Texas Attorney General Ken Paxton is challenging Epic Systemsâ handling of pediatric medical records, alleging unlawful limits on parental access and raising broader questions about data control, compliance, and oversight for providers and laboratories.
For clinical laboratory leaders, the growing legal and regulatory scrutiny of electronic health record (EHR) vendors is no longer a peripheral issue. How patient data are controlled, shared, and accessed has direct implications for test ordering, result reporting, compliance, and patient trust. That context frames a new lawsuit filed by Texas Attorney General Ken Paxton against Epic Systems Corporation, one of the nationâs most dominant health IT companies.
Paxton alleges that Epic has unlawfully monopolized the EHR market and engaged in deceptive practices that restrict parental access to minorsâ medical records, in violation of Texas law. Epicâs software houses more than 325 million patient records, representing roughly 90% of the U.S. population, according to the complaint.
Providers and EHRs restrict parental access to adolescent records primarily to comply with state and federal privacy laws. In many states, including Pennsylvania, minors age 13 and older can legally consent to certain types of careâsuch as mental health services, substance use treatment, sexual and reproductive health, and some infectious disease testingâwithout parental involvement. When a minor has the right to consent, providers are legally required under state law and HIPAA to keep that related protected health information confidential.
EHR systems like MyChart enforce these rules by automatically limiting parental access when a child turns 13 and masking sensitive results or medications to prevent accidental disclosure. These controls also align with national clinical guidance, including recommendations from the American Academy of Pediatrics, which emphasize protecting adolescent confidentiality to ensure teens seek care and communicate openly with clinicians.
The lawsuit claims Epic uses âexclusionary tacticsâ to suppress competition, including interfering with hospitalsâ ability to use their own patient data and limiting interoperability with competing software. Paxton argues these practices result in incomplete or outdated health records being shared among providers, diminishing care quality for Texas patients and increasing costs for hospitals.
For laboratories, these allegations raise concerns about data liquidity and timely access to diagnostic information. In fragmented or restricted EHR environments, lab results may not follow patients across care settings, potentially affecting clinical decision-making and continuity of care.
Parental Access to Pediatric Records at the Center of Legal Challenge
The suit also focuses on Epicâs handling of pediatric records. Paxton alleges the company automatically restricts parental access to medication lists, treatment notes, and provider messages once a child turns 12. The attorney general argues Epic does not own this data and has no authority to withhold it.
âThese deceptive practices undermine the fundamental right of parents to direct their childrenâs healthcare,â the lawsuit states, citing Texas Health & Safety Code § 183.006, which grants parents âcomplete and unrestricted accessâ to their minor childrenâs medical records.
âWe will not allow woke corporations to undermine the sacred rights of parents to protect and oversee their kidsâ medical well-being,â Paxton said. âThis lawsuit aims to ensure that Texans can readily obtain access to these records and benefit from the lower costs and innovation that come from a truly competitive electronic health records market.â
The Epic lawsuit is part of a broader enforcement push. Earlier this year, Paxtonâs office reached a settlement with Austin Diagnostic Clinic requiring full restoration of parental proxy access for patients ages 12 to 17. Civil investigative demands have also been issued to other EHR vendors operating in Texas.
For lab leaders, the case underscores increasing regulatory attention on how diagnostic data are governed inside EHR systems. As states and regulators challenge vendor practices around data access, interoperability, and patient rights, laboratories may find themselves navigating new expectations for transparency, parental access, and complianceâwhile also reassessing their dependence on a highly consolidated health IT ecosystem.
KLAS Research characterized partnership and responsiveness as key drivers of customer satisfaction
Epic Systems has bolstered its status as the dominant player among vendors of electronic health records (EHR) software, winning nearly 70% of new hospital contracts in 2024. Most, if not all, of these rollouts will include clinical laboratory data imported into the EHR system.
According to a recent market share report from KLAS Research, Epic added a net 176 acute care multispecialty hospitals in 2024, marking its largest-ever annual net gain, KLAS reported. Meanwhile, Epicâs largest rival, Oracle Health, saw a net loss of 74 hospitals during the year. Meditech, the No. 3 EHR vendor, saw a net decline of 57 hospitals.
The report, titled, âUS Acute Care EHR Market Share 2025,â was based on interviews with healthcare organizations as well as data from vendors and other sources, KLAS said.
