Dell Medical School just announced they’re running Epic entirely on Rackspace’s private cloud. No physical servers, no data center. They’re building an academic medical center that’s been cloud-native from the start.
I’ve been getting calls about this all week. The reactions range from fascination to skepticism, which seems about right. After staffing healthcare IT projects for the past 13 years, I’ve learned to look past the press releases and focus on what these moves actually mean for the organizations trying to keep their systems running while caring for patients.
Dell Medical School has an advantage most hospitals don’t have. They’re starting fresh. Their CIO, Michael Ryan, talks about the Epic deployment as “one of the first big steps” in building something new. Meanwhile, most health systems are trying to figure out what to do with data centers full of equipment that still has years of useful life left.
The Strategic Drivers: Why Hospitals Are Moving EHRs to the Cloud
The thing is, this isn’t happening in isolation. According to Black Book Research, 78% of U.S. hospitals have already approved major cloud investments for the next 18 months. The healthcare cloud market is growing from $63.5 billion this year to nearly $200 billion by 2032. Those aren’t projections anymore. They’re commitments.
What we’re seeing in our staffing practice reflects this shift. We used to get calls for traditional Epic analysts and report writers. Now it’s cloud architects who understand HIPAA, integration specialists who know both HL7 and Azure, project managers who’ve actually moved clinical systems to AWS. The skill sets are converging in ways that are hard to find in one person.
Epic’s approach to cloud is particularly interesting. They’re not trying to be a cloud provider themselves. Instead, they’re certifying their software to run on AWS and Azure. About 30 organizations are already running Epic workloads in public cloud, and they’re reporting significant performance improvements. But Epic’s documentation assumes a level of cloud expertise that most hospital IT departments simply don’t have. That’s not a criticism of hospital IT teams. They’ve been focused on keeping critical systems running, not becoming cloud engineers.
Oracle is taking a different path with Cerner. They’ve moved over 1,000 customers to Oracle Cloud Infrastructure, often covering the migration costs. It’s an aggressive play, but it also means customers are locked into Oracle’s ecosystem. MEDITECH went even further with their SaaS model. Over 130 organizations are using MEDITECH-as-a-Service, and some smaller hospitals have gone live in just six months.
Beyond the Sales Pitch: The Hard Truths of a Cloud Migration
The reality of these migrations is messier than the success stories suggest. According to research from Cloudticity, Epic migrations are “arguably one of the most difficult workloads to move to a public cloud environment”. You’re not just moving Epic. You’re moving the entire ecosystem around it. Lab systems, imaging, revenue cycle, all those specialty departmental systems that somehow got integrated over the years. They all have to work together in the new environment.
The statistics on migration projects aren’t encouraging. Gartner found that 83% of data migration projects either fail or exceed their budgets and schedules. That sounds dramatic, but I’ve seen enough of these projects to know it’s accurate. The technology usually works fine. It’s everything else that gets complicated.
The Talent Question: Bridging the Skills Gap for Your Migration Project
The biggest challenge we see is the talent gap. CHIME reports that 67% of healthcare providers are experiencing IT staff shortages, and that was before cloud migrations became urgent. The people who’ve been maintaining your on-premise Epic system for years are excellent at what they do. But cloud architecture requires different skills. It’s not better or worse, just different. And right now, everyone needs these skills at the same time.
We’re competing for cloud talent against banks, tech companies, and consulting firms that can offer packages we can’t match in healthcare. A good AWS architect with healthcare experience can pretty much name their price right now. That’s why we’re seeing more organizations bring in specialized teams for the migration rather than trying to hire permanently.
Mount Sinai’s migration of their Epic instance to Azure is worth studying. They consolidated from 13 data centers and are now using AI for patient communications and payer appeals. But it took them over two years and a significant investment in both technology and people.
The timelines vary wildly. Simple applications can move in a couple months. A full Epic production environment typically takes one to two years. Most organizations start with disaster recovery, then development and test environments, then finally production. It’s a marathon, not a sprint.
Cost is complicated. Some organizations report dramatic savings. One academic hospital claimed a 95% cost reduction moving off mainframes. But most see costs increase initially, especially with Epic. The savings come later, after you learn how to optimize resource usage and shut down unnecessary services. Budget anywhere from $500,000 for an enterprise Epic migration, not counting the ongoing operational costs.
KLAS Research found that 70% of organizations feel only “somewhat prepared” for cloud migration. That actually seems optimistic to me. The organizations that succeed treat this as a business transformation, not an IT project. They get executive sponsorship early, invest in training their existing staff, and bring in external expertise where needed.
From a staffing perspective, we’ve found that a hybrid approach works best. Bring in experienced cloud migration specialists to lead the technical work and architect the solution. Pair them with your internal team who knows your workflows, your customizations, your organizational quirks. The consultants handle the cloud complexity while your people ensure everything works for your clinicians and patients. Knowledge transfer is critical. The consultants will leave eventually, and your team needs to be able to manage what’s been built.
The Dell Medical School announcement is significant because it shows what’s possible when you start fresh. But it’s also a reminder that most of us don’t get to start fresh. We have to transform while flying the plane, so to speak. 90% of U.S. hospitals are expected to run core clinical systems in the cloud by 2028. That’s not very far away.
Partner with Experts in EHR Migration and Healthcare IT Staffing
If you’re thinking about cloud migration, my advice is to start planning now, even if you won’t move for another year or two. Understand what you really want to achieve. Cost savings? Better disaster recovery? AI capabilities? The answer shapes everything else. Be realistic about your team’s capabilities and the gaps you need to fill. And remember that every successful migration we’ve supported had strong leadership commitment from the start.
The cloud isn’t magic. It’s just someone else’s data center with better automation and more flexible pricing. But getting there successfully requires careful planning, the right expertise, and realistic expectations about what’s involved.
An EHR cloud migration is one of the most complex and high-stakes initiatives your organization will undertake. Having the right team on the field is the single most critical factor for success. HealthTECH Resources has spent over 20 years providing the specialized, on-demand experts—from cloud architects and cybersecurity specialists to certified Epic and Oracle Cerner analysts—that health systems need to navigate this journey. We help you augment your team with the precise talent required to mitigate risk, manage complexity, and deliver results.
Contact us or call (602) 903-7961 to connect with a consultant.
PRESIDENT/CEO AT HEALTHTECH RESOURCES
Larry has specialized in building strategic healthcare relationships for over 25 years, helping the nation’s top payors and providers solve some of their most pressing business challenges through an intelligent mix of staffing services, training, and consulting.