Acute care electronic health record purchasing activity dropped sharply in 2025 as health systems delayed major platform decisions amid economic pressure, policy uncertainty and growing investment in AI technologies.That's according to the 2026 KLAS U.S. Acute Care EHR Market Share report, which examined hospital purchasing activity between January and December 2025 using contract data, vendor reporting and interviews with healthcare organizations. KLAS researchers said the number of hospitals making EHR purchasing decisions fell 40% compared to 2024 and nearly 50% compared to 2023.The report attributed the slowdown to several converging factors, including uncertainty around government policy, increased focus on operational efficiency initiatives and hesitation among Oracle Health customers awaiting greater clarity around the vendor’s long-term direction following the Cerner acquisition.Despite the broader slowdown, Epic continued expanding its footprint, particularly among smaller health systems and standalone hospitals.Just two health systems with more than 10 hospitals made enterprise-wide EHR purchasing decisions in 2025, and both selected Epic, and no vendor besides Epic was chosen in a purchasing decision involving more than three multispecialty hospitals.The report noted Epic added 49 hospitals among smaller health systems and midsize standalone hospitals during the year, with many of those wins coming from organizations replacing 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," according to KLAS.Epic also continued expanding its Community Connect program among smaller standalone hospitals, with seven organizations selecting the offering in 2025.Meditech, meanwhile, showed stronger retention among customers still operating legacy platforms. The percentage of legacy Meditech customers migrating to Expanse instead of leaving for competing vendors has increased steadily since 2023, aided in part by workflow improvements such as updated nursing functionality.Still, organizations evaluating Meditech continue seeking stronger interoperability and broader platform capabilities that could reduce reliance on third-party tools in areas such as capacity management.Oracle Health experienced its third consecutive year of declining market share and customer satisfaction, according to the report. Losses were concentrated primarily among smaller health systems, with nearly all departing customers selecting Epic.The report pointed to continued customer instability surrounding the Millennium platform following Oracle’s acquisition of Cerner, including layoffs, restructures and shifting strategic priorities.In KLAS’s 2026 Best in KLAS rankings, Millennium received the lowest scores among ranked large, midsize and small organization solutions.Nearly a third of sampled Oracle Health customers told KLAS the vendor is no longer part of their long-term plans, while another third said they are considering leaving or want to leave but feel unable to do so.The report concluded 2026 will likely be a "pivotal proofpoint" year for Oracle Health as the company rolls out its new EHR platform."2026 will be a critical year for Oracle Health customers as the new AI-enabled EHR becomes a reality," said KLAS researchers, noting that its "success will be imperative to restoring confidence among both existing customers and the broader market."KLAS also noted modest gains for smaller vendors: TruBridge posted a net gain of two hospitals in 2025, while Altera Digital Health recorded its first Sunrise platform win since 2023 and saw its fewest annual hospital losses in four years.Nathan Eddy is a healthcare and technology freelancer based in Berlin.Email the writer: [email protected]Healthcare IT News is a HIMSS Media publication.