A Forrester Total Economic ImpactTM Study Commissioned By Microsoft, December 2023
Epic has been an industry standard for providing hospitals and healthcare systems with comprehensive electronic medical and health record management. Administrators, physicians and other medical practitioners, and numerous other provider staff utilize many value-added aspects of Epic. However, providers more and more are moving to the cloud to increase productivity and manage significant costs associated with on-prem deployments, and thus utilize Azure as a viable option for cloud migration.
Microsoft commissioned Forrester Consulting to conduct a Total Economic Impact™ (TEI) study and examine the potential return on investment (ROI) enterprises may realize by deploying Epic on Azure.1 The purpose of this study is to provide readers with a framework to evaluate the potential financial impact of Epic on Azure on their organizations.
To better understand the benefits, costs, and risks associated with this investment, Forrester interviewed four representatives with experience using Epic on Azure. For the purposes of this study, Forrester aggregated the interviewees’ experiences and combined the results into a single composite organization that is a healthcare organization with a revenue of $2 billion per year.
Prior to using Epic on Azure, interviewees explained that their organizations hosted Epic on servers located in on-prem data centers. They would buy hardware they needed for the next five years of growth but would then need to refresh their hardware. After the investment in Epic on Azure, interviewees migrated their Epic environment to Azure cloud.
Quantified benefits. Three-year, risk-adjusted present value (PV) quantified benefits for the composite organization include:
Unquantified benefits. Benefits that provide value for the composite organization but are not quantified in this study include:
Costs. Three-year, risk-adjusted PV costs for the composite organization include:
The representative interviews and financial analysis found that a composite organization experiences benefits of $17.01 million over three years versus costs of $7.09 million, adding up to a net present value (NPV) of $9.92 million and an ROI of 140%.
Return on investment (ROI):
Benefits PV:
Net present value (NPV):
Payback:
From the information provided in the interviews, Forrester constructed a Total Economic Impact™ framework for those organizations considering an investment Epic on Azure.
The objective of the framework is to identify the cost, benefit, flexibility, and risk factors that affect the investment decision. Forrester took a multistep approach to evaluate the impact that Epic on Azure can have on an organization.
Interviewed Microsoft stakeholders and Forrester analysts to gather data relative to Epic on Azure.
Interviewed four representatives at organizations using Epic on Azure to obtain data about costs, benefits, and risks.
Designed a composite organization based on characteristics of the interviewees’ organizations.
Constructed a financial model representative of the interviews using the TEI methodology and risk-adjusted the financial model based on issues and concerns of the interviewees.
Employed four fundamental elements of TEI in modeling the investment impact: benefits, costs, flexibility, and risks. Given the increasing sophistication of ROI analyses related to IT investments, Forrester’s TEI methodology provides a complete picture of the total economic impact of purchase decisions. Please see Appendix A for additional information on the TEI methodology.
Readers should be aware of the following:
This study is commissioned by Microsoft and delivered by Forrester Consulting. It is not meant to be used as a competitive analysis.
Forrester makes no assumptions as to the potential ROI that other organizations will receive. Forrester strongly advises that readers use their own estimates within the framework provided in the study to determine the appropriateness of an investment in Epic on Azure.
Microsoft reviewed and provided feedback to Forrester, but Forrester maintains editorial control over the study and its findings and does not accept changes to the study that contradict Forrester’s findings or obscure the meaning of the study.
Microsoft provided the customer names for the interviews but did not participate in the interviews.
Consulting Team:
Roger Nauth
Otto Leichliter
| Role | Industry | Region | Employees |
|---|---|---|---|
| CISO and ACISO | Healthcare | $490 million | 2,300 |
| Director of infrastructure | Healthcare | $1.5 billion | 6,000 |
| CFO | Healthcare | $2.5 billion | 10,500 |
| Specialist | Healthcare | $2 billion | 14,000 |
Prior to migrating Epic to Azure, interviewees’ organizations struggled to refresh old and expensive hardware that became outdated before it was time to be refreshed and struggled with server downtime.
The interviewees noted how their organizations struggled with common challenges, including:
The interviewees’ organizations searched for a solution that could:
Based on the interviews, Forrester constructed a TEI framework, a composite company, and an ROI analysis that illustrates the areas financially affected. The composite organization is representative of the four interviewees, and it is used to present the aggregate financial analysis in the next section.
Description of composite. The US-based healthcare organization has more than $2 billion in annual revenues and 9,000 employees across the country. The composite organization has a strong brand and approximately 200 hospital and provider locations.
