No. 03 · The observatory
Hospital records (EHR)
The VA paused its EHR rollout for 20 months. Users said it slowed them down.
- Status
- Open
- Rank
- 32 of 35 in the atlas
- Scored
- 2026-10-05
- Report
- Back to the study
- Rank
- 32 of 35, published score 43.0
- Scoring date
- 2026-10-05, reported 2026-10-09
- Buyable
- $12.7B buyable midpoint, $9.3B to $17.3B recorded legacy spend
- Factors
- size 4, pain 2.8, AI fit 3, lock-in 3.5, crowding 4.7
- Coverage
- none recorded; AI-native challenger recorded
Hospital records (EHR)
Ranked 32 of 35 at 43 out of 100.
Hospital electronic health record systems of record.
What the evidence says
The checked evidence corroborates bounded EHR pain. A GAO report documents the VA halting new deployments in April 2023. User feedback said the new system delivered less than expected. Resumption came about 20 months later after over 1,500 changes.
Sources:
Providers
The card checked three incumbents: Epic, Oracle and MEDITECH. Epic reports 325 million-plus patients across its environments. Oracle documents one buyer’s network of 41 practices and clinics. MEDITECH reports about 2,200 active sites at fiscal 2019 year-end. The units are incompatible. No ranking is supported.
Abridge is the recorded challenger. It is a clinical-documentation overlay, not an EHR-core replacement. Its AI-native status is recorded as unknown.
Sources:
- Generative AI for Clinical Conversations | Abridge
- Transforming Medical Notetaking for Our Customers | Abridge Customers
- Pioneers in Generative AI for Healthcare | About Abridge
- About | Epic
- Huntsville Hospital Health System Standardizes on Oracle Health to Improve Patient Care and Drive Innovation
- Medical Information Technology, Inc. Form 10-K for the fiscal year ended December 31, 2019
- United States Government Accountability Office
The pain
The VA halted deployments after five sites. Surveyed users disagreed that the system made them efficient.
About 1,800 complex change requests remained open in February 2025. The 2022 lifecycle cost estimate was $49.8 billion and needing update.
Sources:
Events
The VA announced its deployment halt in April 2023. Resumption was announced in December 2024. Improvement since 2022 is documented alongside persistent dissatisfaction.
Sources:
Limits
All pain evidence is one GAO report on one federal buyer. The interviews were a judgmental sample of 71 users. No universal obsolescence or replacement-caused-all-harm claim is made.
Sources:
- About | Epic
- Huntsville Hospital Health System Standardizes on Oracle Health to Improve Patient Care and Drive Innovation
- Medical Information Technology, Inc. Form 10-K for the fiscal year ended December 31, 2019
- Generative AI for Clinical Conversations | Abridge
- Transforming Medical Notetaking for Our Customers | Abridge Customers
- Pioneers in Generative AI for Healthcare | About Abridge
- United States Government Accountability Office
In their words
the new system was not meeting expectations
Source: GAO attributed account of VA explanation, 2025-03-12
the increase in the number of steps required to complete actions in the system
Relevant workflows
6 recorded openings. A missing mapped round is a coverage gap, not an empty field.
| Workflow | Index | Labour | AI use | Core | Mapped |
|---|---|---|---|---|---|
| Clinical documentation (nursing flowsheets, physician notes, discharge summaries) ehr-hospital:wf_clinical_documentation | 219 | $109.2B | 32% | non-core | 10 |
| Coding, CDI, charge capture, prior authorization and HIM/release of information ehr-hospital:wf_coding_revenue_him | 150 | $18.0B | 32% | non-core | 2 |
| Care coordination: results inbox, handoffs, discharge planning and referrals ehr-hospital:wf_care_coordination | 141 | $81.5B | 9% | non-core | 4 |
| EHR build, interfaces and legacy system maintenance ehr-hospital:wf_ehr_build_maintenance | -224 | $34.1B | 48% | touches core | 0 |
| Patient registration, ADT and scheduling (patient administration system) ehr-hospital:wf_registration_adt | -266 | $21.1B | 44% | touches core | 0 |
| Orders, medication reconciliation and pharmacy verification (CPOE / MAR / BCMA) ehr-hospital:wf_orders_medication | -292 | $113.5B | 7% | touches core | 0 |
Recorded providers
Provider claims carry their recorded kind and citations. Undisclosed figures stay undisclosed.
| Provider | Products | Parent | Claims |
|---|---|---|---|
| Epic Systems | Epic EHR | unknown | cl-ehr-epic-rel (inference) source cl-ehr-m-epic-325m (observation) source |
| Oracle | Oracle Health Foundation EHR | unknown | cl-ehr-oracle-rel (inference) source cl-ehr-m-oracle-41 (observation) source |
| Medical Information Technology, Inc. (MEDITECH) | MEDITECH EHR | unknown | cl-ehr-mtc-rel (inference) source cl-ehr-mtc-inc (inference) source cl-ehr-m-mtc-2200 (observation) source cl-ehr-m-mtc-hca200 (observation) source |
Recorded inputs
Raw scored inputs exactly as frozen. Values and units keep their recorded definitions.
| Factor | Input | Value | Count | Score |
|---|---|---|---|---|
| pain | keep_alive_share | 0 | 63 | 1 |
| pain | backend_failure_share | 0.31 | 100 | 5 |
| pain | app_rating_inverted | 3.84469 | 27 | 3 |
| pain | failed_rate | 0.4166666666666667 | 12 | 2 |
| pain | s3_grade | weak | 1 | 3 |
| pain | mean | 2.8 | unavailable | 2.8 |
| lockin | award_duration_months | 48 | 14 | 3 |
| lockin | noncompetitive_share | 0 | 17 | 1 |
| lockin | replacement_duration_months | 104 | 5 | 5 |
| lockin | regulator_approval | true | 1 | 5 |
| lockin | mean | 3.5 | unavailable | 3.5 |
| crowding | ai_native_traction | 5 | 5 | 5 |
| crowding | funding_per_billion | 156142942.39837757 | 16 | 5 |
| crowding | yc_2024_plus | 11 | 11 | 4 |
| crowding | mean | 4.666666666666667 | unavailable | 4.7 |
| size | users_midpoint | 88 | unavailable | unavailable |
| size | buyers_mid | 479536.5 | unavailable | unavailable |
| size | midpoint | 12699901574.42175 | unavailable | unavailable |
| ai_fit | mean | 3.348750000000001 | 12 | 3 |
| ai_fit | unanswered | unavailable | 0 | unavailable |
Recorded sources
40 recorded citations. Each link lands on the sources catalogue.
Back to the 35-category table or the explorer.