Are EHR switches slowing down?
The number of hospitals affected by new EHR decisions dropped significantly in 2025 compared to prior years, down 40% compared to 2024 and 50% compared to 2023.
In May, a KLAS report tied the decline to ongoing uncertainty around government policy and health systems redirecting investment toward technologies such as AI and advanced analytics aimed at delivering more immediate financial or operational returns.
The slowdown was already visible a year earlier. In 2024, 272 hospitals were impacted by an EHR purchase decision, down from 319 in 2023, according to KLAS.
Even as new contract decisions have slowed, implementations from contracts signed in prior years are continuing to move forward. In early 2026, OhioHealth Morrow County Hospital in Mount Gilead, Ohio, went live with Epic as part of a $6 million IT investment, and Door County Medical Center in Sturgeon Bay, Wis., launched a new Epic system in February, having previously operated on Meditech. Western Missouri Medical Center in Warrensburg also announced plans to adopt Meditech Expanse to unify care across its hospital and 19 affiliated clinics.
Despite the overall pullback, Epic has continued to expand. Epic controlled 43.7% of the acute care EHR hospital market share in 2025, up from 31% in 2021, though it was the company’s slowest year of growth by percentage points in that span. Only two large health systems with more than 10 hospitals made enterprise-wide EHR decisions in 2025, and both selected Epic. No other vendor was chosen in a decision involving more than three multispecialty hospitals.
Health system CIOs told Becker’s they believe Epic can keep expanding its reach as it increasingly designs software products outside the traditional EHR, though some note the pool of large unconverted systems is shrinking.
“Most of the larger systems are already on Epic (except HCA), and Northwell is converting this year,” Lisa Nelson, PharmD, associate vice president of IT applications and chief applications officer of the University of Rochester (N.Y.) Medicine, told Becker’s in May. “There are only so many large systems left to convert.”
Why has this occurred?
1. Diminishing reimbursements due to CMS formulas
2. Capitation contracts
3. Diagnostic-related group payments
4. Return on Investment Calculations.
UPFRONT INVESTMENT
Cost Range by Organization Size
| Organization size | Upfront investment | Ongoing cost |
| Small practice (1–10 physicians) | $100,000–$300,000 | $50,000–$150,000/year |
| Mid-size practice (10–50 physicians) | $500,000–$1,000,000 | 15–20% of license/year |
| Large practice / small hospital (50–200 physicians) | $2,000,000–$5,000,000 | 15–20% of license/year |
| Enterprise hospital system (200+ physicians) | $10,000,000–$30,000,000+ | $1.5M–$3M/year |
The analysis breaks down the specific areas of ROI and which areas should be analyzed first.
Large health systems such as UCLA, Kaiser, Mayo Clinic, etc invested in EPIC five or more years ago. These systems have had time to analyze their ROI and the integration of their architectures.
Most likely, they have reached their apex and are operating in a steady state of user experience.
AI is now becoming commonplace in terms of scribing, diagnosing, and treating.
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