Deployment characteristics. The composite typically migrates its Epic platform to Azure cloud over the span of four months and is able to sunset approximately 80% of its legacy on-prem hardware.
| Ref. | Benefit | Year 1 | Year 2 | Year 3 | Total | Present Value |
|---|---|---|---|---|---|---|
| Atr | Annual savings from sunsetting on-premises hardware | $3,420,000 | $4,560,000 | $4,560,000 | $12,540,000 | $10,303,681 |
| Btr | Increased productivity from reduction in effort to build and manage network and storage capabilities | $2,565,000 | $2,565,000 | $2,565,000 | $7,695,000 | $6,378,775 |
| Ctr | Reduction in effort to deploy VMs and projects | $132,192 | $132,192 | $132,192 | $396,576 | $328,742 |
| Total benefits (risk-adjusted) | $6,117,192 | $7,257,192 | $7,257,192 | $20,631,576 | $17,011,198 |
Evidence and data. Interviewees’ organizations were able to avoid expensive hardware refresh cycles and reliance on buying equipment in advance to be prepared to scale when needed.
Modeling and assumptions. To calculate the value of this benefit, Forrester assumes the following:
Risks. The value of this benefit can vary across organizations due to differences in:
Results. To account for these risks, Forrester adjusted this benefit downward by 5%, yielding a three-year, risk-adjusted total PV (discounted at 10%) of $10.3 million.
| Ref. | Metric | Source | Year 1 | Year 2 | Year 3 | |
|---|---|---|---|---|---|---|
| A1 | Previous spend for on premise hardware | Composite | $6,000,000 | $6,000,000 | $6,000,000 | |
| A2 | Percentage sunsetted | Composite | 60% | 80% | 80% | |
| At | Annual savings from sunsetting on-premises hardware | A1*A2 | $3,600,000 | $4,800,000 | $4,800,000 | |
| Risk adjustment | ↓5% | |||||
| Atr | Annual savings from sunsetting on-premises hardware (risk-adjusted) | $3,420,000 | $4,560,000 | $4,560,000 | ||
| Three-year total: $12,540,000 | Three-year present value: $10,303,681 | |||||
Evidence and data. After deploying Epic on the Azure cloud, interviewees’ organizations realized increased productivity when building and managing network and storage capabilities.
Modeling and assumptions. To calculate the value of this benefit, Forrester assumes the following:
Risks. The value of this benefit can vary across organizations due to differences in:
Results. To account for these risks, Forrester adjusted this benefit downward by 5%, yielding a three-year, risk-adjusted total PV of $6.4 million.
| Ref. | Metric | Source | Year 1 | Year 2 | Year 3 | |
|---|---|---|---|---|---|---|
| B1 | FTEs required to build and manage network and storage capabilities prior to Azure deployment | Interviews | 23 | 23 | 23 | |
| B2 | FTEs required to build and manage network and storage capabilities after to Azure deployment | Interviews | 5 | 5 | 5 | |
| B3 | Net change in FTEs managing network and storage capabilities | B1-B2 | 18 | 18 | 18 | |
| B4 | Annual blended salary of experienced solutions and data engineer FTEs | TEI standard | $150,000 | $150,000 | $150,000 | |
| Bt | Increased productivity from reduction in effort to build and manage network and storage capabilities | B3*B4 | $2,700,000 | $2,700,000 | $2,700,000 | |
| Risk adjustment | ↓5% | |||||
| Btr | Increased productivity from reduction in effort to build and manage network and storage capabilities (risk-adjusted) | $2,565,000 | $2,565,000 | $2,565,000 | ||
| Three-year total: $7,695,000 | Three-year present value: $6,378,775 | |||||
Evidence and data. Evidence and data. Hosting Epic on Azure enabled interviewees’ organizations to rapidly deploy VMs by leveraging automation that was not feasible on-prem.
Modeling and assumptions. To calculate the value of this benefit, Forrester assumes the following:
Risks. The value of this benefit can vary across organizations due to differences in:
Results. To account for these risks, Forrester adjusted this benefit downward by 15%, yielding a three-year, risk-adjusted total PV of $329,000.
