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Becker’s Hospital Review Ranks 16 Healthcare Systems with the Largest Investment in EHR Platforms

Jan 6, 2025 | Laboratory News, Laboratory Pathology, Laboratory Resources, Molecular Diagnostics, Genetic Testing, Whole Gene Sequencing

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 Becker’s Hospital Review, the top 16 hospital systems each spent $500 million or more on EHRs, adding, however, that the information is “not an exhaustive list.” 

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.

“Looking 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,” 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 Geisinger’s clinical laboratory. “But what we gain immediately—having all the patient information accessible in one place in a linked and integrated fashion—is very important.” (Photo copyright: Yale School of Medicine.)

Provider, EHR, Investment

Becker’s 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. 

  • US Department of Veteran Affairs, Washington, D.C. (Oracle)    $16 billion.
  • Military Health System, Washington, D.C. (Oracle)                    $5.5 billion.
  • Kaiser Permanente, Oakland, Calif. (Epic)                                 $4.0 billion.
  • Catholic Health Initiatives (CommonSpirit Health),
    Englewood, Colo. (Oracle/Meditech)                                         $1.5 billion.
  • Mayo Clinic, Rochester, Minn. (Epic)                                        $1.5 billion.
  • Mass General Brigham, Somerville, Mass. (Epic)                       $1.2 billion.
  • Northwell Health, New Hyde Park, N.Y. (Epic)                          $1.2 billion.
  • Dignity Health, San Francisco (Oracle/Meditech)                          $1 billion.
  • NYC Health and Hospitals, New York, N.Y. (Epic)                       $1 billion.
  • Sutter Health, Sacramento, Calif. (Epic)                                        $1 billion.
  • NewYork-Presbyterian, New York, N.Y. (Epic)                       $964 million.
  • Providence, Renton, Wash. (Epic)                                            $800 million.
  • Trinity Health, Livonia, Mich. (Epic)                                       $800 million.
  • Duke University Health System, Durham, N.C. (Epic)              $700 million. 
  • AdventHealth, Altamonte Springs, Fla. (Epic)                          $660 million.
  • Memorial Hermann Health System, Houston (Epic)                  $500 million.

Becker’s 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.

Shifting EHR Market

According to KLAS’ 2024 US Acute Care EHR Market Share report, Epic was the only EHR vendor to increase its market share in 2023.

Epic added 153 hospitals to its client base in 2023. Epic’s EHR competitors—Oracle and Meditech—both experienced declines in client retention rate, Healthcare IT News reported based on the KLAS data.

“Both 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 clinicians’ satisfaction,” Healthcare IT News said of the KLAS report’s findings.

In a blog post, authors of the KLAS report explained that in 2023 Oracle added specialty hospital clients and Meditech “saw several new sales” which included healthcare systems and independent providers.

In the next few years, the industry is “ripe for disruption. Another vendor could come in and turn everything on its head,” the KLAS blog article concluded. “Even those who choose Epic want to have more competitive options to choose from.”

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. 

In September, Yale School of Medicine in New Haven, Conn., sent a department of pathology team to visit Geisinger Diagnostic Medicine Institute, Danville, Pa. Geisinger had adopted Epic Beaker and has a workflow similar to Yale’s, according to a Yale News article. 

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 “information that’s from many different places when we’re talking about cancer care, prognostic testing, and diagnostics.

“It’s become much more complicated to manage all those data points,” she continued. “Without being on an integrated and aligned system, you’re getting pieces of information from different places, but not the ability to have linked and integrated reports in one spot.”

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.

—Donna Marie Pocius

Related Information:

Most Expensive EHRs, Ranked

Broward Health Transforms Care with Epic Implementation

US Acute Care EHR Market Share 2024

Top 6 EHR Vendors Worldwide

Epic’s EHR Market Share Gains Continue, KLAS Report Shows

US Acute Care EHR Market Share in 2024

Pathology Team Encouraged about Migration to Epic Beaker Laboratory Information System

Two New York City Hospitals Join New Genetic Study to Perform Whole Genome Sequencing on 100,000 Newborn Babies to Search for 250 Rare Diseases

Nov 4, 2022 | Laboratory News, Laboratory Pathology, Laboratory Testing, Molecular Diagnostics, Genetic Testing, Whole Gene Sequencing, Precision Medicine

Goal is to demonstrate how whole human genome sequencing of newborns can deliver important diagnostic findings associated with 250 genetic conditions

Clinical laboratory testing and genetics are moving closer to the delivery room than ever before. In the largest study of its kind in North America, genomic scientists plan to supplement traditional screening for inherited diseases—traditionally performed on a blood sample taken shortly after birth—with whole genome sequencing (WGS) on 100,000 newborns in New York City during their first five years of life, LifeSciencesIntelligence reported.

