The two most influential figures in the hospital EHR market have reached almost opposite conclusions about how to win it.
Judy Faulkner, founder and CEO of Epic, built the nation’s largest EHR vendor by refining a single integrated system, without going public, taking outside investment or acquiring another business. Larry Ellison, co-founder, executive chair and chief technology officer of Oracle, entered the market by buying Cerner in June 2022 and has since argued that the EHR is only a starting point for automating payers, regulators, public health and much of the rest of the industry.
Both now promise that AI built into their EHRs will take documentation and administrative work off clinicians. But their public remarks over the past two years, as reported by Becker’s, describe opposite theories of how a healthcare technology company should be built, owned and paid — and so far, hospitals have sided heavily with one of them.
The divide starts with ownership. Ms. Faulkner holds all of Epic’s voting shares, and her succession plan transfers them to a trust bound by her rules: Epic can never go public, acquire another company or be acquired. Three health system CEOs from Epic’s CEO Council have agreed to take anyone who breaks those rules to court.
Her reasoning is as much about the software as the balance sheet. Ms. Faulkner told Katie Couric during a live interview at Epic’s headquarters this year that acquisitions break the consistency an integrated system depends on.
“If you look at some of the other companies out there who do software and they acquire different products, it’s not the same as having one product,” she said. “Terminology differs, colors differ, styles differ, placement differs, coding schemes differ. So when you acquire a product, it no longer works so smoothly for your users.”
That conviction has occasionally meant turning business away. In a 2024 blog post, Ms. Faulkner recalled a health system whose leaders visited Epic wanting a McKesson EHR for pharmacy, Cerner for nursing and Epic for documentation. Other vendors told them it was a misguided approach but offered to sell them software anyway. Epic did not.
“When it was our turn to speak, we said, ‘That’s an awful way to design a system and we’re sorry you traveled here, but we won’t sell our software to you,'” she wrote. The health system ultimately installed Epic’s integrated system, according to Ms. Faulkner.
Mr. Ellison’s model runs the other way. At Oracle’s 2024 health summit in Nashville, Tenn., he told former U.S. Sen. Bill Frist, MD, that Epic’s reach ends where Oracle’s would begin, listing payers, pathology departments, surveillance, medical devices and regulators such as the FDA as areas Oracle intends to automate.
“Epic does providers, hospitals,” Mr. Ellison said. “But we’ve also got to automate the payers.”
When Dr. Frist asked how much of that Oracle planned to take on, Mr. Ellison didn’t hedge.
“All of it,” he said. “We can do all of it.”
He described the approach as applying “Musk’s law” to healthcare, borrowing Tesla’s strategy of controlling its entire supply chain. An Epic spokesperson countered at the time that all seven of the largest U.S. payers are Epic customers, that a medical device manufacturer had joined its community and that organizations on Epic manage thousands of clinical trials each year.
The two founders’ views of patient data follow the same split. Oracle rebuilt its patient portal from the ground up rather than extending the legacy Cerner portal, so that it consolidates a patient’s history no matter how many EHRs, hospitals or providers contributed to it. Mr. Ellison explained the premise at the Oracle Health and Life Sciences Summit in September.
“That record doesn’t belong to the hospital, that record belongs to the patient, and the patient needs a full longitudinal record, regardless of whether it’s in Epic format or in a Cerner format or an Allscripts format,” he said.
Epic’s data strategy, by contrast, is built from inside its own customer base. Its Cosmos research database now holds data from 320 million deduplicated, deidentified patients across 23 billion encounters, Ms. Faulkner told attendees at Epic’s Users Group Meeting in August. That data now powers tools that flag whether a patient’s case is unusual and, through a forthcoming product called Curiosity, predict outcomes such as length of stay and stroke risk.
The same pattern holds for AI. Mr. Ellison has said AI won’t be a separate line of business at Oracle but the substance of everything it sells, and has dismissed competitors that plan to charge extra for AI agents.
“Our applications are going to be primarily AI applications — everything. How do you charge separately for everything?” he said on a 2024 earnings call.
Oracle layers models from OpenAI, xAI, Google and Llama on top of its application data, Mr. Ellison said in 2025. This year, Oracle Health has extended its Clinical AI Agent to draft orders during visits and suggest professional fee codes, and added a version for nurses. It unveiled an oncology EHR and five revenue cycle AI tools in September.
Epic’s AI ambitions are similarly broad, with an AI agent-building platform called Agent Factory offering 120 out-of-the-box AI features and Art-generated summaries in use at more than 300 organizations. But Ms. Faulkner frames the technology as a partner to clinicians rather than a replacement, and she pushed back on predictions that AI will make physicians obsolete during a June 23 interview with Jon LaPook, MD, at Aspen Ideas: Health.
“What we hear people say is that the physician plus the AI is better than either of them alone,” she said.
Money is where the two models diverge most sharply. Asked on the “Freakonomics Radio” podcast in April whether Epic is profit maximizing, Ms. Faulkner agreed that it is not.
“Plainly, that’s a choice we make,” she said. “We have enough money as revenue to run our company and be successful. Our customers need it more than we do, and so we don’t want to misuse them.”
Oracle, a public company, reports to investors every quarter. It has said it expects Oracle Health to post double-digit revenue growth in fiscal 2027 on the strength of its AI-driven modernization of the Cerner platform, and it is expanding outcome-based pricing for clinical AI tools. It also cut 539 jobs at the former Cerner campus in Kansas City, Mo., in June and, according to a Sept. 11 SEC filing, expanded its restructuring plan by about $700 million, to roughly $2.8 billion.
Mr. Ellison’s pitch to cost-pressured health systems is that better care is the path to affordability, through fewer complications, fewer readmissions and faster diagnoses.
“The goal is to provide the highest quality of care, but at a price that doesn’t ruin Western civilization,” he said. “The great thing about higher-quality care, it’s actually cheaper.”
So far, the market has rewarded Ms. Faulkner’s approach. Epic held 43.7% of the acute care hospital EHR market at the end of 2025, compared with 21.9% for Oracle Health, according to KLAS Research. Oracle Health shed a net 56 hospitals in 2025, its third straight year of net hospital losses, and about 30% of sampled Oracle Health customers told KLAS the platform is not part of their long-term plans. Wilmington, Del.-based ChristianaCare this month completed its switch from Oracle Health to Epic. Ms. Faulkner, for her part, has said no customer has ever sued Epic and only one has ever left, before eventually returning.
Oracle’s highest-profile healthcare customer has also become its biggest liability. The House Committee on Veterans’ Affairs voted 19-0 Sept. 2 to subpoena Mr. Ellison and Oracle co-CEO Mike Sicilia over a no-bid modification that raised the VA EHR contract’s ceiling from roughly $10 billion to $27 billion. Oracle has said it supports congressional oversight and will testify after the election. Oracle is still winning new business, though: Brentwood, Tenn.-based Quorum Health selected it in September to standardize technology across its 11 hospitals.
For health system executives, the contrast amounts to a strategic choice. Epic’s roadmap, which now includes an ERP product and an AI agent-building platform, invites more functions to migrate into a single vendor’s system. Oracle’s bet is that the record, and the AI built around it, should follow the patient across vendors and out to payers and public health agencies. KLAS has called 2026 a pivotal year for Oracle Health as it rolls out its new AI-enabled EHR.
Ms. Faulkner, meanwhile, graded Epic against its own promises during her August address. Of 167 projects announced at the previous year’s meeting, she said, 84 were completed on time, seven were completed or nearly so and 76 were in progress and on track.
“What you hear here is very likely to happen,” she said.
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