Epic installation, which resulted in negative operating cash flow in 2024 and 2025.
2. Kaleida Health (Buffalo, N.Y.): Kaleida Health’s transition to Epic cost $170 million and contributed to a $21.1 million operating deficit in the second quarter of 2026, a spokesperson confirmed to Becker’s. The May 30 systemwide go-live included $24.5 million in one-time operating expenses through June tied to equipment, staff and provider training, and a temporary reduction in some outpatient services. The $170 million figure does not include Erie County Medical Center Corp. or UBMD, which are set to go live on Epic this fall. Kaleida expects to post a positive operating margin by year’s end.
3. Memorial Sloan Kettering Cancer Center (New York City): Memorial Sloan Kettering posted a $47.9 million operating loss in 2025, down from $202.2 million in operating income in 2024. The cancer center said $177 million of its operating expense growth was associated with Epic go-live support and training following its Feb. 1, 2025, launch; excluding Epic-related costs, expenses grew 6.6% year over year instead of 8%. MSK had reported a $113.2 million operating loss for the first half of 2025.
4. Brown University Health (Providence, R.I.): CEO John Fernandez told The Boston Globe that Brown University Health spent tens of millions of dollars wrestling with former owner Steward Health Care’s EHR at Morton Hospital in Taunton, Mass., and Saint Anne’s Hospital in Fall River, Mass., while transitioning the two hospitals to a new system. Brown Health acquired both hospitals from Steward in 2024.
5. Boston Medical Center Health System: Boston Medical Center Health System relied on Steward’s EHR for about six months after taking over St. Elizabeth’s Medical Center in Brighton, Mass., and Good Samaritan Medical Center in Brockton, Mass., in October 2024, CEO Alastair Bell told The Boston Globe. The system struggled to collect payments while on Steward’s platform. Massachusetts has provided financial support tied to the transition, including $80 million dedicated to a new EHR, the Globe reported.
6. Merrimack Health (Lawrence, Mass.): At the former Holy Family Hospital campuses in Methuen and Haverhill, Mass., Merrimack Health CEO Diana Richardson told The Boston Globe the organization was “hemorrhaging cash” while trying to operate Steward’s systems and make critical upgrades.
7. Regional West Health Services (Scottsbluff, Neb.): Regional West Health Services has tied financial trouble to two EHRs. Fitch downgraded the system two notches to “BB-” in 2023, citing ongoing cost pressures and problems associated with its Oracle Health EHR implementation, and management attributed its 2022 losses mainly to ongoing issues with the system. Regional West later settled with Oracle for $6 million, down from Oracle’s initial $15 million demand, and moved to Epic. In December 2025, Fitch downgraded Regional West to “CCC” from “B-,” citing persistent operating challenges that led to negative cash flow in fiscal 2025.
8. Veterans Memorial Hospital (Waukon, Iowa): Veterans Memorial Hospital posted a $430,135 loss in July 2025 after going live on Epic.
9. University Hospitals (Cleveland): University Hospitals reported a $256 million operating deficit in 2023, and its Epic and MyChart implementation alone cost $179 million. The system has since recovered, posting $191.8 million in operating income (2.6% margin) in 2025, up from a $172.6 million operating loss in 2024. Its 2025 revenue included $182 million from the sale of about 50 outpatient laboratories to Quest Diagnostics.
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
