Epic Now Controls 57% of US Hospital Beds. Here's What the 2026 EHR Scorecard Actually Tells Us.
The US EHR market is consolidating. If you work in healthcare IT, the direction of travel is no longer a question.
Epic is winning. Oracle Health is losing ground fast. And health systems that have not made an EHR decision yet are watching carefully while quietly redirecting their capital somewhere else.
Here is what the numbers actually say.
Epic's Dominance
Epic now holds 43.7% of all US acute care hospitals and 56.9% of all hospital beds. In 2025 alone, the company added 77 hospitals and 18,679 beds. Since 2021, Epic has gained a net 568 hospitals.
Every large health system that made an EHR decision in 2025 chose Epic. Both enterprise purchases involving more than 10 hospitals went to Epic. No other vendor was chosen in a decision involving more than three multispecialty hospitals.
MyChart now has over 200 million activated patient accounts. Epic holds records for 325 million patients. The company is still private, still headquartered in Verona, Wisconsin, and still run by founder Judy Faulkner.
The growth is not accidental. Epic has built a platform that large health systems find difficult to leave and smaller systems are increasingly choosing to join through its Community Connect program. The network effect is real and it is compounding year over year.
The Oracle Health Decline
Oracle Health lost 56 hospitals and 14,676 beds in 2025. That is the third consecutive year of major net losses. Since 2021, Oracle has shed a net 173 hospitals.
The customer base has grown increasingly unstable. About 30% of sampled Oracle Health customers say the platform is not part of their long-term plans. Another 35% are considered at risk of leaving. That means roughly two thirds of the Oracle customer base is either actively planning to leave or watching closely for a reason to.
Customer satisfaction with the Millennium platform has continued to slide following repeated layoffs, restructuring, and strategic uncertainty since Oracle's acquisition of Cerner. In the 2026 Best in KLAS report, Millennium ranked as the lowest-scoring acute care EHR across large, midsize, and small organizations.
Major health systems including UAB Medicine, Indiana University Health, and MedStar Health have announced plans to move to Epic.
The one thing Oracle has working in its favor in 2026 is its new AI-enabled EHR platform. Whether it lands well with existing customers will go a long way toward determining whether the bleeding slows or accelerates.
The VA Situation
The Oracle Health story cannot be told without the VA.
The VA signed a $10 billion contract with Cerner in 2018 to modernize its EHR across 170 medical centers. Oracle acquired Cerner in 2022 and inherited the project. The contract has since been revised to over $16 billion, with some lifecycle cost estimates from lawmakers running as high as $37 billion.
As of now, 10 of the VA's 170 medical centers are live on the new system. The rollout was paused for nearly three years due to patient safety concerns, technical failures, and usability problems. VA restarted deployments in April 2026 with four simultaneous go-lives in Michigan, a new approach after previous single-site rollouts struggled badly.
The target is full deployment by 2031. The GAO has flagged 16 of 18 outstanding recommendations as not yet implemented. Employee groups at recently deployed sites report many of the same problems that caused the original pause.
It is the largest IT implementation in federal government history. The outcome still matters for Oracle Health's credibility in the broader market.
The Rest of the Market
MEDITECH holds 14.7% of acute care hospitals and is showing the strongest legacy customer retention in the market right now. 84% of their legacy customers are migrating to Expanse rather than leaving for a competitor. That is a quiet stability story that does not get enough attention.
The ambulatory market looks different. Epic leads with 19.5% share. eClinicalWorks follows at 11.9%. athenahealth holds 6.9%. The ambulatory space remains more fragmented, with vendors carving out specific niches in independent practice, specialty care, and outpatient settings where Epic's cost and complexity are harder to justify.
The Slowdown Nobody Is Talking About
EHR purchasing decisions dropped roughly 40% in 2025 compared to 2024 and nearly 50% compared to 2023.
That is not a vendor story. That is a market story. Health systems are not standing still. They are redirecting capital toward AI tools, operational efficiency platforms, and technologies with faster financial returns. The big EHR replacement cycle has slowed significantly, and organizations still weighing a move are largely waiting to see what Oracle's next chapter looks like before they act.
Why This Matters Beyond the Numbers
The EHR vendor controls the clinical workflow. It shapes what data you can access, what integrations are possible, and what your technology roadmap looks like for the next decade.
Organizations on stable platforms are building toward AI, workflow automation, and deeper interoperability. Organizations on uncertain platforms are managing vendor risk, watching peers leave, and trying to figure out the right moment to make a move.
That gap will widen over the next few years, not narrow.
How Safeguard Can Help
Whether your organization is navigating an EHR transition, supporting a go-live, or building the operational and IT infrastructure to get the most out of the platform you are already on, Safeguard Consulting Group can help.
We work with health systems across payer and provider environments to provide experienced consulting and staffing support at every stage of the technology lifecycle. EHR transitions are complex, long-cycle projects that require the right people at the right time. We help you find them and deploy them effectively.
If your organization is in the middle of an EHR decision or preparing for what comes next, we are happy to have a direct conversation about what support actually looks like.
Reach out at info@safeguardcg.com.