KLAS: Acute Care EHR Purchasing Activity Drops Off

Policy uncertainty and other spending priorities such as AI have constrained recent acute care EHR purchasing activity, according to the latest EHR market share report from KLAS Research. The number of hospitals impacted by EHR purchase decisions dropped 40% in 2025 compared to 2024 and nearly 50% compared to 2023.

According to the KLAS report, new EHR contract decisions in 2025 were driven primarily by smaller health systems (those with 2-10 hospitals). Only two large health systems (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 multi-specialty hospitals.

KLAS found that Epic has broadened its reach to include more small health systems and midsize stand-alone hospitals, adding 49 hospitals from these groups in 2025. In addition, the report notes that these wins for Epic have primarily come from organizations leaving Oracle Health. “Key factors in these decisions include the desire to more easily exchange data with regional partners as well as Epic’s platform strength, partnership, and standardization,” the report states. 

The new market share report also found that Meditech saw the strongest retention of legacy customers to date amid the general decline in small stand-alone hospital purchasing.

In a note about its research on Oracle Health, KLAS said that it gives all tracked EHR vendors the opportunity to report their new contracts for the past year, and KLAS then validates this information with hospitals and health systems. For 2025 decisions, all vendors except Oracle Health provided a list, marking the second year in a row Oracle Health has declined to share new contracts. To independently identify Oracle Health’s 2025 wins, KLAS relied on its internal research methods as well as publicly available information. Therefore, the data for Oracle Health may not encompass 100% of their new contracts, particularly among smaller hospitals, whose purchase decisions are less likely to be publicized.

In 2025 KLAS published a “First Look” Insights Brief on Oracle Health’s Clinical AI Agent for Note Generation based on interviews with 17 health system executives. Soon after, lead author Coray Tate, KLAS’ vice president of clinician experience & interoperability, spoke with Healthcare Innovation about the largely positive response Oracle was seeing from customers for its AI scribe technology.  

“This was the first stake in the ground of Oracle delivering something that they said they were going to do, and having it land in a way that has caught their customers’ attention,” Tate said. “And the customers are saying this could be really good. We are feeling a change in the tone of the conversation from one that a year ago was really pretty frustrated. In general, there were a few folks who were optimistic that things were going to get better, but by and large, it was mostly people saying things are tough. Now it's changed to where they’re  saying this could be really good, and we may be with the right vendor right now. Again, there's a lot of water that's got to get down the river on this and be delivered in the way that this ambient speech solution has been delivered. But if things land that way, and they start to fulfill these promises that they've made, it'll be good to have a more competitive market.”