Conducted by genetic scientists at NewYork-Presbyterian (NYP) and Columbia University, in collaboration with genetic company GeneDx, a wholly-owned subsidiary of health intelligence company Sema4 (NASDAQ:SMFR), the genetic research study, called GUARDIAN (Genomic Uniform-screening Against Rare Diseases In All Newborns), will screen newborn babies for 250 rare diseases that are generally not tested for.

The GUARDIAN program will “drive earlier diagnosis and treatment to improve the health of the babies who participate, generate evidence to support the expansion of newborn screening through genomic sequencing, and characterize the prevalence and natural history of rare genetic conditions,” according to a Sema4 news release.

Robert Green, MD

“The appetite for this is growing. The awareness of this is growing. We all see it as inevitable,” medical geneticist Robert Green, MD, at Brigham and Women’s Hospital and Harvard Medical School told USA Today. “We are grossly underutilizing the life-saving benefits of genetics and we have to get past that.” Clinical laboratory leaders understand the value of early detection of disease and subsequent early treatment. (Photo copyright: Harvard Medical School.)

Improving Health of Babies Through Early Detection of Disease

GUARDIAN aims to use WGS to identify conditions at birth that can affect long-term health and subsequently enhance treatment options and possibly prevent disability or death.

The 250 different diseases GUARDIAN will be screening for typically strike young children. They are mostly rare conditions that:

  • have an onset before five years of age,
  • have a greater than 90% probability of the condition developing based on the genetic result,
  • have effective approaches and treatments that are already available, and/or
  • have a well-established natural history of the condition.

“We’re entering the therapeutic era and leaving the diagnostic era,” Paul Kruszka, MD, Chief Medical Officer at GeneDx told USA Today. “This potentially has the opportunity to change the way we practice medicine, especially in rare disease.”

Some Parents Reluctant to Agree to Genetic Testing

Green and his research team first began analyzing the genetic sequences of newborns back in 2013. They believe the costs of performing infant WGS is worthwhile because it can improve lives. However, Green also recognizes that some parents are reluctant to agree to this type of genetic testing due to concerns regarding privacy and the fear of discovering their baby may have an illness.

“You’ve gone through all this pregnancy and you’re sitting there with a healthy baby (and I’m) offering you the opportunity to find out something that’s devastating and terrifying,” he told USA Today. “How fun is that?”

Green continued. “We can respect people who don’t want to know, but also respect people who do want to know. Some families will say ‘I treasure the precious ignorance.’ Others will say ‘If I could have known, I would have poured my heart and soul into clinical trials or spent more time with the child when she was healthy.’”

WGS Screening Identifies Undiagnosed Illnesses in Newborn’s Family

The scientists also found that performing WGS in newborns can detect diseases in the infants as well as unknown illnesses in the families of those babies. According to Kruszka, many parents often seek a diagnosis for a rare disease present in their children for several years. Since many common diseases develop as a result of certain combinations of genes, if illnesses are diagnosed at birth, it could extradite the treatment process, prevent complications, and provide better health outcomes for patients.

“We are relentlessly focused on accelerating the adoption and use of genomic information to impact the lives of as many people as possible, particularly newborns and children,” said Katherine Stueland, President and CEO, Sema4, in the Sema4 news release. “As the first commercial laboratory to launch a rapid whole genome sequencing offering, to address broad unmet needs for early diagnosis, participation in this study is an important step forward for healthcare and in delivering on our goal to sequence once, analyze forever.”

The study is open to all babies in New York City who are born in a health system that participates in the GUARDIAN program, regardless of their race, income, or health insurance coverage.

“The results from this study will help us understand the true impact sequencing at birth can have on newborns and their families in comparison to the current standard of care, particularly as we’ll evaluate clinical outcomes in addition to the psychosocial effect on families,” said Kruszka in the Sema4 news release.

Anything that improves the health of newborn babies is a good thing. Regardless of the cost, if DNA analysis can give newborns and their families a better chance at detecting inherited diseases early while clinical laboratory treatment could make a difference, it is worth pursuing.

—JP Schlingman

Related Information:

Understanding the Impacts of Newborn Whole Genome Sequencing

Sema4, GeneDx to Provide Whole Genome Sequencing and Interpretation Services for Landmark Genomic Newborn Screening Study

The Story Behind GUARDIAN, a Groundbreaking Newborn Screening Study

Can Gene Sequencing at Birth Prevent Terrible Diseases? Researchers Hope So.

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