The Epic Effect
The Epic
Effect
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Executive Summary
Epic’s position as the dominant electronic health record platform has never been stronger. As more health systems standardize on Epic, its influence over technology continues to grow. To better understand how that shift is changing the market, Redesign Health surveyed 112 senior health system leaders, including CEOs, CIOs, CMIOs, and vice presidents, at Epic-based health systems across the United States. The results paint a picture of a market increasingly consolidating around a single platform, with important implications for every health tech founder and investor.
While health system leaders express strong confidence in Epic’s expanding capabilities, they also recognize its limits. Many remain eager to partner with startups that solve problems Epic is less equipped to address, integrate seamlessly into existing workflows, or deliver meaningful improvements in speed, usability, and specialized functionality. The opportunity for startups is shifting, not disappearing.
The following report summarizes the survey findings and examines what they mean for health systems, founders, and investors navigating an increasingly Epic-first market.
This report presents the findings in full. The data tells three stories:
of health systems describe themselves as “Epic-first” — and 80% expect that bias to intensify over the next 3–5 years
have “complete” or “significant” confidence that Epic will execute on its AI roadmap to match best-in-class external solutions
of respondents are likely or very likely to purchase from a net-new startup, but the specific areas will be very important
The implication for founders and investors:
The window for competing with Epic is narrowing in the eyes of health system leaders. The startups that win will likely target certain functional areas, demonstrate an outsized ROI, and integrate with limited friction. This report identifies where some of those opportunities are.
Methodology
Redesign Health commissioned a quantitative survey of senior executives at health systems currently using Epic as their EHR platform. The study was fielded from October 29, 2025 through March 12, 2026. A total of 112 qualified respondents completed the survey.
Respondents were screened for seniority and purchasing authority. Thirty-six percent identified as CEOs, 21% as CIOs, 16% as CMIOs, 6% as Chief Clinical Information Officers, and 21% as VP-level decision makers within the CIO organization. Two-thirds (66%) are final decision makers for clinical and administrative information systems; the remaining third hold formal evaluation roles on purchasing committees.
The sample spans organization types: 52% from for-profit community hospital systems, 40% from non-profit community hospital systems, and 8% from non-profit academic-affiliated health systems. Revenue distribution is broad, ranging from under $250 million (13%) to over $10 billion (6%), with 50% of respondents from organizations with $500 million to $5 billion in annual operating revenue.
Self-assessed knowledge is high: 87% reported being “highly knowledgeable” about their organization’s Epic deployment and purchasing dynamics, with the remaining 13% “fairly knowledgeable.” No respondent rated themselves as only somewhat or not knowledgeable.
Statistical testing was performed at the 95% and 90% confidence levels (z-test) across organization type segments. Subgroups with fewer than 30 respondents are flagged accordingly throughout the data.
The Epic-First Reality
“Epic-first” isn’t an analyst’s label, it’s often how health systems describe themselves. Seventy-one percent of respondents say their organization prioritizes implementing Epic modules or solutions whenever possible. Not a single respondent said they prefer to incorporate external vendors over Epic first.
The remaining 29% say they evaluate Epic and external vendors equally on a best-in-breed basis. But even among this group, the gravitational pull is real: when asked about the factors driving their purchasing philosophy, “ease of integration and interoperability” was cited by 74% of all respondents. Single-platform value (45%), standardization preference (42%), and available internal resources (42%) round out the top tier.
The trend is also moving in one direction. Seventy percent of respondents said they’ve put greater emphasis on purchasing Epic modules over the past 3–5 years. And 80% expect Epic to become even more of a priority going forward. Only 6% anticipate shifting toward external best-in-breed solutions.
Source: Survey Questions S10 & S10a
The Spending Split
Source: Survey Question S9a
Non-profit community systems skew more heavily toward Epic (61% of spend) compared to for-profit systems (54%), representing a statistically significant difference.
These numbers are directionally consistent with the self-reported Epic-first philosophy. They also help demonstrate why Epic is so top of mind for any health system IS leader. With only $4 of every $10 going to external vendors for admin and clinical solutions, the question becomes: where is the best chance for another vendor (startup or otherwise) to compete?
AI Budget Dynamics
The survey uncovered an important structural shift in how AI solutions are budgeted compared to legacy software. 43% of respondents said AI solutions are more likely to hit department or service-line budgets first before eventually transitioning to central IT budget. Another 33% said AI will stay in department budgets permanently. Only 18% said AI would be completely centralized under IT from the start.
Startups selling AI solutions may find more receptive buyers at the department level, service-line leaders with autonomy and urgency, than through traditional IT procurement channels. 52% of respondents said department and service-line leaders have full autonomy to make purchasing decisions. That being said, AI governance committees are now found across health systems, so even a department with its own budget control doesn’t operate independently — AI solutions it pays for still get centrally reviewed for efficacy, safety, security, and so on. Those departments will also likely face the question of why Epic can’t just do it for them, especially once the central IS team that would help integrate the solution gets involved.
Source: Survey Questions S15–S16
Epic’s AI Ambition and the Confidence Question
Epic’s 2025 User Group Meeting appears to have landed. Sixty-six percent of respondents reported increased interest in Epic solutions following UGM announcements, with another 17% waiting to see real-world performance before forming an opinion. Only 4% reported decreased interest. We’d hypothesize that this trend will continue following future meetings.
Source: Survey Question S17
The most-anticipated new offerings tell you where Epic is directing attention:
Source: Survey Questions S18–S19
People who think health system leaders don’t believe Epic can deliver on its promises may be disappointed. 60% of respondents expressed “complete confidence” that Epic will execute on its AI solutions to match best-in-class external vendors. Another 31% expressed “significant confidence.” Only 9% fell below that threshold and just 1% reported “little confidence.”
