Dear Judy,

Healthcare's digital transformation deserves more than just a change of scenery. As health systems across the country race to move their Epic installations to the cloud, we risk mistaking motion for progress. This massive migration, while appearing innovative on the surface, threatens to lock healthcare into another decade of fragmented operations and delayed innovation. But what if there was a way to fundamentally transform how healthcare technology enables patient care, clinician efficiency, and organizational innovation? What if, instead of thousands of health systems maintaining parallel operations, we could channel those resources into advancing care delivery and clinical outcomes? The answer might lie not in where we host our systems, but in how we fundamentally reimagine healthcare technology delivery through a true Software-as-a-Service (SaaS) model.

I'd love to see Epic commit to a SaaS model by 2026.

Epic's current approach maintains distinct advantages in several critical areas. Your model ensures healthcare organizations retain control over their infrastructure, maintain stringent data governance, preserve deep customization capabilities, and control their update cycles. This approach has historically provided the security and flexibility that healthcare organizations require.

Modern SaaS platforms have developed sophisticated solutions to address traditional enterprise concerns. They now offer dedicated instances, advanced data residency controls, and hybrid deployment options that rival traditional on-premises control. Their data governance capabilities include comprehensive audit trails, granular permissions, and customer-managed encryption keys. Customization has been revolutionized through extensive APIs, feature flags, and no-code configuration options. Even the historic concern about update control has been addressed through staged rollouts, preview environments, and optional feature adoption.

The Cloud Mirage in Healthcare: Why Moving Epic to the Cloud Isn't Enough

As healthcare systems across the country grapple with technological transformation, many are considering what appears to be an obvious next step: moving their Epic installations to cloud platforms. However, this seemingly progressive move may actually be holding healthcare back from true innovation and meaningful improvement in patient care.

The False Promise of "Lift and Shift" Healthcare organizations are investing millions in migrating their Epic environments to cloud platforms, yet this expensive and resource-intensive initiative delivers surprisingly little value to patients or clinicians. It's essentially taking the same system, with all its existing limitations, and merely changing where it lives. The fundamental challenges of healthcare delivery remain unaddressed: clinician burnout, fragmented patient experiences, and rigid workflows persist regardless of where the servers reside.

A Costly Distraction The migration to cloud-hosted Epic environments demands significant financial investment, countless IT hours, and extensive organizational focus. Healthcare systems are diverting precious resources to what amounts to an infrastructure change, while more transformative opportunities go unexplored. This "lift and shift" approach represents a stop-gap measure that fails to leverage the true potential of modern cloud technologies.

SaaS Transformation Rather than simply relocating existing systems, healthcare needs a fundamental reimagining of how technology supports care delivery. A true SaaS model offers transformative possibilities:

Financial Transformation in Healthcare IT: The Power of Shared Economics

The current healthcare IT landscape represents a massive duplication of effort and resources, with each health system operating as an isolated entity, bearing the full burden of infrastructure, staffing, and operational costs. Every organization independently maintains its own Epic environment, complete with redundant hardware, disaster recovery sites, security teams, and specialized IT staff. This model not only creates enormous financial inefficiencies but also diverts precious healthcare resources away from patient care and innovation. The move to cloud platforms, while appearing progressive, simply shifts these individual burdens to a new location without addressing the fundamental inefficiency of thousands of parallel operations.

A true SaaS transformation would fundamentally reshape this economic model by leveraging shared economies of scale. Instead of thousands of health systems individually maintaining separate environments, Epic would operate a single, robust platform serving all clients. This consolidation would transform everything from infrastructure costs and security management to innovation and risk mitigation. Hardware refresh cycles, security updates, and compliance measures would be managed once centrally rather than replicated across thousands of organizations. The resources currently spent on maintaining individual environments could be redirected toward patient care improvements and healthcare innovation. This shift wouldn't just reduce costs—it would fundamentally transform how healthcare organizations invest in and benefit from technology, creating a shared ecosystem that leverages collective scale, knowledge, and resources to drive healthcare forward.

