For hospitals and health systems, the cost of an EHR extends well beyond implementation. Leaders at two health systems told Becker’s their EHR costs keep climbing, but they split on whether that spending should be shielded when budgets tighten.
Sinai Chicago budgets roughly $9.5 million a year for its EHR and treats it as an essential cost. Tallahassee (Fla.) Memorial HealthCare, where annual per-user system access costs rose more than 50% year over year, is instead weighing EHR spending against the value it delivers, like any other technology investment.
The increases come as health systems face pressure to maintain essential technology while investing in AI, digital tools and other strategic priorities.
At Sinai Chicago, EHR spending has grown by about 8% on average across 2024, 2025 and 2026, Ekerete Akpan, executive vice president and CFO, told Becker’s.
The health system spends approximately $9.5 million annually on its EHR and generally budgets another 5% for special requests and additional needs, bringing its annual investment to roughly $10 million.
For Mr. Akpan, that spending is not simply another technology expense that can be reduced when budgets tighten.
“The EHR really is foundational. It’s an essential cost of running a health system today and an important part of the standard of clinical care, so it’s an investment we have to maintain even when budgets are under pressure,” he said. “It helps our caregivers to provide the best care possible, which is what our patients need and deserve.”
For Sinai Chicago, the challenge is particularly pronounced because of its safety-net mission.
“For a safety-net health system like Sinai Chicago, where reimbursement pressures and other external headwinds already stretch limited resources, there is a real balancing act,” Mr. Akpan said. “We have to maintain the technology that is essential to delivering safe, high-quality care while still finding room to invest in innovation.”
When evaluating the return on its EHR investment, Sinai Chicago considers patient safety, quality of care, clinical standards and the technology’s ability to improve revenue capture.
Tallahassee Memorial HealthCare is taking a different approach. Rather than treating EHR spending as a separate, protected budget category, the health system is moving away from funding individual systems and toward an organizationwide approach focused on strategic outcomes and value, Chris Belmont, vice president and interim CIO told Becker’s.
“Our goal is to prioritize investments that advance our strategic initiatives, rather than funding technology simply because it supports a particular platform,” he said.
That approach is particularly important as Tallahassee Memorial works with Florida State University to develop FSU Health, an integrated academic health system. The organizations finalized agreements setting the long-term framework for FSU Health in September.
As part of that work, Tallahassee Memorial expects to invest in EHR enhancements, data platforms and other technologies to expand research capabilities.
The organization is also exploring opportunities to consolidate third-party applications into its EHR, including ambient listening, AI tools, voice communications and messaging systems. Those changes may not necessarily lower spending but could improve integration, efficiency and clinical workflows, according to Mr. Belmont.
“Ultimately, our technology investments are guided by the broader strategic priorities of FSU Health,” he said. “The EHR will remain a significant area of investment, but our focus is on the value those investments deliver to the organization, our clinicians and the patients we serve.”
That shift has not slowed Tallahassee Memorial’s costs. EHR and broader technology expenses are increasing across nearly every category, including licensing, staffing, optimization, AI, security and infrastructure, Mr. Belmont said.
One of the biggest drivers is growth. As the health system expands facilities, adds services and develops partnerships, it needs more technology resources, infrastructure and specialized staff, he said.
Vendor pricing is adding pressure.
“We are also seeing significant increases in vendor costs,” Mr. Belmont said. “New EHR features, including VoIP and certain AI enhancements, often carry additional transaction-based fees. At the same time, many vendors have substantially increased their annual support and maintenance costs.”
He pointed to a particularly sharp increase in system access expenses.
“For example, our annual cost per user simply to maintain system access increased by more than 50% year over year, even as our total number of users continues to grow,” he said.
Hardware prices are also climbing. Tallahassee Memorial saw double-digit percentage increases in hardware pricing during the three months between submitting and approving its budget, and major vendors are anticipating similar increases next year, Mr. Belmont said.
The question of EHR returns extends beyond these two organizations. In October, Becker’s examined whether health systems have recouped their initial Epic investments, with leaders pointing to improvements in revenue capture, operational efficiency and reduced downtime as important sources of value.
But for health systems already operating on established EHR platforms, the financial considerations continue well after implementation.
“Ideally, every new investment would be evaluated through a comprehensive cost-benefit analysis,” Mr. Belmont said. “However, much of our current cost growth is tied to maintaining and supporting technology we have already implemented.”
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