An Epic Fail? An Intriguing Trend Involving a Top EMR Vendor

Don’t you hate it?  It’s that cringe moment when everyone’s watching and you end up falling flat on your face.  Maybe it’s fumbling on the last, must-have-it play of the game; or maybe you’re being recorded just as you happen to trip into the pool, fully clothed.  Epic fails are funny to watch but not so much fun for those who end up being embarrassed, hurt or humiliated in the process.  And, if we were being honest, we can all relate, because we’ve all been there at one time or another.

But, when it comes to a large, nationally recognized company having a public misstep, that can be detrimental to the bottom line.  Is that what just happened with a recent assessment of a large electronic medical record (EMR) vendor as detailed in a highly visible healthcare publication?  On November 2, Becker’s Health IT published an article pointing out an interesting factoid that many may find surprising.  Here’s the headline: “Most big for-profit health systems aren’t on Epic.”  What?!  Does this qualify as an Epic fail?  Let’s dig into the details.

Top EMR Vendors

Before anyone starts panicking or participates in disparaging the vendor in question, it is important to note that Epic still remains at the top of EMR providers in this country.  Over 500 vendors are offering some type of EMR product, worldwide.  According to a report by Technavio, the $35 billion global EMR market will increase by $57.39 billion by 2030.  Despite the number of options and the growth opportunities involved, there are only two or three companies that currently dominate the American EMR market.

According to a 2026 analysis by Definitive Healthcare, Epic holds the largest share of the EMR market among U.S. acute care hospitals.  The full market share numbers are as follows:

1. Epic: 43.9%
2. Oracle Health (Cerner): 18.9%
3. MEDITECH: 10.7%
4. TruBridge: 4.3%
5. WellSky: 3.4%
6. Vista: 1.7%
7. Netsmart Technologies: 1.7%
8. Paper Charts: 1.6%
9. MEDHOST: 1.6%
10. Other: 1.0%

Despite this decisive dominance of the Epic brand among U.S. hospitals, something must be wrong.  How else do we explain the Becker’s headline referenced above?

Cause for Concern?

It’s true that Epic has won over most of the country’s largest health systems, but many of the biggest holdouts are investor-owned.  Interesting.

The folks at Becker’s compiled a list of the largest health systems not on the Epic platform back in October.  It was then that a pattern emerged.  The names that stood out were some of the prominent for-profit health systems.  For example, HCA Healthcare, based in Nashville, Tennessee, is moving its roughly 190 hospitals to Meditech.  Dallas-based Tenet and Universal Health Services of King of Prussia, Pennsylvania use Oracle Health’s EMR.  The Franklin, Tennessee Community Health Systems also use Oracle Health, as well as Athenahealth and Medhost.  Lifepoint Health in Brentwood, Tennessee uses a varied mix of EMRs.

While there certainly are exceptions, there does seem to be a trend developing as it concerns the for-profit hospital sector.

So, what is the reason for this apparent reluctance among certain facilities to forego Epic in favor of other EMR flatforms?  According to Becker’s the biggest factor may involve geography. Much of an EMR’s pull comes from “physicians who practice at several hospitals in the same market and don’t want to learn a new system at each one.”

Mark Gilliam, CIO of Louisville, Kentucky-based ScionHealth (a for-profit that also runs multiple EHRs) had the following comment:

The last thing you want a physician to do is have to use four different systems depending on where they provide their [services].  So, some of that comes into play.  I’m not saying it’s major, but you can’t ignore it.  So, it depends on the market you’re in.

Becker’s makes the point that many large nonprofit systems tend to be concentrated in one region, where those physician networks overlap.  In contrast, the big for-profit chains are spread across dozens of states.  In addition, “for-profits grow and shrink through acquisitions, divestitures and spinoffs, and each deal brings in hospitals running whatever EMR they already had.

There are other factors that come into play, such as cost and long-standing vendor relationships.  At the end of the day, Epic still stands at the top of the mountain, and there are no signs of an impending fall.  But there is certainly plenty of competition nipping at their heels.