Clinical Innovation at Scale: Breaking Free from the Upgrade Cycle Trap

The current approach to clinical innovation in healthcare IT resembles a thousand separate laboratories, each working in isolation, bound by rigid upgrade cycles that can span years. Health systems invest enormous resources implementing the same features, testing the same workflows, and solving identical problems - yet rarely benefit from each other's learnings. When Epic introduces new clinical capabilities, each organization must undertake its own lengthy implementation project, complete with extensive testing, training, and rollout plans. This siloed approach not only delays the delivery of potentially life-saving innovations but also creates a patchwork of different versions and capabilities across healthcare organizations. By contrast, a true SaaS platform would revolutionize how clinical innovation reaches the bedside. New features, from AI-powered decision support to updated clinical protocols, could be deployed seamlessly across all organizations simultaneously. Imagine a world where a proven workflow improvement or enhanced clinical algorithm could be available to every clinician by the next shift, rather than months or years later. This transformation would not only accelerate the pace of healthcare innovation but would also ensure that best practices and cutting-edge capabilities are democratized across the entire healthcare ecosystem, regardless of an organization's size or resources. The result would be a healthcare system that evolves as rapidly as medical science itself, with every patient benefiting from the collective learning and advancement of the entire healthcare community.

Breaking Down Healthcare's Digital Walls: The Promise of True Interoperability

Healthcare's current approach to data sharing resembles a medieval city-state system, where each organization operates behind its own digital walls, even when running identical systems in the cloud. Despite years of interoperability initiatives and federal regulations, sharing data between health systems remains a complex dance of interfaces, protocols, and custom integrations. Even organizations using Epic must navigate complicated data-sharing agreements and technical configurations. A SaaS platform would fundamentally disrupt this fragmented landscape by creating a single, unified data fabric across all participating organizations. Rather than building bridges between silos, the silos themselves would disappear. Clinicians could seamlessly access relevant patient information regardless of where care was delivered, population health initiatives could effortlessly span multiple organizations, and researchers could analyze de-identified data across the entire care continuum. This transformation would shift healthcare from a collection of isolated digital fortresses to an interconnected ecosystem where data flows as freely as patients do between care settings, finally delivering on the decades-old promise of truly coordinated care.

Beyond Refuel and Foundation: The Next Evolution

Epic's Refuel and Foundation initiatives acknowledge a critical truth: healthcare organizations are drowning in parallel efforts, customizations, and delayed implementations. Recent Refuel success stories demonstrate the power of standardization and rapid feature adoption. When health systems successfully implement hundreds of features in under a year and standardize operations across entire networks of facilities, they prove that healthcare organizations can move faster and achieve better outcomes through standardization.

However, Refuel and Foundation still operate within the constraints of traditional software deployment. Each organization must independently maintain their environment, manage their own upgrade cycles, and dedicate resources to infrastructure operations. While health systems save thousands of clinician hours through automation and achieve higher Gold Stars status through focused efforts, imagine what could be accomplished if these innovations were automatically available to every Epic organization immediately upon validation.

A SaaS transformation would take the principles of Refuel and Foundation to their logical conclusion. Instead of each organization independently implementing proven features, they would be automatically available in a continuously evolving platform. The resources currently devoted to parallel implementations could be redirected toward innovation and care improvement. The standardization sought through Foundation would be maintained naturally through shared infrastructure, while still allowing for necessary local variations through modern configuration approaches.

This isn't about abandoning the principles behind Refuel and Foundation - it's about fully realizing their potential. The success of these initiatives proves healthcare organizations are ready for standardization and rapid innovation deployment. The next step is eliminating the technological barriers that force each organization to reinvent the wheel.

Transforming Promise into Reality

Healthcare stands at the threshold of its next great digital evolution. The industry has proven through Foundation and Refuel initiatives that standardization and rapid innovation deployment aren't just possible - they're essential for modern healthcare delivery. But maintaining thousands of parallel environments isn't just inefficient; it actively hinders healthcare's ability to respond to today's challenges of clinician burnout, rising costs, and care accessibility.

The path forward is clear. Modern SaaS platforms have already solved the technical challenges of security, privacy, and regulatory compliance while enabling unprecedented operational efficiency. The same standardization and rapid innovation deployment principles that make Foundation and Refuel successful could be amplified through a unified platform approach. Instead of each organization maintaining separate environments and managing independent upgrade cycles, healthcare could finally realize the full potential of shared innovation and true interoperability.

Epic has consistently led healthcare's technological evolution by understanding not just where healthcare is, but where it needs to go. A transformation to SaaS isn't just another technology change - it's the key to unlocking healthcare's next wave of innovation. By eliminating the burden of parallel operations and infrastructure management, healthcare organizations could redirect those resources toward what matters most: improving patient care and clinical outcomes. The foundation has been laid. The technology is proven. The time has come to take healthcare technology to the next level.

Best, Bill