What You Should Know
- The number of hospitals impacted by EHR purchase decisions dropped 40% compared to 2024 and nearly 50% compared to 2023, according to a new KLAS 2026 EMR Market Share report.
- Shift to AI: Health systems redirected capital toward technologies with immediate financial returns, specifically AI and operational efficiency solutions, rather than core EHR upgrades.
- Epic Dominance: Epic was the only vendor selected by large health systems (>10 hospitals) in 2025 and added 77 hospitals and 18,679 beds to its multispecialty market share.
- Oracle Health Volatility: Oracle Health saw its third consecutive year of major net losses, losing 56 hospitals and 14,676 beds.
- MEDITECH Retention: MEDITECH achieved its strongest legacy customer retention to date, with 84% of customers choosing to migrate to the Expanse platform.
The U.S. acute care EHR market hit a significant “purchase freeze” in 2025. Driven by ongoing questions around government policy and a strategic pivot toward Artificial Intelligence, health systems largely deferred major EHR transitions. This market exhaustion resulted in a 40% year-over-year decline in decision-making energy, leaving many vendors struggling to maintain momentum.
For health systems that did move forward, the primary motivation was standardization. Epic emerged as the clear winner of this trend, broadening its footprint among smaller health systems and midsize standalone hospitals that were largely fleeing Oracle Health.
The Oracle Health Proofpoint: A Critical 2026
Oracle Health continues to face a period of intense volatility. Since the acquisition of Cerner, repeated layoffs and restructuring have contributed to a steady decline in customer satisfaction with the Millennium platform.
- Market Erosion: Oracle Health saw the largest net loss in market share for the third year in a row.
- Customer Fragility: Nearly one-third of sampled customers report that Oracle Health is not part of their long-term plans.
- The AI Hope: 2026 is viewed as a pivotal year for the vendor as it launches its new AI-enabled EHR; its success is considered imperative for restoring market confidence.
Epic’s Strategic Expansion
As the overall market trended down, Epic successfully pivoted its strategy to capture smaller segments of the market.
- Large System Lock: Only two large health systems made enterprise-wide decisions in 2025; both chose Epic.
- Community Connect: Epic added seven standalone hospitals through its Community Connect offering, which allows smaller facilities to “tether” to a larger neighbor’s Epic instance.
- Data Exchange: A key driver for hospitals switching to Epic was the desire for easier regional data exchange with existing partners.
The MEDITECH “Expanse” Migration
Despite the general decline in small standalone hospital purchasing, MEDITECH reported its strongest retention numbers to date.
- Legacy Loyalty: 84% of MEDITECH customers making a decision chose to migrate to the Expanse platform, up from 63% in 2024 and 30% in 2023.
- Workflow Improvements: These migrations were largely credited to continued software improvements, including updated nurse workflows.
- Future Needs: However, customers noted a continuing need for better interoperability and broader capabilities to eliminate the need for third-party solutions like capacity management.
