The Source Blog

Discussions of health care consolidation often center on providers and insurers, but growing concentration among the companies that operate behind the scenes poses equally serious risks.  For example, the Change Healthcare data breach in early 2024 caused significant disruptions in healthcare because Change processes approximately half of all U.S. medical claims, and a single cyberattack disrupted large swaths of the health care system.  Similar dynamics are playing out in other sectors of the health care system.  More than 305 million patients have electronic health records controlled by Epic.  At the end of 2025, Texas filed suit against Epic, claiming that Epic used its significant market share in healthcare records to exclude competitors and protect its market dominance, thereby raising costs for Texas hospitals and patients.  The Texas complaint also alleges that Epic violated parents' rights by limiting access to children's health records, which the Texas Attorney General claims is a violation of the Texas Medical Records Privacy Act.

Epic’s history of electronic health record market dominance

Epic is a software company that provides electronic health record resources for hospitals and health systems that allows them to access, store, organize, and share electronic medical records.  Epic includes patient portals, telehealth, charting, and clinical systems for healthcare providers.  According to 2024 numbers from Definitive Healthcare, Epic controls 37.7% of the acute care hospital electronic health records market, with its closest competitors being Oracle at 21.7% and Meditech at 13.2%.  Epic has a 43.9% market share for ambulatory health records and controls 51.5% of the U.S. healthcare record market for acute multispecialty hospital beds.  In recent years, Epic has expanded into the European market, with sales in countries including Denmark, Finland, Norway, and the United Kingdom.  According to Forbes, Epic made about $5.7 billion in sales in 2024, and more than 305 million patients have an electronic record in Epic.

Claims made in the case filed in Texas

The Texas lawsuit lays out a series of interrelated allegations that together portray Epic as using its dominance to control access to health data, restrict competition, and raise costs. The complaint describes Epic as a powerful intermediary that leverages its dominance in electronic health records to entrench its market position and shape how patient data can be accessed and used.

First, the suit claims that Epic uses its market share to limit hospitals’ ability to use their own patient data, to prevent others from developing competing products, and to impose barriers that prevent hospitals from working with competing health record vendors and third-party application developers, making Epic a gatekeeper over patient data.  The filing also claims Epic improperly denies or delays access to patient records by providers who don’t use Epic.  Additionally, the suit noted the high costs of using Epic, explicitly citing the $500 million cost to Memorial Hermann Health System for implementing Epic in 2024.

Second, the suit claims that Epic’s systems are preconfigured to automatically restrict parental access to their children’s medication lists, treatment notes, and provider messages once a child turns 12.  In a related press release, the Texas Attorney General stated, “We will not allow woke corporations to undermine the sacred rights of parents to protect and oversee their kids’ medical well-being.”  The wording of the release suggests that the primary motivation for Texas to bring this suit may be the parental access aspect, more than the market dominance aspect.

The suit asserts that these claims violate the Texas Free Enterprise and Antitrust Act, the Texas Deceptive Trade Practices Act, and the Texas Medical Records Privacy Act.  The relief sought by the state includes injunctive orders barring Epic from continuing the conduct, structural remedies to restore competition, and civil penalties and damages.

Recent history of cases involving Epic

This Texas suit is the third major recent case filed against Epic.  On September 23, 2024, Particle Health, a startup that aggregates and shares data among healthcare providers and health technology companies, filed suit alleging that Epic is using its market power to destroy competition.  In May 2025, CureIS Healthcare filed suit claiming that Epic engaged in a "multi-prong scheme to destroy" competition and used market dominance to prevent innovation.

In 2020, when the federal Department of Health and Human Services proposed regulations to promote interoperability of healthcare records, Epic lobbied hard to oppose them.

Similar claims about parental access by Texas

The suit’s focus on parental access to health records of minors is not new for Texas.  In October 2025, the Texas Attorney General announced an agreement with a Texas health provider to restore parental access to the medical records of minors after electronic record settings had restricted them.  The Epic case differs in that it shifts the focus from a healthcare provider to the health record technology provider.

Epic’s response

In a response to Becker’s, an Epic spokesperson stated that Epic facilitates more than 725 million record exchanges each month, more than any other EHR vendor, with more than half occurring with non-Epic systems, and that it does not determine parental access to children’s medical records; those decisions are made by physicians and health systems.  Epic called the Texas suit “flawed and misguided by its failure to understand both Epic’s business model and position in the market and the enormous contributions our company has made to our nation’s healthcare system”.

Conclusions

The Epic cases show an interest in healthcare market dominance that goes beyond hospitals and insurance companies.  Specifically, for health IT companies, the concepts of interoperability and access may go beyond best practices.  A health electronic record company that doesn’t work well with others, especially when that company has a dominant market position, could be suggestive of a misuse of market power.  There is value in healthcare records, and regulators are increasing scrutiny of who really controls them.

The recent focus by Texas on parental rights over the electronic healthcare records of minors, and the claims that Epic’s actions violate Texas medical records law puts an unusual wrinkle in what would otherwise be a straightforward antitrust case.

The Texas case against Epic is worth watching; if Texas is successful, it seems likely that other states may pursue their own lawsuits.

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