The Total Economic Impact™ Of Epic On AWS

Avoided Data Center And Infrastructure Costs

Evidence and data. Both HS and SI interviewees described their infrastructure environments before AWS adoption.

The interviewees from HSes described that their legacy infrastructure environments had become increasingly complex and costly due to years of growth, acquisitions, and expanding clinical operations.

• They noted that numerous clinical and operational applications were supported across multiple environments, requiring substantial investments in servers, storage, networking, and DR capabilities. The AVP of Epic and clinical systems at an integrated HS stated, “We didn’t want to stay on-prem because we knew that wasn’t where we were going to be.”

• Several interviewees cited growing compute demands, infrastructure refresh cycles, and excess capacity requirements to support future growth and resiliency.

• The CIO at an integrated HS noted that modernizing and expanding their organization’s legacy infrastructure would have required between $15 million and $20 million in additional investment.

The interviewees from SIs reinforced these challenges across the broader healthcare market.

• The CEO at a healthcare cloud services and SI organization estimated that a representative midsize HS with eight to 12 hospitals, $2 billion to $3 billion in annual revenue, and about 7,000 Epic users would spend approximately $22 million in capex every five years to support Epic infrastructure across primary and redundant data centers, with roughly half of that investment attributed to production infrastructure and half to DR infrastructure.

• The CEO at a healthcare technology and SI organization expressed that HSes commonly operate Epic across primary and DR environments that require duplicate infrastructure investments and significant ongoing maintenance. He noted, “Everything you do in data centers, you have to do times two.”
  He added that these environments were frequently sized with substantial capacity reserves to accommodate future growth and peak demand, resulting in infrastructure that is provisioned beyond typical day-to-day requirements.

Following their AWS adoption, the healthcare organizations migrated portions or all of their Epic and supporting environments to the cloud to reduce reliance on capital-intensive data center investments. Interviewees indicated that AWS allowed them to align infrastructure costs more closely through a consumption-based model, resulting in greater resiliency, scalability, and flexibility.

Modeling and assumptions. Based on the interviews, Forrester assumes the following about the composite organization:

• The composite organization maintains Epic production and DR environments in on-premises data centers before adopting AWS.

• Baseline infrastructure costs include hardware lifecycle costs, infrastructure operations and support, backup and storage, software licensing, facilities, network connectivity, and colocation costs.

  • As Epic workloads migrate to AWS, the composite organization reduces its reliance on virtualization and hypervisor software supporting on-premises production and DR environments, reducing ongoing licensing requirements and exposure to future licensing cost increases.

• Total baseline data center and infrastructure costs equal $16.4 million in Year 1 and increase by 5% annually.

• As Epic workloads migrate to AWS, the composite organization progressively decommissions legacy infrastructure and associated support requirements. The phased migration and decommissioning path reflects the organization’s legacy technical debt, independent IT organizations, and acquisition-related complexity.

• The composite organization avoids 45% of baseline infrastructure costs in Year 1, 75% in Year 2, and 90% in Year 3 as it retires production, DR, and supporting infrastructure environments.

Risks. The scale of this benefit may vary based on:

• The size of the healthcare organization and complexity of its existing infrastructure environment.

• The number of facilities, applications, and Epic-related workloads supported within the environment.

• The organization’s ability to decommission production, DR, and supporting infrastructure environments following migration to AWS.

• Existing hardware refresh schedules, software licensing agreements, data center operating costs, and colocation requirements.

• Geographic location and regional differences in infrastructure, facilities, power, and operating expenses.

Results. To account for these risks, Forrester adjusted this benefit downward by 20%, yielding a three-year, risk-adjusted total PV (discounted at 10%) of $23.7 million.

Application Rationalization And Consolidation

Evidence and data. Before adopting AWS, interviewees described complex application environments that had expanded through acquisitions, organizational growth, and disparate clinical and operational system accumulation.

• These environments included multiple EHRs, patient portals, ERP systems, payroll platforms, and departmental applications that required ongoing maintenance, integration, reporting, and analytics. The CIO at a community HS called their legacy environment the “black box.”

• As their organizations migrated Epic workloads to AWS, interviewees gained greater visibility into their application portfolios and executed large-scale modernization initiatives that had previously been difficult to undertake in fragmented legacy environments.

• Rather than performing a “lift and shift” migration, they consolidated disparate clinical and operational systems and retired redundant applications inherited through acquisitions and legacy operating models.
  The AVP of Epic and clinical systems at an integrated HS noted that they had 900 applications and explained, “We went through an exercise where we looked at all the applications that we had, identified any duplication, got rid of that, and consolidated applications.”

