Hospitals face strategic risk from vendor lock-in

Vendor lock-in in healthcare is framed as a governance, clinical and financial risk, not simply an IT issue. High switching costs can weaken hospitals’ ability to adopt better clinical tools, respond to regulation and negotiate renewal pricing. Peer-reviewed analysis cited in the briefing says large health systems can face migration costs from hundreds of millions to over $1 billion, with Partners HealthCare budgeting $600 million for a rollout that ultimately cost $1.2 billion.

The risk is amplified by market concentration and regional interoperability mandates. Epic Systems is cited as serving 42.3% of acute care hospitals, controlling 54.9% of acute care hospital beds and capturing nearly 70% of new hospital contracts in 2024. In the EU, the EHDS Regulation requires EHR systems on the market to support a common European exchange format, while NHS England mandates FHIR UK Core for new and migrating APIs.

The recommended safeguards center on contract terms set before signature: standards-based export in formats such as HL7 FHIR, published read and write APIs, explicit ownership of clinical and operational data, no punitive extraction fees and a maintained exit strategy for each critical system. An openEHR-based architecture and CaboLabs’ Atomik platform are positioned as ways to support vendor-neutral persistence by separating clinical knowledge from application software, keeping data portable across systems and regulatory environments.