Judith Faulkner came to Madison, Wisconsin in the 1970s for graduate studies in computer science, then stayed on to teach it at the University of Wisconsin-Madison. In 1979 she founded what became Epic Systems with $70,000 from friends and family, running it out of a basement office with two part-time assistants. Forty-seven years later, Epic has never taken a dollar of venture capital or private equity, never gone public, and never acquired another company -- Faulkner has said publicly it never will go public. Every line of its software is still built in-house.[1]
The result of that refusal to dilute control is now one of the most consequential single companies in American healthcare. Epic's own count is more than 325 million patients with a current electronic record in its software -- a global figure, since Epic also operates in the UK and several other countries, not a US-only one, despite that distinction getting blurred in some of the coverage of it. The cleaner US-specific numbers: in 2025 Epic held 43.7 percent of the U.S. acute-care hospital market by facility count, up from 42.3 percent the year before, and 56.9 percent of hospital beds nationwide, up from 54.9 percent -- the largest single-vendor share of America's hospital data that any company has ever held.[2]
In December 2025, Texas Attorney General Ken Paxton sued Epic in state court, alleging the company runs an "anticompetitive playbook" that blocks rivals from accessing data, enforces noncompete agreements that Paxton's office says have restricted former Epic employees from working at thousands of other healthcare software firms, and defaults MyChart's parental-proxy settings to cut off parents from a child's full medical record once that child turns 12. Epic called the lawsuit "flawed and misguided," saying the state misunderstands its business model and its contributions to American healthcare.[3][4]
Texas is not the only front. Particle Health, a smaller data-interoperability company, filed a separate federal antitrust suit against Epic in 2024 alleging Epic made competition in the health-data-exchange market effectively impossible; a judge let that case proceed to discovery in late 2025. The Federal Trade Commission has also opened its own investigation into how Epic grants or restricts competitors' access to the data it holds -- the kind of inquiry that tracks classic Sherman Act monopolization theory: refusal to deal, exclusionary contract terms, self-preferencing against rivals trying to interoperate with a dominant platform. None of the three cases has been decided. All three are live, unresolved, and running at the same time.[5]
Epic is not only on the defending end of that fight. In January 2026, Epic and a coalition of healthcare providers sued the interoperability network Health Gorilla and several of its clients, alleging they set up fraudulent provider identities to improperly access and monetize nearly 300,000 patient records -- Epic acting to police access to the data its own dominance puts it in a position to gate.[6]
Forward BIOLABS, a nonprofit shared-lab space that opened in 2018 inside University Research Park, runs on the reverse premise: a startup rents lab space by the six-foot bench and shares equipment that would otherwise cost any single young company hundreds of thousands of dollars and six to twelve months to acquire on its own. It has hosted 13 University of Wisconsin-Madison spinouts so far, including BrainXell, founded by UW-Madison neuroscience professor Su-Chun Zhang, and Vascugen, founded by Carter Cliff, a veteran of two earlier UW spinouts, Cellular Dynamics and Opsis.[7][8]
The distributed model has its own real scale. Since 1990, more than 400 startups built on UW-Madison research have generated a combined $12.4 billion in Wisconsin economic impact and supported 88,571 jobs across the state -- part of the university's total $38.9 billion annual footprint on the Wisconsin economy.[9][10]
Both bets draw from the identical source: the University of Wisconsin-Madison's research and talent pipeline, the same one that trained Faulkner herself before she ever founded a company. But the mechanism each one runs on points in opposite directions. Epic's is concentration by design -- refuse outside capital, refuse acquisition, keep every process in-house, and let one company become the default infrastructure for an entire category. Forward BIOLABS's is distribution by design -- treat the expensive infrastructure as a shared resource on purpose, specifically so that no single company has to own it all to survive its first few years. Concentration produces exactly the kind of dominance that a state attorney general, a federal court, and the FTC are now all separately scrutinizing at once. Distribution produces the opposite risk: no single company built this way is likely to ever reach Epic's scale, because reaching that scale was never the design goal.
Neither bet is free. Concentration built the company capable of managing more American medical records than any hospital system, insurer, or government program ever has -- and it also built the company now facing three simultaneous legal challenges over what that scale lets it do. Distribution built an ecosystem structurally insulated from that specific risk -- and none of its 13 companies individually employs a fraction of Epic's 14,000 people. Madison did not choose one strategy over the other. It ran both, from the same university, at the same time, and forty years later the tradeoffs each one was always going to produce have both arrived.