• The CIO at an integrated HS stated that AWS accelerated consolidation efforts, helping reduce the number of applications from 800 to 229. He added, “We will save about $14 million total when we’re all said and done with all our applications.”

Modeling and assumptions. Based on the interviews, Forrester assumes the following about the composite organization:

• The composite organization conducts a large-scale application rationalization and consolidation effort as part of its Epic on AWS transformation.

• Rationalization efforts focus on retiring redundant clinical, operational, and departmental applications while standardizing on core enterprise platforms.

• Annual baseline application-related costs include software licensing, maintenance and support contracts, vendor fees, infrastructure, hosting, and operational support expenses.

  • As it retires applications, the organization realizes savings from eliminated software licenses, maintenance and support contracts, vendor fees, infrastructure costs, and operational support requirements.
  • It generates additional operational efficiencies through reduced integration complexity and application consolidation.

• The composite organization decommissions 40% of identified application costs in Year 1, 50% in Year 2, and 65% in Year 3.

• Rationalization occurs gradually because it requires clinical and business stakeholder approvals, contracts expire over time, users must migrate workflows, and duplicate system retirement occurs in phases.

Risks. The scale of this benefit may vary based on:

• The size and complexity of the HS application environment.

• The decommissioning rate and execution.

  • The number of stakeholders participating in the decision-making process and their technology preferences.
  • Existing vendor contracts, licensing commitments, and support agreements.

• Application dependencies, data migration requirements, and user adoption timelines.

Results. To account for these risks, Forrester adjusted this benefit downward by 15%, yielding a three-year, risk-adjusted total PV (discounted at 10%) of $9.1 million.

Reduced Operational Impact From Downtime

Evidence and data. Before adopting AWS, interviewees described highly complex infrastructure environments supporting large numbers of clinical and operational applications.

• Interviewees described these environments as including multiple EHRs, application portfolios expanded through acquisitions, and a combination of internal, managed-service, and hosted infrastructure components.

• As complexity increased, their organizations experienced infrastructure-related disruptions, such as server or storage failures, network outages, and other operational events.

• Interviewees noted that these events had the potential to affect clinician workflows, application availability, and business continuity of patient care, increasing the importance of resilient operating environments.

• The CIO at an integrated HS reported 50 hours of downtime in their organization’s highly fragmented technology environment, explaining that infrastructure complexity contributed to recurring operational disruptions and recovery challenges.

• The same interviewee added that after migrating to AWS, their organization achieved a 60% reduction in downtime, 40% faster mean time to recovery, and 32% fewer critical incidents. He attributed these improvements to a more resilient infrastructure architecture, simplified operations, and fewer legacy systems and dependencies.

• Other healthcare interviewees similarly cited reliability, availability, and business continuity as important objectives for their cloud modernization initiatives.
  The CIO at a community HS described their legacy environment as experiencing “a lot of up and down time.”

• After migrating to AWS, interviewees explained that resiliency improvements continued to increase over time as they fully migrated additional Epic workloads to AWS, retired legacy infrastructure dependencies, and matured cloud operating processes.

Modeling and assumptions. Based on the interviews, Forrester assumes the following about the composite organization:

• The composite organization experiences 20 infrastructure-related downtime incidents annually, with each incident lasting approximately 1 hour.

• Downtime incidents include server failures, storage failures, network outages, power or cooling issues, infrastructure maintenance events, and unexpected disruptions during upgrades and refreshes.

• Before adopting AWS, the complexity of the legacy infrastructure environment contributes to operational disruptions and recovery efforts across clinical and operational systems.

• The composite organization realizes a reduction in downtime incidents through improved operational simplicity, greater reliability, and faster recovery from infrastructure-related disruptions. As it retires migration progresses and legacy infrastructure dependencies, downtime continues to decrease.

• Reduced downtime lowers operational disruption across clinical, administrative, and IT functions.

Risks. The scale of this benefit may vary based on:

• The size, age, resiliency, and complexity of the organization’s infrastructure environment.

• The number of facilities, systems, and geographic regions supported by the organization, as well as their exposure to weather-related and other disruptive events.

• The frequency and duration of downtime incidents experienced by the organization.

• The operational impact associated with each downtime event, including the number of affected users, applications, and business processes.

Results. To account for these risks, Forrester adjusted this benefit downward by 10%, yielding a three-year, risk-adjusted total PV (discounted at 10%) of $3.4 million.

