Cardiovascular IT systems keep evolving with AI, Epic integration on the rise

Epic’s growing presence in cardiology

Epic has grown to become the biggest acute care EMR vendor in the U.S., with about 42.3% of the market according the KLAS Research. The next closest competitor is Oracle, with less than 25% of the market. Epic's continued growth and consistent high end-user ratings have made it one of the most important to ensure interoperability with cardiology and other speciality health IT vendor software. While Epic does have a cardiology department software module, Cupid, it lacks some of the more detailed clinical information needed for care decisions, which has opened a space for third-party vendors.

Epic, along with most other EMR vendors, has not pursued the necessary U.S. Food and Drug Administration (FDA) regulatory clearances that would be needed to offer clinical software that would have a direct impact on patient care. This has enabled many of the traditional CVIS or cardiac PACS vendors to continue offer their long-standing cardiology health IT systems, provided they have solid integration capability with Epic. This has also created a cooperative environment between these third-party vendors and Epic.

Thompson said a recurring theme among cardiology IT vendors at the meeting was the widespread adoption of Epic’s Cupid cardiology module, which requires a balancing act for third-party vendors. While Cupid may have some limitations, it is offered as part of the Epic package to health systems, and some cost-conscience C-suite executives are asking why they need to pay for other third-party IT systems as add-ons.

"Because many of these institutions have invested in Epic, Cupid isn't an additional cost to them; it's an extension of their broader enterprise contracts. So it's very challenging for institutions and cardiologists to justify, for example, a free product versus a specialized add-on when there is overlap in functionality, although there is still distinct differences between what both do still offer," Thompson explained.

There is wide expectation that Epic will not cross the boundary into clinical software that requires regulatory approvals because it would create a lot of headaches.

"Epic's drawn a very clear line so far. There's no indication that Epic, or any EMR vendor, is seeking the regulatory side of becoming a medical device company. But that's also one of the big concerns of what if they do, because then that does stir a very different market dynamic," she said.

Unlike radiology, where EMRs have displaced some PACS and reporting tools, cardiology has maintained a more specialized ecosystem because of its different requirements and data registry associated to cardiovascular care, Thompson said.

Remote patient monitoring on the rise

The ability to integrate with Epic and other enterprise systems is more than necessity for having a complete patient medical record in one location. Thomson said it also is becoming a critical part of managing the explosion of data from remote monitoring, wearables and at-home cardiac care devices. The integration of this remote monitoring data was a big discussion point at ACC.25.

"I think a really important trend in the industry is that fundamental interoperability is not only about playing well with the EMR vendors. We are also seeing an increase in ECG wearables and a lot more home care management," Thompson explained. "Of course, all of that leads to more data that needs to come back to the cardiologist to optimize and ensure patient care quality."

Remote monitoring of implantable electrophysiology devices and wearable ECG monitors, which are quickly replacing traditional cardiac event and Holter monitors, has been a popular IT talking point in 2025. With large amounts of real-time data now being streamed into IT systems, AI is also playing a growing role with its ability to sift through a lot of information and pull out nuggets of actionable data.

AI becoming central to cardiovascular IT strategy

Artificial intelligence in cardiology is no longer an experimental tool, it is now seeing rapid deployment and is becoming foundational ion health IT systems, especially in imaging and diagnostics. Cardiology ranks is No. 2 behind radiology in FDA clearances for clinical AI, with more than 180 algorithms.

Thompson highlighted two key trends for why AI is being adopted in cardiology. The first is the rise of automation in echocardiography, and the second is improved reimbursements that are driving the adoption of coronary CT angiography (CCTA) AI tools.

She noted that the “most standout showcase” has been CT and CCTA AI platforms, especially around image-derived fractional flow reserve (FFR-CT) and automated coronary soft plaque analysis.

AI developers such as HeartFlow and Cleerly are “not done,” Thompson emphasized. “Achieving a Category 1 code is a gold standard, but that’s also not it ... if one vendor’s doing well or a new vendor comes to market, it’s all helping build the market up to help with that adoption,” she said.

Next wave of AI adoption is CT plaque and inflammation imaging

Beyond traditional metrics to measure disease and patient risk scores for cardiac events, new AI vendors are pushing deeper into plaque composition and inflammation imaging. “It’s going from calcium scoring, down to FFR-CT, down to plaque, and now for Caristo, going actually further into coronary inflammation,” Thompson said.

AI vendor Caristo recently received FDA clearance for its base CCTA analysis platform and is pursuing approval for its unique fat attenuation index (FAI) inflammation imaging tool. This allows the visualization of inflammation around soft plaques to produce much more precise risk assessments for each patient, rather than using population level one-size-fits-all risk scoring. With new drugs to treat coronary inflammation, this may be the tool to show clinicians which patients need this extra therapy. This imaging also can show the reversal of inflammation due to drug therapy.

New AI that is just entering the market allows for algorithms to view all types of CT scans that include part of the heart in the field of view to conduct opportunistic coronary artery calcium (CAC) screenings. With AI alerting clinicians to patient risk scores based on a completely unrelated scan will likely catch large numbers of at-risk patients long before they become symptomatic and seek help from a cardiologist.  

The evolving strategy around early identification of cardiovascular risk is also reshaping both diagnostics and therapeutic development.

"If you can identify them sooner and you have drugs to help mitigate or even prevent the plaque from actually building up in the first instance, it could become a really powerful market dynamic," Thompson explained.

But, integration of all this AI-generated information and alerts into the CVIS and cardiac PACS will be needed in order for it to be actionable.