Approaches to Moving Epic in the Cloud 2023
Which Public Cloud Providers Are Early Movers Considering?

Microsoft Azure Often a Front-Runner Due to Respondents Already Leveraging Azure or Microsoft Tools in Other Areas

AWS’ Epic Expertise and Strong Bench of Technical Resources Drive Considerations 

Because AWS introduced broad cloud capabilities to the market relatively early, they are frequently considered in this sample and perceived as being ahead of Microsoft Azure in developing the capabilities healthcare organizations need. Reasons for consideration include existing proof points with other Epic customers, technical expertise (Epic publishes architectural guidance for AWS), and a strong bench of resources that can provide professional services, support onboarding, and help develop organizations’ long-term cloud strategies beyond moving their EHR to the cloud. Among those who likely won’t select AWS, one feels AWS has an immature healthcare focus and hasn’t yet built up clinical subject matter expertise, while another feels the overall cost—when factoring in AWS’ partner costs—is much higher than other similarly structured options. Further, because many respondents already use Microsoft products—including Microsoft Azure—at their organizations, some are contemplating moving forward with Azure to consolidate contracts and vendor relationships.

What about Google's and Epic’s Hosting Services?

Google Cloud Platform (GCP) is rarely considered because of concerns about poor relationships, lacking Epic experience, a weak healthcare strategy, and their methods for managing security and protecting patient information. Four respondents are considering using Epic’s hosting services instead of a public cloud provider; reasons for consideration include Epic’s knowledge of their products and the engineering and IT resources that allow clients to be relatively hands-off. Cost and the lack of support for non-Epic products are each mentioned as reasons for not considering Epic more seriously.

Most Respondents Want to Quickly Leverage Disaster Recovery Capabilities while Moving Their Production Environment to the Cloud over Next Year or Two

Several interviewed organizations feel a sense of urgency to begin transitioning to the cloud, though their reasons for doing so vary. Some want to avoid making significant capital investments in hardware, improve data security, and find alternatives to current hosting options that can’t meet their needs. Most respondents want to use the cloud for disaster recovery within the first three months of contracting with their public cloud provider; this would give them ample opportunity to test the migration process and safeguard against the need to resort to paper during an outage. Moving to a full production environment is then expected to take one or two years. Beyond moving the EHR to the cloud, almost all respondents plan to take advantage of having Cogito data in their cloud environment. They also anticipate moving other applications (both Epic and non-Epic) to the cloud. Respondents who anticipate taking the longest to move to the cloud say that finding skilled resources, developing a deep understanding of cloud architecture, and consolidating their health system onto one EHR are constraints that will likely slow them down.

For Most Respondents, Capital Cost Reduction Is the Primary Goal of Moving to the Cloud; However, Uncertainty around Costs Are the Primary Concern

Respondents’ number-one goal in moving their Epic environment to the cloud is to cut capital costs by eliminating hardware investments. Further, public cloud providers’ flexible contracting (which allows organizations to pay for only the cloud services they use) is anticipated to help reduce spending; those considering AWS mention this benefit more frequently than organizations considering other public cloud providers. Other frequently mentioned goals include improved system reliability and uptime and fewer FTEs providing on-premises support. Though capital cost reduction is the main driver for moving to the cloud, cost uncertainty is the top concern. There are many variables that make the true cost of cloud hosting difficult to nail down, and respondents worry their costs could increase in the long run if their cloud environment isn’t architected properly, if utilization isn’t effectively monitored, or if their cloud provider increases the price when the contract renews. Additionally, several respondents (particularly those at larger organizations) are concerned about scalability, as public hyperscale cloud providers are still relatively new to hosting Epic in a production environment. Respondents are also concerned their staff doesn’t have the needed skills to support a move to the cloud.

Most Respondents Anticipate Using Third-Party Firms to Support Their Cloud Migration; Management Consulting Firms Are Top of Mind

About This Report

This report is the result of a perception study where healthcare organizations shared their decision-making process around moving their Epic environments to the cloud. To gather these perspectives, KLAS used a supplemental evaluation to interview 10 healthcare organizations that are actively considering moving part or all of their Epic environment to the cloud. Data was collected between September 2022 and January 2023.

Respondents were asked the following questions:

1. What Epic environments are you considering moving to the cloud?
2. When do you plan to select a public cloud provider and transition to the cloud?
3. Which public hyperscale cloud providers are you considering for your Epic environment, and why?
4. What are the key steps in your cloud-provider selection process?
5. What are you trying to achieve by moving to the cloud?
6. What are your primary concerns with moving to the cloud?
7. How prepared is your organization to move to the cloud?
8. Will you use a third party to support your cloud migration?
9. Do you intend to manage your own Epic application environment, or do you prefer to delegate this responsibility to a third party?