EHRs remain among the largest investments healthcare organizations will ever make — and several multimillion- and multibillion-dollar projects are still in progress in 2026, even as others crossed the finish line this fall.
Here are the most expensive EHR implementations currently underway, 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 finished its 2026 rollout Oct. 24 with go-lives at the Louis Stokes Cleveland VA Medical Center and the Alaska VA Healthcare System in Anchorage, bringing this year’s total to 13 medical facilities. The agency plans to deploy the system at 26 hospitals in 2027 and aims to have it in every VA facility by 2031; the contract’s period of performance now runs through May 16, 2031.
2. Indian Health Service (Rockville, Md.): $2.5 billion (Oracle Health). The HHS agency, which serves about 2.8 million American Indians and Alaska Natives, tapped General Dynamics Information Technology in 2023 to build a new EHR on Oracle Health technology under a 10-year contract worth up to $2.5 billion. The system replaces the agency’s homegrown Resource and Patient Management System, which it has used for nearly 40 years. The new EHR, called PATH EHR, went live Sept. 26 at its first site, the Lawton Service Unit in Oklahoma. That site covers Lawton Indian Hospital, Anadarko Indian Health Center and Carnegie Indian Health Center. The agency will use the pilot to evaluate the system before rolling it out to federal, tribal and urban Indian Health facilities nationwide.
3. 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 in May, bringing nine hospitals and about 42,000 users onto Epic. The third wave — South Oaks Hospital in Amityville, South Shore University Hospital in Bay Shore, Huntington (N.Y.) Hospital and Mather Hospital in Port Jefferson, plus 538 ambulatory sites — began a soft go-live for scheduling Oct. 19, with full go-live set for Nov. 7. Only a handful of hospitals will be left to convert after that.
4. 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.
5. 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.
6. 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. As of mid-September, 72 HCA hospitals were live on Expanse, including every hospital in its Capital and North Florida divisions, 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 the system. 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, the 40-plus-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 covering 15 hospitals in the Pittsburgh region and most of southwestern Pennsylvania went live in early October, and the system is in a “stabilization period” amid patient portal issues, said UPMC CIO Chris Carmody. UPMC Washington & Greene and UPMC Trinity will join in future phases over the coming years. 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 plans a systemwide go-live Oct. 31. It 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.
— Trinity Health (Minot, N.D.): Epic. Slated to go live Nov. 1, 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.
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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