| Ref. | Metric | Source | Year 1 | Year 2 | Year 3 | |
|---|---|---|---|---|---|---|
| C1 | On prem deployment time for new VM or project (minutes) | Interviews | 180 | 180 | 180 | |
| C2 | Time to deploy a new VM or project via Azure (minutes) | Interviews | 25 | 25 | 25 | |
| C3 | Savings in time to deploy new project (minutes) | C1-C2 | 155 | 155 | 155 | |
| C4 | Savings in time to deploy new project (hours) | C3/60 | 3 | 3 | 3 | |
| C5 | Number of projects (including VMs and servers) | Composite | 48 | 48 | 48 | |
| C6 | Number of FTEs per implementation | Interviews | 12 | 12 | 12 | |
| C7 | Total number of hours saved in deploying VMs and projects (hours) | C4*C5*C6 | 1,728 | 1,728 | 1,728 | |
| C8 | Fully burdened average hourly salary for senior analyst involved in deploying VMs and projects | TEI standard | $90 | $90 | $90 | |
| Ct | Reduction in effort to deploy VMs and projects | C7*C8 | $155,520 | $155,520 | $155,520 | |
| Risk adjustment | ↓15% | |||||
| Ctr | Reduction in effort to deploy VMs and projects (risk-adjusted) | $132,192 | $132,192 | $132,192 | ||
| Three-year total: $396,576 | Three-year present value: $328,742 | |||||
Interviewees mentioned the following additional benefits that their organizations experienced but were not able to quantify:
The value of flexibility is unique to each customer. There are multiple scenarios in which a customer might implement Epic on Azure and later realize additional uses and business opportunities, including:
Flexibility would also be quantified when evaluated as part of a specific project (described in more detail in Appendix A).
| Ref. | Cost | Initial | Year 1 | Year 2 | Year 3 | Total | Present Value |
|---|---|---|---|---|---|---|---|
| Dtr | Initial Implementation Costs | $1,000,000 | $0 | $0 | $0 | $1,000,000 | $1,000,000 |
| Etr | Azure licensing costs | $0 | $1,470,000 | $1,470,000 | $1,470,000 | $4,410,000 | $3,655,672 |
| Ftr | Consulting and support | $0 | $490,000 | $490,000 | $490,000 | $1,470,000 | $1,218,557 |
| Gtr | Training | $0 | $367,500 | $367,500 | $367,500 | $1,102,500 | $913,918 |
| Htr | Data storage | $0 | $122,500 | $122,500 | $122,500 | $367,500 | $304,639 |
| Total costs (risk-adjusted) | $1,000,000 | $2,450,000 | $2,450,000 | $2,450,000 | $8,350,000 | $7,092,786 |
Evidence and data. The composite organization was charged an initial implementation cost of $1 million for Epic on Azure.
Modeling and assumptions. This cost is valued using data provided by the composite and Forrester’s insight into similar implementations.
Risks. The value of this cost can vary across organizations based on their previous experience migrating from on-prem solutions to cloud deployments.
Results. To account for these risks, Forrester did not adjust this cost, yielding a three-year total PV (discounted at 10%) of $1 million.
| Ref. | Metric | Source | Initial | Year 1 | Year 2 | Year 3 | |
|---|---|---|---|---|---|---|---|
| D1 | Initial Implementation Costs | Assumption | $1,000,000 | ||||
| Dt | Initial Implementation Costs | D1 | $1,000,000 | $0 | $0 | $0 | |
| Risk adjustment | 0% | ||||||
| Dtr | Initial Implementation Costs (risk-adjusted) | $1,000,000 | $0 | $0 | $0 | ||
| Three-year total: $1,000,000 | Three-year present value: $1,000,000 | ||||||
Evidence and data. The composite organization was charged a licensing cost of $3.7 million for Epic on Azure over three years.
Modeling and assumptions. This cost is valued using data provided by the composite and Forrester’s insight into similar implementations.
Risks. The value of this cost can vary across organizations due to:
Results. To account for these risks, Forrester did not adjust this cost, yielding a three-year total PV of $3.7 million.
| Ref. | Metric | Source | Initial | Year 1 | Year 2 | Year 3 | |
|---|---|---|---|---|---|---|---|
| E1 | Azure licensing costs | Assumption | $1,470,000 | $1,470,000 | $1,470,000 | ||
| Et | Azure licensing costs | E1 | $0 | $1,470,000 | $1,470,000 | $1,470,000 | |
| Risk adjustment | 0% | ||||||
| Etr | Azure licensing costs (risk-adjusted) | $0 | $1,470,000 | $1,470,000 | $1,470,000 | ||
| Three-year total: $4,410,000 | Three-year present value: $3,655,672 | ||||||
Evidence and data. The composite organization was charged consulting and support expenses of $1.2 million for Epic on Azure.
Modeling and assumptions. This cost is valued using data provided by the composite and Forrester’s insight into similar implementations.
