Did one company quietly become the gatekeeper of U.S. patient records? That’s the claim Texas Attorney General Ken Paxton made in a lawsuit this week, filing antitrust charges against Verona, Wisconsin–based Epic Systems and accusing the electronic health records (EHR) giant of wielding monopoly power and restricting parental access to children’s medical records.
Epic — whose software runs in hospitals and clinics across the country — is no stranger to scrutiny. But this case plants a state-level challenge squarely on Epic’s business model: Texas says the company has locked hospitals into its ecosystem, amassed control over patient data, and used that control to choke off competition and limit how patients and families access their own medical information.
What Texas alleges
The suit paints a familiar picture in monopoly cases: an incumbent amasses an enormous base of users and then raises the technical and financial barriers so high that rivals can’t compete. According to Texas, Epic’s database contains more than 325 million patient records — a scale that, the filing says, encompasses over 90% of U.S. citizens. Once a hospital adopts Epic, the state alleges, switching away is effectively impractical: it can take years and cost upwards of $1 billion.
Texas accuses Epic of operating an “anticompetitive playbook,” including delaying or restricting data access for potential competitors, imposing heavy penalty fees that deter customers from adopting rival apps, and otherwise acting as a gatekeeper for who gets to use patient data and on what terms. The lawsuit seeks a court order to stop the alleged unlawful conduct and wants damages and civil penalties.
There’s a second, politically charged claim in the complaint: Texas says Epic sold software to health systems that was "preconfigured to remove parental access" to minor children’s records, which the state argues violates Texas law on parental rights. Epic has pushed back, saying it does not determine parental access and that individual health systems make decisions about record access.
Why it matters beyond the courtroom
If the allegations stick, the case could ripple across health care and digital-data policy. EHRs are the plumbing of modern medicine — they route test results, prescriptions, imaging and more. When a few vendors dominate that plumbing, it shapes who innovates around it: startups building patient-facing apps, research projects that rely on data flows, and hospitals that want modular tools rather than monolithic suites.
The dispute also revives an old debate about the word "monopoly." Consumers and regulators wrestle with whether dominance is harmful by itself or only when coupled with exclusionary conduct — a debate playing out across industries from game distribution to cloud services. For a parallel discussion about market concentration and the meaning of 'monopoly' in tech, see coverage of how developers view platform dominance in the games market.
And this is ultimately a data‑access story. Patient records are sensitive, regulated, and immensely valuable. The Texas suit frames Epic as controlling access to that data in ways that could limit innovation and patient choice. That echoes broader anxieties about who controls personal and health data as new AI and search tools increasingly rely on large, centralized datasets; for context on how data access and privacy are being debated in other tech spheres, consider reporting on AI systems that plug into personal services like Gmail and Drive.
Epic’s response and the broader legal landscape
Epic has dismissed the Texas suit as "flawed and misguided," saying the company doesn’t set policies about parental access — hospitals and clinicians do — and pointing to the scale of data sharing its customers have enabled. Public statements from Epic emphasize the number of patient-facing app connections and the claim that health systems, not Epic, control access policies.
This suit is the latest in a string of antitrust challenges involving Epic. Competitors and some customers have argued in recent months that Epic’s market position and integration practices make it hard for rivals to compete. How courts interpret that mix of market share, switching costs and contractual relationships will be crucial.
The stakes for patients, providers and startups
For patients and parents, the immediate question is access: can families retrieve and share records easily, or do technical and contractual hurdles stand in the way? For hospitals, the calculus involves cost, disruption and patient safety when considering a switch. For startups and app builders, limited data access means either expensive integration deals or being shut out.
Legal outcomes aside, the case will pressure health systems, regulators and vendors to clarify who owns, controls and can move health data. That’s not just about dollars; it’s about how smoothly care coordinates across providers, how quickly innovation can roll out, and who gets to build the next useful tool that helps patients.
This is a live legal fight, and the court’s handling of complex technical and economic evidence will matter. Expect other states, federal agencies, or industry groups to watch closely — and to keep asking a simple question: when health records become both essential infrastructure and high-stakes data, who decides who gets through the gate?