âAcross all vendors, the level of partnership has emerged as a key differentiator,â KLAS stated in its report. âA vendorâs reputation for listening to customers, taking feedback, and implementing requested changes greatly impacts customer satisfactionâoften translating to gains in overall market share.â
In their KLAS report, authors Bradley Hunter (left) and Paul Warburton (right) wrote, âThough still high overall, acute care EHR purchase energy slightly cooled in 2024. Health systems continued to drive most of the decisions.â Photo copyrights: KLAS Research.)
Drivers of Epicâs Success
Among large health systemsâdefined as those with more than 10 hospitalsâKLAS noted the following market share for EHR vendors:
Epicâ48%.
Oracleâ27%.
Meditechâ15%.
All other EHR vendorsâ10%.
Among all acute care hospitals, Epicâs market share is 42.3% compared with 22.9% for Oracle and 14.8% for Meditech.
Epic also dominates in terms of percentage of hospital beds, with a 54.9% market share compared with 22.1% for Oracle and 12.7% for Meditech.
Overall, acute care EHR purchases declined in 2024, as 272 hospitals bought an EHR system, compared with 319 in 2023, KLAS reported.
The report attributed Epicâs success to âthe stability and interoperability capabilities of the product as well as generally high satisfaction among current customers. Beyond strictly technological considerations, Epicâs reputation for customer partnership has brought them to the forefront of most EHR considerations.â
Oracleâs Market Decline
For the first time, Oracle declined to offer a list of new contracts, KLAS reported. To arrive at its estimates for the company, KLAS said it used âpublicly available resources and our standard internal research methods.â
What accounts for Oracleâs market decline? âAs has been the case historically, healthcare organizations continue to cite poor partnership and a lack of follow-through on promises as some of their biggest concerns,â KLAS reported, adding, âWhile many Cerner customers hoped the 2022 acquisition by Oracle Health would lead to relationship improvements, the vendorâs loyalty and relationship ratings have dropped over 10 points since November 2021 (just before the announced acquisition).â
On the other hand, current and potential Oracle customers have expressed âcautious optimismâ due to recent technology developments, KLAS reported, including rollouts of Clinical AI Agent, Seamless Exchange, and Oracle Cloud Infrastructure, plus announcements of a new EHR system and patient portal.
âMore than one-third of customers report that over the last six months, there has been a positive change in the vendorâs execution/delivery,â KLAS reported. âThis represents a notable change from the overall sentiment during the last couple of years.â
Compilation shows US Veterans Administration spent the most at $16B
Clinical laboratory leaders and pathologists will be interested in which hospital systems are making the largest investments in electronic health record (EHR) technologies. Especially considering laboratory information systems (LIS) must interface with these platforms and require extensive reworking when hospitals change their EHRs. For example, hospitals moving to the Epic Systems EHR often require their laboratories to implement the Epic Beaker LIS as well.
According to information sourced by Beckerâs Hospital Review, the top 16 hospital systems each spent $500 million or more on EHRs, adding, however, that the information is ânot an exhaustive list.âÂ
Number three on the list is Kaiser Permanente which operates multiple hospitals within its nine healthcare networks across the United States serving 12.5 million members. For that reason, its total investment in EHR technology represents a much larger number of hospitals than the other health systems on the list.
Of the 16 providers on the list, 12 installed EHRs provided by Epic Systems of Verona, Wis. Four of the providers implemented EHRs from Oracle Health (formerly Cerner), North Kansas City, Mo., and Meditech of Westwood, Mass.
âLooking forward, there are many advantages in terms of investing in the future and how we will be aligned with technologies including digital and AI applications,â said pathologist Angelique W. Levi, MD (above), vice chair and director of pathology reference services at Yale School of Medicine, in a news release following a site visit to Geisinger Diagnostic Medicine Institute in Danville, Pa., to see Epic Beaker in operation at Geisingerâs clinical laboratory. âBut what we gain immediatelyâhaving all the patient information accessible in one place in a linked and integrated fashionâis very important.â (Photo copyright: Yale School of Medicine.)
Provider, EHR, Investment
Beckerâs list below shows the total amount invested by the 16 healthcare systems was approximately $38.32 billion. The average EHR implementation cost is $2.39 billion for a large healthcare provider.