IT Team Productivity Efficiency With AWS

Evidence and data. Before AWS, interviewees from HSes maintained complex technology environments ranging from on-premises deployments and managed hosting providers to hybrid operating models, requiring significant IT effort to support infrastructure provisioning, upgrade preparation, hardware lifecycle management, and application maintenance.

• Interviewees noted that their legacy infrastructure created technology constraints, limited their visibility and transparency into cost and utilization metrics, and impacted IT teams’ availability for other strategic initiatives such as modernization, reporting, and analytics.

• Interviewees also managed highly fragmented application environments, increasing the effort required to administer applications and technology systems across the enterprise.
  The CIO at a community HS added, “We had a sundry of two or three little EMRs floating around the ecosystem here.” And he further noted: “We didn’t really want to further the growth of a data center. ... We’re trying to free it up so we can put service lines in there eventually.”

Interviewees from SIs reported that many healthcare organizations entered cloud migrations with infrastructure teams heavily dedicated to operational continuity, since supporting on-premises Epic environments required significant effort to provision, maintain, and scale infrastructure.

• The CEO at a healthcare technology and SI organization explained: “You’re looking at a multimillion-dollar investment and a lead time to select it, acquire it, and implement it. It could easily be a six-month process from start to finish. By the time you issue purchase orders and get the approval to buy all of that equipment and then you actually have to install it in your data center, it’s a time-consuming process.”

The same interviewee also noted that organizations needed to procure infrastructure well in advance of demand and maintain sufficient capacity to support future growth and resiliency requirements.

Following the migration to AWS, interviewees’ organizations reduced the effort required to provision, maintain, and scale infrastructure environments.

• Interviewees reported faster new environment deployment, reduced infrastructure administration, improved resource utilization visibility, and streamlined Epic and related application support.

• They noted that migrating to AWS accelerated IT workforce transformation by requiring teams to develop expertise in cloud technologies and shifting resources toward modernization initiatives, analytics programs, cybersecurity activities, and cloud optimization efforts.

Modeling and assumptions. Based on the interviews, Forrester assumes the following about the composite organization:

• The composite organization employs 35 IT personnel supporting Epic infrastructure, cloud operations, networking, storage, virtualization, backup, and platform management.

• AWS enables the organization to reduce time spent on infrastructure provisioning, environment deployment, hardware administration, capacity planning, monitoring, and maintenance.

• The composite organization’s IT operations experience a 30% productivity improvement due to infrastructure automation, cloud-based infrastructure management, faster provisioning, improved scalability, and streamlined operational processes.

• The composite applies a 75% productivity recapture rate.

• The organization upskills and redeploys technical staff to higher-value initiatives, including cloud engineering, cybersecurity, analytics, automation, and innovation programs.

Risks. The scale of this benefit may vary based on:

• The size and complexity of the organization’s infrastructure.

• The existing operational processes and level of cloud adoption.

• The cloud skills, experience, and technical capabilities of IT personnel supporting Epic and related infrastructure.

• Salary levels, which vary based on employee expertise, geographic location, and job role.

Results. To account for these risks, Forrester adjusted this benefit downward by 10%, yielding a three-year, risk-adjusted total PV (discounted at 10%) of $2.7 million.

Clinician Efficiencies With AWS

Evidence and data. Interviewees from HSes and SIs observed an increase in Epic performance responsiveness after migrating Epic environments to AWS.

• Interviewees from HSes reported improved Epic responsiveness, lower latency, and better scalability after migrating Epic workloads to AWS. They noted that clinicians experienced faster access to information and more consistent application performance, particularly during periods of peak utilization.
  According to the chief information and digital officer at a regional HS, “My cloud support team been able to run these [efficiency] metrics, and they were able to say we run 20% to 22% faster in the cloud than we do on-premises, and that has been verified by Epic as well.”
  
  The AVP of Epic and clinical systems at an integrated HS said that feedback from end users was so overwhelmingly positive and performance improvements were so significant that the organization elected to continue operating in AWS rather than fall back to its prior environment as originally planned. He noted, “We were expecting [the clinicians] wouldn’t see a significantly different experience, but they were expressing how positive it was: faster response times, less latency.”
  
  The CIO at an integrated HS stated, “In the original way, [before AWS], it used to take us 120 to 180 minutes to identify the CT scan and then tell the neurologist and the radiologist. Now it takes less than 2 minutes.”