However, confidence in a vendor’s ability to execute is not the same as believing that vendor will outperform every other vendor in every area. As the next section shows, the same executives who express high confidence in Epic’s AI trajectory also identify specific functional areas where they believe external vendors will win.
Where External Vendors Can Compete
Respondents were asked to rate, on a 1–5 scale, how likely it is that an external vendor of any kind could compete against new and existing Epic solutions across 17 functional areas. Higher scores indicate greater perceived opportunity for external vendors. The overall mean across all categories was 3.37 — slightly above the midpoint, suggesting cautious but real openness.
Source: Survey Question S21
Source: Survey Question S21
The gap between the highest- and lowest-ranked categories (3.52 vs. 3.16) may look narrow in absolute terms, but it represents very different probability environments for startups entering these markets. The categories at the bottom (bed management, interoperability, and clinical decision support) are areas where Epic’s existing data position and workflow integration give it a structural advantage that is difficult to displace. The higher-ranked areas, by contrast, often require coordination with external organizations (e.g., discharge), represent domains where Epic has historically placed less emphasis (e.g., imaging), or involve patient-facing experiences where specialized vendors may have an advantage.
The Startup Question
For those launching new businesses, the survey asked respondents to identify which four functional areas they believe a new startup (not an established vendor) has the best opportunity to compete in. The results somewhat mirror what we saw for where external vendors can compete, with some reordering of the prioritization.
Source: Survey Question S23
The bottom of the list is equally instructive:
Clinician-facing AI (ambient scribing) tops the list at 48%, which is notable because this is also the category where Epic just announced its own native ambient scribe. This may be a legacy reaction to having kicked the tires and/or already deployed other scribing solutions prior to Epic’s announcement.
Imaging AI ranks second (44%), consistent with its top position in the general external vendor competition analysis. This is a category with deep specialty requirements and a fragmented workflow landscape that plays to the strengths of focused startups.
At the bottom, interoperability was selected by just 4% of respondents. Interestingly, supply chain and research also appeared infrequently in respondents’ top four choices, despite research ranking highly in the previous section and supply chain being a well-known pain point for many health systems. We’ve also heard feedback that Epic’s risk stratification capabilities can be relatively basic. Yet for most leaders, they appear to be good enough to meet current needs.
The ROI Bar and How Deals Get Done
Even when health systems see opportunity for external vendors, it’s important to note that their bar will be higher. 49% of respondents said external vendors must demonstrate a “significantly higher” ROI and/or target outcome improvement over Epic solutions. Another 29% require “somewhat higher” ROI. Only 18% apply the same evaluation criteria to both.
A product that is marginally better than Epic’s offering, or even one Epic is likely to build in the future, won’t win. It needs to be demonstrably and measurably superior, and ideally compete in areas where health system leaders don’t expect Epic to eventually catch up.
Source: Survey Question S31
Why Health Systems Choose Epic
When asked why they’ve selected Epic over available external solutions, the top reasons were:
Source: Survey Question S26
The “good enough” signal at 48% is worth pausing on.
Nearly half of these executives are saying Epic gets to clear a lower bar when weighed against the friction of deploying an external vendor (50%), which likely factors into the cost efficiency calculation they are making (47%). Integration, however, may become easier as AI continues to advance. As that friction comes down, it will be interesting to see what new opportunities open up.
How External Vendors Win
When we asked respondents to rank the ways external vendors beat Epic, ease of integration appeared in over 63% of rankings, with faster time to value close behind at 59%. Those two were also the most common first-place picks: 27% ranked ease of integration first, and 16% ranked faster time to value first.
Source: Survey Question S30
There Is Still Receptivity to Working with Startups
The final data point that matters for founders and investors is how willing these executives are to actually buy from a new company or startup?
Source: Survey Question S32
64% of respondents rated themselves as likely or very likely to purchase from a net-new startup with three or fewer live customers. That number rises only modestly to 68% for medium-sized startups and 76% for established incumbents. The gap between a brand-new startup and an established vendor is “only” 12 percentage points.
Non-profit community hospital systems are notably more open to startups than for-profit systems: 47% of non-profit leaders rated themselves “very likely” to buy from a net-new startup, compared to 24% of for-profit leaders, which is statistically significant.
Design-partner arrangements (≤3 live customers, willingness to co-build) showed similar appetite at 62% likely. Perhaps surprisingly, these findings suggest that co-development opportunities, roadmap influence, and feature collaboration may be less important to health system leaders than the product itself, even when compared with vendors at a similar stage of traction. We’d hypothesize that many organizations see the co-development as more work than it’s worth to them given the influx of AI solutions and projects they are managing.
What It All Means
For Founders
Pick your functional area with extreme care. The difference between building an imaging AI company (44% of executives say startups can compete) and an interoperability solution company (4%) is the difference between a viable market and a market that doesn’t think you have something worth buying. Clinician-facing AI, imaging AI, patient AI assistants, discharge & care transitions, and revenue cycle AI are the categories where health systems are most willing to look beyond Epic.
Your integration story is what leaders are going to immediately consider and something not enough startups optimize for. Ease of integration is the single most-cited factor when external vendors win over Epic.
Needing to demonstrate a higher ROI shouldn’t come as a surprise to most founders. But these findings underscore the importance of articulating, with absolute clarity, why your product is materially better than Epic’s and why Epic is unlikely to catch up.
The GTM surface area is getting wider; AI budgets are landing in department and service-line budgets, not centralized IT. 52% of department leaders have full purchasing autonomy.
For Investors
The highest-conviction categories for startup investment are those that rank high on both the general ability to compete (mean score on the 1–5 scale) and the startup-specific opportunity question (% selecting).