Acute care purchases of electronic health record systems declined significantly in 2025, as market uncertainty cut buying decisions among hospitals and health systems, according to data from KLAS Research.
The number of hospitals impacted by EHR purchase decisions dropped 40% compared to 2024 and nearly 50% compared to 2023, KLAS Research reported in its 2025 EHR market share report. Ongoing questions around government policy contributed to hesitation, and at the same time, many health systems redirected investment toward technologies with more immediate financial returns, such as AI and other solutions designed to improve operational efficiency, KLAS Research analysts wrote.
Despite the slowdown, Epic's share of the U.S. EHR market continued to inch up, primarily driven by contract decisions at smaller health systems, or organizations with two to 10 hospitals.
"As EHR buying energy has trended down over the last few years, Epic has broadened their reach to include more smaller health systems and midsize standalone hospitals; they added 49 hospitals from these groups in 2025," KLAS Research analysts wrote in the report.
Overall, Epic gained a total of 77 multispecialty hospitals and 18,679 beds in 2025 and "lost" one customer. The health IT company now commands 43.7% of the acute care EHR market, up from 42.3% a year prior. Epic has a 56.9% market share of hospital beds, according to KLAS Research data.
Only two large health systems (organizations with more than 10 hospitals) made enterprise-wide EHR purchase decisions in 2025, and both chose Epic. No other vendor was selected in a decision that included more than three multispecialty hospitals. These wins have primarily come from organizations leaving Oracle Health, KLAS reported.
Health system leaders cited Epic’s platform strength, partnership and standardization as key factors in their EHR contract decisions, along with a desire to easily exchange data with regional partners.
Epic also continues to expand into smaller standalone hospitals or organizations with less than 200 beds) with its Community Connect offering. Epic Community Connect extends the EHR platform to smaller practices, clinics and hospitals, offering access to tools without independent implementation costs. Seven smaller, standalone hospitals chose Community Connect in 2025, although the KLAS report did not specifically name those hospitals.
KLAS Research's market share data is based on acute care EHR purchasing activity, specifically executed contracts, that occurred in the U.S. from January 1 to December 31, 2025. It includes EHR market share data for acute care hospitals and for non-acute care specialty hospitals—meaning psychiatric, long-term acute care, rehabilitation, surgical, orthopedic, and other specialty hospitals. KLAS sources publicly available information and collects data based on the "thousands of conversations" it has with healthcare organizations each year.
KLAS also gives vendors the opportunity to report their annual acute care hospital EHR wins, which KLAS then validates with healthcare organizations, the company said.
2025 was the third consecutive year Oracle Health saw the largest net loss in market share compared to other EHR vendors, according to KLAS' data. Oracle bought Cerner, a competing EHR vendor, for $28.3 billion in June 2022 and the company lost a net 56 hospitals and 14,676 beds in 2025.
The company now has a 21.9% share of the acute care hospital EHR market, down from 22.9% a year prior, according to KLAS' estimates. Cerner's market share stood at 25% in 2020.
Of note, KLAS said Oracle Health did not provide a list of new contracts for 2025, marking the second year in a row the company has declined to share information about new contracts. To independently identify Oracle Health’s 2025 "wins," KLAS said it relied on its internal research methods as well as publicly available information.
According to KLAS' tally, Oracle lost 56 hospitals and 14,676 beds. The company's losses in 2025 were highest among small health systems, and all but three of those losses went to Epic, KLAS reported.
Oracle Health’s gains in 2025 came primarily from one large specialty organization that chose the company's EHR for its eight rehabilitation hospitals.
"Amid the repeated layoffs, restructures, and focus shifts that have occurred since Cerner was acquired by Oracle, customer satisfaction with the Millennium platform has continued to decline," KLAS Research analysts wrote. "In the 2026 Best in KLAS report, it was the lowest-scoring ranked solution across large, midsize, and small organizations."
The result is increasing volatility in the customer base—30% of sampled customers report that Oracle Health is not part of their long-term plans while 35% say either that they might leave or that "they want to leave but can’t," KLAS wrote in the report.
Following the Oracle-Cerner deal in 2022, analysts at KLAS Research spoke with customers over the course of a year and found that CIOs were concerned about the company's vision. Throughout 2023 and 2024, Oracle Health implemented several major technology developments, including its clinical AI agent, seamless exchange capabilities and Oracle Cloud Infrastructure.
In August, the company launched its next-gen electronic health record solution equipped with the latest artificial intelligence and voice capabilities, which is designed to be easier for clinicians to navigate.
2026 will be a critical year for Oracle Health customers as the new AI-enabled EHR becomes a reality, KLAS Research analysts noted. The success of the new platform will be imperative to restoring confidence among both existing customers and the broader market, analysts wrote.
Many Oracle Health customers have been deferring action as they await greater clarity on the vendor’s evolving direction, analysts noted.
Meditech lost seven hospitals and 1,015 beds in 2025 and has a 14.7% share of the acute care EHR market, according to KLAS' data, but the company is seeing strong retention among legacy customers. Meditech customers make up the third-largest acute care EHR customer base in the U.S. About 45% of these hospitals use one of Meditech's various legacy platforms, and each year, a number of these customers make a go-forward EHR purchase decision.
"The percentage that chooses to migrate to Expanse rather than leave for another vendor has increased steadily since 2023, thanks to Meditech's continued improvement efforts," KLAS Research analysts wrote in the report.
Across the market in general, purchasing among small standalone hospitals has slowed, but a handful of these organizations signed net-new contracts with Meditech last year.
"Meditech customers and those that consider the vendor in purchase decisions do note the need for better interoperability and broader capabilities that would allow them to eliminate third-party solutions, e.g., in areas like capacity management," KLAS analysts wrote.
Other EHR vendors evaluated in the report include TruBridge (7.6% share of acute care hospital market) and Altera Digital Health (2.9%), while other companies made up 9.2% of the market.
In May 2022, N. Harris Computer Corporation, a subsidiary of Constellation Software, bought health IT company Allscripts' hospital business segment, which included Sunrise, Paragon, Touchworks, Opal, dbMotion, STAR and Healthquest solutions. That business, now operating as Altera Digital Health, saw just one net-new customer in the acute care hospital market in 2025, according to KLAS data.
The customer, a 155-bed hospital, is the vendor’s first "win" since 2023. Customers are cautiously optimistic about Paragon, including the forthcoming clinical usability improvements, and in 2026, customers started going live on Denali, the new web-enabled version of Paragon.
TruBridge, formerly CPSI, continues to be considered and chosen by smaller organizations with budgetary constraints and by existing customers for TruBridge’s legacy solutions. In 2025, TruBridge gained six hospitals and lost four, for a positive net change of two hospitals.