• Interviewees from SIs reported that healthcare organizations experience measurable workflow improvements after migrating Epic to AWS.
  According to both SI interviewees, cloud infrastructure improved application performance, reduced workflow latency, and provided the scalability required to support clinician workloads during peak periods.
  
  The CEO at a healthcare cloud services and SI organization noted that one HS customer experienced “a 40% increase in performance as measured by the clinical workflow … just by migrating to AWS.”

Modeling and assumptions. Based on the interviews, Forrester assumes the following about the composite organization:

• The composite organization employs 5,000 clinicians who regularly use Epic to access patient information, complete documentation, and support clinical workflows.

• After migrating to AWS, the composite’s Epic performance is enhanced through improved scalability, reduced latency, optimized infrastructure resources, and better application responsiveness.

• Clinicians experience fewer delays when accessing patient records, opening charts, and completing routine workflows.

• These clinicians realize a 0.5% productivity improvement due to reduced wait times and improved workflow efficiency when using Epic.

• The organization applies a 50% productivity recapture rate.

Risks. The scale of this benefit may vary based on:

• The level and speed of AWS adoption across Epic environments and related clinical systems.

• The number of clinicians regularly using Epic and the volume of patient encounters supported by the platform.

• Variations in clinician workflows, specialties, and patterns of Epic usage across healthcare organizations.

• Salary levels, which vary based on clinician role, specialty, and geographic location.

Results. To account for these risks, Forrester adjusted this benefit downward by 10%, yielding a three-year, risk-adjusted total PV (discounted at 10%) of $4.5 million.

Unquantified Benefits

Benefits that provide value for the composite organization but are not quantified for this study include:

• AWS partnership and support. Interviewees described AWS as a strategic partner, highlighting ongoing collaboration throughout planning, migration, optimization, and operational activities. They emphasized the value of AWS expertise, executive engagement, and alignment with Epic requirements, helping reduce implementation risk and support long-term cloud success. The CIO at a community HS noted: “When we selected who we were going to host with, the AWS folks were at the table engaged. That was a big deal. I view them as a partner, and I can’t say that about everybody.”

• Improved resiliency, business continuity, and DR. Interviewees described increased confidence in their ability to maintain continuity of care and recover from disruptions following migration to AWS. Interviewees noted that AWS enabled more resiliency through multiavailability zone architectures and strengthened DR capabilities. The chief information and digital officer at a regional HS explained, “AWS provided significant Epic global reference capacity beyond current requirements, giving the organization flexibility to accommodate future growth and demand surges.” He added, “It gives me a powerful and flexible option to provide continuity of my Epic system.”

• Greater scalability, visibility, and operational control. Interviewees explained that AWS enabled their HS to scale infrastructure resources more effectively in response to changing business and clinical requirements while reducing reliance on excess infrastructure capacity. They also reported greater visibility into infrastructure and application environments, helping strengthen operational governance, financial oversight, and support for evolving security and compliance requirements. The CIO at a community HS noted, “We didn’t have visibility before; … now we have insights into everything.”
  
   

Flexibility

The value of flexibility is unique to each customer. There are multiple scenarios in which a customer might implement AWS and later realize additional uses and business opportunities, including:

• Future growth and modernization initiatives. AWS enables HSes to support future growth without requiring significant infrastructure investments or data center expansion. HSes gain flexibility to modernize applications, support acquisitions, and pursue new technology initiatives while scaling infrastructure as business requirements evolve. The AVP of Epic and clinical systems at an integrated HS stated, “A cloud infrastructure allows you to have that flexibility.”

• Advanced analytics and data capabilities. Interviewees explained that AWS can provide a scalable foundation to consolidate, access, and leverage data across clinical and operational environments. They expect to pursue advanced analytics, operational reporting, and emerging AI use cases with data that is more accessible and easier to integrate across systems.

• AI and generative AI. Interviewees identified AI as one of the most significant future opportunities enabled by AWS. Few of the interviewees from HSes are already pursuing AI-enabled clinical workflows, automation, ambient documentation, and other emerging healthcare AI use cases. However, the CEO at a healthcare cloud services and SI noted, “Migration to AWS is a foundation for exponential AI adoption.”

• Clinical innovation and patient engagement opportunities. Interviewees described opportunities to improve patient engagement through modern digital experiences, unified patient access, and cloud-enabled patient communication tools. The CIO at a community HS noted that they selected AWS partly because it enables future patient-facing capabilities, including contact center modernization, automation, and digital patient engagement initiatives.
   

Flexibility would also be quantified when evaluated as part of a specific project (described in more detail in Total Economic Impact Approach).