For most of the past decade, the default move when a health system wanted a new technology capability was to wait for Epic or Oracle to build it. The EHR was the biggest line item in the IT budget, the system of record for everything clinical, and the safest bet for interoperability. Waiting made sense.
That calculus is changing fast.
In our 2026 CIO Research Report, 74% of health system technology leaders identified reliance on their EHR vendor’s AI roadmap as a top obstacle to executing their AI strategy. That figure alone is striking. But the year-over-year shift tells an even more urgent story. In 2025, more than half of respondents said they would wait 18 months for an EHR vendor to deliver an AI feature rather than deploy a proven third-party solution in three months. In 2026, only 22% said they would.
The patience has run out — and health system leaders know exactly why.
The cost of waiting isn’t hypothetical
The math has changed on waiting. Hospital margins averaged just 2.1% at year-end 2024. Federal spending cuts affecting Medicaid and the ACA have already started working their way through system budgets. And the workforce pressure that AI could help relieve continues to accelerate. Given these realities, waiting 18 months for a potential solution is hard to justify.
“I think that the cost of waiting for Epic or Oracle, or any of them, is you might lose out,” said Matthew Anderson, MD, CMIO at HonorHealth. “There’s a late-mover disadvantage.”
77% of the technology leaders we surveyed agreed that delaying AI operationalization — even by just one to two years — would mean real lost savings and efficiency gains. 94% said it would put their organization at a competitive disadvantage.
The decision framework CIOs are using
That doesn’t mean abandoning the EHR relationship. The leaders making the most progress have developed a clear filter for these decisions:
- Does the AI use case directly affect the bottom line, where every percentage improvement translates to millions in revenue?
- Does it touch a mission-critical area like patient experience?
- Can we afford the wait?
EHR vendors can’t do everything. The right tool for a given problem might not be the EHR, and the cost of pretending otherwise is increasingly visible on the balance sheet.
What this means in practice
The shift away from unconditional EHR dependency isn’t a rejection of those relationships. It’s a more honest accounting of what they can and can’t deliver at the pace healthcare now requires.
But both paths carry risk. While over-reliance on the EHR locks health systems into a single vendor’s roadmap, unchecked third-party AI sprawl creates a different kind of cost — more on that in our findings on vendor consolidation.
The full picture of how CIOs are navigating EHR dependency, use case prioritization, and the move toward platform consolidation is in the 2026 report.