Military Health System, Washington, D.C. (Oracle) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $5.5 billion.
Kaiser Permanente, Oakland, Calif. (Epic) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $4.0 billion.
Catholic Health Initiatives (CommonSpirit Health), Englewood, Colo. (Oracle/Meditech) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $1.5 billion.
Mayo Clinic, Rochester, Minn. (Epic) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $1.5 billion.
Mass General Brigham, Somerville, Mass. (Epic) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $1.2 billion.
Northwell Health, New Hyde Park, N.Y. (Epic) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $1.2 billion.
Dignity Health, San Francisco (Oracle/Meditech) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $1 billion.
NYC Health and Hospitals, New York, N.Y. (Epic) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $1 billion.
Sutter Health, Sacramento, Calif. (Epic) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $1 billion.
NewYork-Presbyterian, New York, N.Y. (Epic) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $964 million.
Providence, Renton, Wash. (Epic) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $800 million.
Trinity Health, Livonia, Mich. (Epic) Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â $800 million.
Beckerâs stated they assembled this list from public sources and that there may be other EHR/hospital contracts with a total cost that also would make the list. It is not common to see a list of what hospitals actually spend to acquire and deploy a new EHR.
Epic added 153 hospitals to its client base in 2023. Epicâs EHR competitorsâOracle and Meditechâboth experienced declines in client retention rate, Healthcare IT News reported based on the KLAS data.
âBoth current and prospective large organization customers are drawn to Epic because they see the vendor as a consistently high performer that provides strong healthcare IT [information technology], quality relationships, and the opportunity to streamline workflows and improve cliniciansâ satisfaction,â Healthcare IT News said of the KLAS reportâs findings.
In a blog post, authors of the KLAS report explained that in 2023 Oracle added specialty hospital clients and Meditech âsaw several new salesâ which included healthcare systems and independent providers.
In the next few years, the industry is âripe for disruption. Another vendor could come in and turn everything on its head,â the KLAS blog article concluded. âEven those who choose Epic want to have more competitive options to choose from.â
Preparing for an LIS Change
Clinical laboratory leaders who may be transitioning their LIS during a new EHR installation may learn from colleagues who completed such an implementation.
Angelique Levi, MD, vice chair and director of pathology reference services at Yale School of Medicine, who was part of the pathology team, noted that one challenge for labs is addressing âinformation thatâs from many different places when weâre talking about cancer care, prognostic testing, and diagnostics.
âItâs become much more complicated to manage all those data points,â she continued. âWithout being on an integrated and aligned system, youâre getting pieces of information from different places, but not the ability to have linked and integrated reports in one spot.â
EHR implementations are among the most labor-intensive, expensive projects undertaken by hospitals. Therefore, it is crucial that clinical laboratory and pathology leaders research and learn why an EHR (and possibly LIS) change is needed, what is expected, and when results will be received.
Technology like Appleâs VR/AR headsets may prove useful to clinical laboratories in accessioning and in pathology labs during biopsy grossing
In what has been billed as a first, medical teams in the US and UK used Appleâs Extended Reality (XR) Vision Pro headset system to assist in surgical procedures. The surgeons themselves did not wear the $3,500 headset. Instead, surgical nurses used the device for touch-free access to a software application that assisted them in setting up, organizing, and performing the operations. For pathologists and clinical laboratories, in the histology laboratory, such an arrangement involving XR headsets could be used when a biopsy is at the grossing station as well.
The headset software the team used during surgery was developed by eXpanded eXistence, Inc. (eXeX), a Florida-based company whose primary product is an iOS (Apple mobile operating system) application that provides similar functions for mobile devices. eXeX adapted the iOS app to work on Appleâs Extended Reality headset.
Extended Reality is an umbrella term for augmented reality (AR) and virtual reality (VR). Apple refers to the technology as âspatialâ computing.
Within the clinical laboratory, XR headsets could be used in the accessioning process as the accessioner works through the steps to confirm all required information accompanies the test requisition and that the patientâs specimen is processed/aliquoted appropriately.
âThe eXeX platform, enhanced by artificial intelligence, is designed not as a medical device but as an organizational and logistics tool. It aims to streamline the management of tens of thousands of items, including equipment, tools, technologies, consumables, implants, and surgical products,â said neurosurgeon Robert Masson, MD, eXeXâs founder and CEO, in a February news release.
