EHRs remain among the largest investments healthcare organizations will ever make — and several multimillion- and multibillion-dollar projects are progressing in 2026.
Here are the most expensive EHR implementations currently underway or wrapping up, ranked by reported cost, according to Becker’s reporting and other publicly available sources (this list is not exhaustive):
1. U.S. Department of Veterans Affairs (Washington, D.C.): $26.9 billion (Oracle Health). The VA raised its Oracle Health contract ceiling to $26.9 billion in August 2026, up from the original $9.99 billion 2018 contract — separate from a roughly $37 billion lifecycle cost estimate cited by lawmakers in December 2025. After a yearslong pause, the VA resumed deployments in April 2026 and had 14 sites live as of July, with 36 more scheduled through January 2028 and 120 of the system’s 170 medical centers still outside the current deployment schedule; the contract’s period of performance now runs through May 16, 2031.
2. Northwell Health (New Hyde Park, N.Y.): $1.2 billion (Epic). The 28-hospital system — New York’s largest — is in the final stretch of a phased, region-by-region migration unifying more than 30 legacy EHRs onto a single Epic platform. Its first wave went live Nov. 1, 2025, in the Western region; a second, larger wave covering Long Island’s Central region followed, bringing total users transitioned to about 70,000. A third wave is set for November 2026, with only a handful of hospitals left to convert after that.
3. 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, consolidating dozens of legacy systems onto one platform.
4. Adventist Health (Roseville, Calif.): $500 million (Epic). The 28-hospital system is replacing Cerner with Epic across its inpatient facilities and 440 clinics, with a systemwide go-live targeted for fall 2026. Adventist tapped roughly $1 billion in tax-exempt bonds, approved by the California Health Facilities Financing Authority, to help fund the Epic buildout alongside refinancing existing debt.
5. UAB Health System (Birmingham, Ala.): $380 million (Epic). The University of Alabama System board approved a roughly $380 million budget for an Epic switch covering EHR, revenue cycle and clinical research, phased in over about two and a half years and extending to the newly acquired Ascension St. Vincent’s hospitals.
6. Kaleida Health (Buffalo, N.Y.): $170 million (Epic). The five-hospital system went live systemwide on Epic May 30, a roughly $170 million transition that contributed to a $21.1 million operating deficit in the second quarter. One-time conversion costs of $24.5 million through June drove the near-term hit, though Kaleida says Epic will ultimately cost less to run than the multiple legacy EMRs it replaced. Affiliated but financially independent Erie County Medical Center Corp. and University of Buffalo are due to go live in fall 2026.
7. Sarasota (Fla.) Memorial Health Care System: $160 million (Epic). The two-hospital public system began its implementation in June 2025 and plans an enterprisewide “big bang” go-live in October 2026, replacing legacy systems across the organization.
8. Memorial Health (Springfield, Ill.): $105 million (Epic). The five-hospital system started its implementation in October 2025 and plans a “big bang” go-live in the first quarter of 2027, consolidating three EHRs to one and moving its largest Community Connect partner, Springfield-based SIU Medicine, onto Epic the same day.
9. Nicklaus Children’s Health System (Miami): $75 million (Epic). South Florida’s largest pediatric health system will transition EHRs in 2027. The organization launched implementation planning workflows in early 2026 to migrate all patient medical records across its three hospital campuses and dozens of outpatient facilities. More than 5,000 physicians, nurses and other care team members will be using Epic by summer 2027.
Several other notable transitions are underway, but the health systems have not attached a public dollar figure:
— HCA Healthcare (Nashville, Tenn.): Meditech. The for-profit giant — about 190 hospitals across 20 states and the U.K. — is in a multiyear, systemwide rollout of Meditech’s cloud-based Expanse platform; it went live at 43 hospitals in January 2026, with more to follow.
— CommonSpirit Health (Chicago): Epic. The 137-hospital Catholic system’s “OneEHR” initiative is collapsing more than a dozen legacy EHRs (including four separate Epic instances) into a single Epic platform across its five regions. Roughly 65% of hospitals are now live — two of eight planned waves complete, running nearly two years ahead of schedule — with full standardization targeted by 2030.
— UPMC (Pittsburgh): Epic. One of the largest active migrations in the country, the 40-hospital system is consolidating nine EHRs and roughly 6 million patient records onto a single Epic platform. Its first wave, covering 21 hospitals outside the Pittsburgh region, went live in September 2025; a second wave is now targeted for Oct. 3, 2026. UPMC expects the project to pay for itself within seven years.
— Billings (Mont.) Clinic-Logan Health: Oracle Health. The combined 30-hospital system is rolling out Oracle Health, a roughly three-year effort that began with its critical-access hospitals in early 2025.
— Indiana University Health (Indianapolis): Epic. The 16-hospital organization plans an all-at-once go-live in mid-2027, timed to the opening of its new $2.3 billion downtown medical center.
— Baptist Health South Florida (Coral Gables): Epic. The 12-hospital, 100-plus-clinic system — South Florida’s largest — plans a simultaneous “big bang” go-live across the enterprise in mid-2027.
— MedStar Health (Columbia, Md.): Epic. The 10-hospital system is targeting a fall 2027 go-live.
— Penn State Health (Hershey, Pa.): Epic. The six-hospital system kicked off its implementation in June 2025 and expects to go live in late 2026, and has signed on for Epic’s full AI suite.
— Jackson Health System (Miami): Epic. The six-hospital public safety-net system is in the midst of an EHR transition.
— ChristianaCare (Newark, Del.): Epic. The three-hospital network is switching EHRs — a change a leader called one of the “largest transformations” in its history — with a go-live planned for Oct. 3, 2026.
— Trinity Health (Minot, N.D.): Epic. Slated to go live Nov. 1, 2026, the two-hospital system projects nearly $1 billion in return on investment.
— NorthBay Health (Fairfield, Calif.): Epic. The two-hospital system is migrating to the new EHR with go-live set for 2026.
— Union Health (Terre Haute, Ind.): Epic. Implementation at the two-hospital system began in August 2025 with a January 2027 go-live.
— Bergen New Bridge Medical Center (Paramus, N.J.): Epic. The 1,070-bed, county-owned safety-net hospital launched implementation in August 2025, with a go-live set for early 2027 and ROI expected in two to three years.
— Children’s National Hospital (Washington, D.C.): Epic. A new EHR is slated to go live at the pediatric health system in 2027.
— Baptist Healthcare (Pensacola, Fla.): Epic. The three-hospital organization announced a move to Epic with a 2028 go-live.
— St. Luke Community Healthcare (Ronan, Mont.): Oracle Health. The hospital and its four clinics are set to go live on Sept. 1, 2026.
NOTE: This is not an exhaustive list. If you know of other EHR projects that should be on this list, please email gbruce@beckershealthcare.com.
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