Only two large health systems — those with more than 10 hospitals — made an enterprisewide EHR purchase decision in 2025, according to KLAS Research. Overall, the number of hospitals affected by a new EHR decision fell 40% compared with 2024 and nearly 50% compared with 2023.
With many big health systems either entrenched with Epic or awaiting further development of Oracle Health’s AI-powered platform, are major EHR transitions becoming a thing of the past?
“Unless a disruptor emerges, I do think the era of major enterprise EHR switches is over,” John Potts, DO, vice president and chief medical information officer of Radnor, Pa.-based Main Line Health, told Becker’s. “Over the years, we’ve all heard rumors or seen YouTube teaser videos about another tech titan getting into the EHR business. Nothing spurs innovation like healthy competition.”
Barring a wave of consolidation or the arrival of a genuine new competitor, EHR purchasing will look less like a hotly competitive market and more like an occasional formality in the years to come, health system IT leaders say.
Russell Cameron, MD, vice president and chief medical information officer of DuBois, Pa.-based Penn Highlands Healthcare, cited the sheer difficulty of converting EHRs.
“I think the pain of transitioning to a new system is substantial,” he said. “So most future transitions will only be because of acquisitions.”
That lines up with what’s actually driving the decisions that are still happening. Financials are increasingly the trigger, according to Jesus Delgado, chief digital and information officer of Concord (N.H.) Hospital Health System.
“There is tremendous economic pressure on hospital systems to reduce the cost of healthcare,” he said. “As a result, the transition to an EHR system that shows tangible value to health systems and demonstrates how the EHR can optimize the delivery of care while optimizing revenue cycle is going to continue to be a priority.”
He added that HR 1 “will add increased financial pressure to hospitals,” pushing systems toward efficiencies “through best-in-class EHR implementations with a greater emphasis on operational efficiency, patient access and supply chain optimization.”
Not everyone is ready to declare the EHR-switching era finished. Curtis Cole, MD, vice president and chief global information officer at Ithaca, N.Y.-based Cornell University, agreed with KLAS’ read on what’s behind the slowdown — government policy uncertainty and competition with AI and analytics for capital — but pushed back on the idea that the market itself has run dry.
“Running out of big health systems to convert is only true in the U.S.,” he said. “There is a much bigger market still to be won outside the U.S., though it would require a fairly radical pivot in functionality more oriented toward care than reimbursement.”
Dr. Cole also cautioned against treating AI as a substitute for what EHRs still get wrong.
“AI pixie dust is not going to fix broken business and clinical processes,” he said. “The bigger problem is that big enterprise systems like EHRs and ERPs have underperformed at fixing core clinical and business processes because they are too reductionistic. Yes, we need to eliminate unnecessary variation. But we also need to promote differences that make a difference — and EHRs are not very good at that. That remains a huge unaddressed market.”
In the long run, Dr. Cole said, AI could reshuffle the EHR-swapping calculus altogether.
“AI is going to lower some switching costs and raise others,” he said. “EHR vendors that don’t improve care and improve efficiency will get replaced when the cost of switching is lower than the cost of not switching. If health systems invest in AI to cover up problems rather than fix them, that day will come sooner than they expect.”
As Epic’s advantage widens — the vendor added 77 hospitals to its acute care base in 2025 and was the only vendor selected in every large enterprise decision — some leaders see a different risk taking shape alongside the slowdown in switching itself.
“As Epic’s lead in the EHR technology space continues to not only dominate but pull away from the others, I do believe large-scale EHR switches will continue to decline in frequency — with the only exceptions being situations where an organization decides to move to Epic, or when a merger or acquisition has occurred and the legacy systems are on disparate EMR platforms,” said Joy Oh, chief information and digital transformation officer of Cincinnati-based Christ Hospital Health Network.
Ms. Oh said that dynamic — what she called “this oligopoly-moving-towards-monopoly” — carries its own risks for health systems, which could opt to mirror what other industries, notably utilities, have done around vendor accountability and regulation.
She said EHR vendors will keep feeling pressure to innovate — just not from each other, but from bolt-on technology providers. Unless companies like Epic keep expanding their own platforms, she added, they risk becoming “only used as a core back-end system” while “third-party technology becomes the tool for patient and clinician integration, for data and analytics, and digital innovation.”
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