Masson first deployed the software in his own surgical practice. Then in March, eXeX announced that a surgical team at Cromwell Hospital in London used the system in two microsurgical spine procedures, according to a March new release.
That news garnered media coverage in the UK as well as in US-based publications that follow Apple.
âWe are in a new era of surgery, and for the first time, our surgical teams have the brilliance of visual holographic guidance and maps, improving visuospatial and temporal orientation for each surgical team and for each surgery in all specialties,â said neurosurgeon Robert Masson, MD (above), eXeXâs founder and CEO, in a press release. Clinical laboratories may one day use XR headsets in the histology lab at the grossing station. (Photo copyright: Masson Spine Institute.)
Surgical Process Not Glamorous, But Important
Despite being on a cutting-edge XR platform, the eXeX software addresses âthe least glamorous partâ of the surgical process, Masson told Gizmodo.
âPeople assume that surgical healthcare has got to be sophisticated and modern,â he said. âThe reality is the way we organize it is probably the most archaic of all the major industries on the planet. Itâs all memorization and guesswork with scribbles on pieces of paper.â
The advantage of an XR headset is that it allows use of the eXeX software in a sterile environment, he added. âThe ability to interact with digital screens and holograms and lists and maps and products unlocks all kinds of possibilities. Suddenly, youâve got an interactive digital tool that you can use without violating the sanctity of sterility.â
Does he foresee a future when the surgeons themselves use XR headsets in the operating room? Not necessarily, Masson told Gizmodo.
âThereâs always a tendency to say, âlook at this amazing tech, letâs put a screw in with it,ââ he said. âWell, weâre already putting screws in without the headset, so it doesnât really solve a problem. People tend to think of floating spines, floating heights, you know, an overlay that tells you where to put a catheter in the liver. Honestly, itâs all unnecessary because we already do that pretty well. What we donât do really well is stay organized.â
Other XR Apps for Healthcare
In a news release, Apple showcased other healthcare apps for its Vision Pro platform.
Epic Systems, an electronic health record (EHR) system developer, has an app called Epic Spatial Computing Concept that allows clinicians âto easily complete charting, review labs, communicate using secure chat, and complete in-basket workflows through intuitive gestures, like simply tapping their fingers to select, flicking their wrist to scroll, or using a virtual keyboard or dictation to type,â Apple stated in the news release.
Stryker, manufacturer of Mako surgical robotic arms for joint-replacement procedures, has an Apple iOS app called myMako that âallows surgeons to visualize and review patientsâ Mako surgical plans at any time in a brilliant, immersive visual experience,â Apple said.
Cinematic Reality, from Siemens Healthineers, is an Apple iOS app that âallows surgeons, medical students, and patients to view immersive, interactive holograms of the human body captured through medical scans in their real-world environment,â Apple said.
New Era in Technology
For the past 20 years, manufacturing companies have installed systems at workstations with audio and video that show each step in a work process and with written checklists on the computer screen. This allows workers to check off each required step as proof that each required work element was performed.
This is similar to professional pilots who use checklists at every step in a flight process. One pilot will read the checklist items, the other will perform the step and confirm it was complete.
These procedures are generally completed on computer displays, but with the advent of XR headset technology, these types of procedures are evolving toward mobility.
To prepare for the emergence of XR-based healthcare apps, the US Food and Drug Administration (FDA) has organized a research team to devise best practices for testing these headset devices, CNBC reported.
It will be some time before XR headset technology finds its way into histology laboratories, clinical laboratories, and pathology practices, but since the rate of technology adoption accelerates exponentially, it might not take very long.
In both the hospital market and the ambulatory market, Epic has the best-selling electronic health records system, according to data issued by ONCHIT
Across the nation, clinical laboratories and pathology groups are busy interfacing their laboratory information (LIS) systems to the electronic health record (EHR) systems of their client hospitals and physicians. Yet, few lab managers know which EHR systems are dominating the market and which EHR systems are barely surviving.
In fact, it can be a challenge to understand market share by vendor. That is because market share can be determined in multiple ways. Dark Daily found three different rankings of EHR vendors. Each was based on slightly different sets of data. (more…)