Risks. The value of this cost can vary across organizations due to:
Results. To account for these risks, Forrester did not adjust this cost, yielding a three-year total PV of $1.2 million.
| Ref. | Metric | Source | Initial | Year 1 | Year 2 | Year 3 | |
|---|---|---|---|---|---|---|---|
| F1 | Consulting and support | Assumption | $490,000 | $490,000 | $490,000 | ||
| Ft | Consulting and support | F1 | $0 | $490,000 | $490,000 | $490,000 | |
| Risk adjustment | 0% | ||||||
| Ftr | Consulting and support (risk-adjusted) | $0 | $490,000 | $490,000 | $490,000 | ||
| Three-year total: $1,470,000 | Three-year present value: $1,218,557 | ||||||
Results. To account for these risks, Forrester did not adjust this cost, yielding a three-year total PV of $914,000.
| Ref. | Metric | Source | Initial | Year 1 | Year 2 | Year 3 | |
|---|---|---|---|---|---|---|---|
| G1 | Training | Assumption | $367,500 | $367,500 | $367,500 | ||
| Gt | Training | G1 | $0 | $367,500 | $367,500 | $367,500 | |
| Risk adjustment | 0% | ||||||
| Gtr | Training (risk-adjusted) | $0 | $367,500 | $367,500 | $367,500 | ||
| Three-year total: $1,102,500 | Three-year present value: $913,918 | ||||||
Evidence and data. The composite organization incurred data storage expenses of $305,000 for Epic on Azure.
Modeling and assumptions. This cost is valued using data provided by the composite and Forrester’s insight into similar implementations.
Risks. The value of this cost can vary across organizations due to:
Results. To account for these risks, Forrester did not adjust this cost, yielding a three-year total PV of $305,000.
| Ref. | Metric | Source | Initial | Year 1 | Year 2 | Year 3 | |
|---|---|---|---|---|---|---|---|
| H1 | Data storage | Assumption | $122,500 | $122,500 | $122,500 | ||
| Ht | Data storage | H1 | $0 | $122,500 | $122,500 | $122,500 | |
| Risk adjustment | 0% | ||||||
| Htr | Data storage (risk-adjusted) | $0 | $122,500 | $122,500 | $122,500 | ||
| Three-year total: $367,500 | Three-year present value: $304,639 | ||||||
The financial results calculated in the Benefits and Costs sections can be used to determine the ROI, NPV, and payback period for the composite organization’s investment. Forrester assumes a yearly discount rate of 10% for this analysis.
These risk-adjusted ROI, NPV, and payback period values are determined by applying risk-adjustment factors to the unadjusted results in each Benefit and Cost section.
| Initial | Year 1 | Year 2 | Year 3 | Total | Present Value | |
|---|---|---|---|---|---|---|
| Total costs | ($1,000,000) | ($2,450,000) | ($2,450,000) | ($2,450,000) | ($8,350,000) | ($7,092,786) |
| Total benefits | $0 | $6,117,192 | $7,257,192 | $7,257,192 | $20,631,576 | $17,011,198 |
| Net benefits | ($1,000,000) | $3,667,192 | $4,807,192 | $4,807,192 | $12,281,576 | $9,918,412 |
| ROI | 140% | |||||
| Payback period (months) | <6 |
Total Economic Impact is a methodology developed by Forrester Research that enhances a company’s technology decision-making processes and assists vendors in communicating the value proposition of their products and services to clients. The TEI methodology helps companies demonstrate, justify, and realize the tangible value of IT initiatives to both senior management and other key business stakeholders.
Benefits represent the value delivered to the business by the product. The TEI methodology places equal weight on the measure of benefits and the measure of costs, allowing for a full examination of the effect of the technology on the entire organization.
Costs consider all expenses necessary to deliver the proposed value, or benefits, of the product. The cost category within TEI captures incremental costs over the existing environment for ongoing costs associated with the solution.
Flexibility represents the strategic value that can be obtained for some future additional investment building on top of the initial investment already made. Having the ability to capture that benefit has a PV that can be estimated.
Risks measure the uncertainty of benefit and cost estimates given: 1) the likelihood that estimates will meet original projections and 2) the likelihood that estimates will be tracked over time. TEI risk factors are based on “triangular distribution.”
The initial investment column contains costs incurred at “time 0” or at the beginning of Year 1 that are not discounted. All other cash flows are discounted using the discount rate at the end of the year. PV calculations are calculated for each total cost and benefit estimate. NPV calculations in the summary tables are the sum of the initial investment and the discounted cash flows in each year. Sums and present value calculations of the Total Benefits, Total Costs, and Cash Flow tables may not exactly add up, as some rounding may occur.
1 Total Economic Impact is a methodology developed by Forrester Research that enhances a company’s technology decision-making processes and assists vendors in communicating the value proposition of their products and services to clients. The TEI methodology helps companies demonstrate, justify, and realize the tangible value of IT initiatives to both senior management and other key business stakeholders.
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