Epic EHR Hosting Options Comparison – which is right for you?

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Cloudticity, L.L.C.


It’s no secret that Epic Systems is dominating the EHR market. A new report running health IT companies rated Epic as the best overall software suite for the 12th year in a row. Epic outperformed competitions in terms of acute care EMR, cardiology, and patient portals, among others. For many healthcare organizations who are looking to upgrade their digital presence, Epic is the way to go.

However, once you’ve made the “what” decision – Epic – you still have the “how” dilemma, as in: “How should I host the Epic Systems software?” 

There are several hosting options available. Your organization’s specific needs will determine which one is best for you. This post takes a look at the most commonly used hosting methods that you should consider and the pros and cons of each. 

Epic Connect

Strictly speaking, Epic Connect is not technically a hosting option but rather a mechanism that allows community hospitals, clinics, vendors, and laboratories to connect to a larger local hospital that is hosting Epic and gain access to the Epic EHR network. Almost 40,000 providers use Epic through Connect, which Epic recommends to independent medical groups because it creates shared patient records with local hospitals. 

Connect can be a viable option for smaller healthcare organizations. The connecting entity gains immediate access to a shared community record of secured patient data without the expense of implementing its own Epic Systems software. Connect enables rapid communication among providers and patients and provides access to real-time, actionable data for population health and value-based contracts. Connect enhances interoperability with the nearby health system, thus, increasing referrals and promoting a more coordinated approach to healthcare.

Epic Connect

The downside of Connect is that the smaller organization can get lost in the much larger and more complex IT operations of the hosting hospital. In some cases, that can lead to less-than-stellar customer support, a huge problem for small healthcare companies that are already struggling to maintain market share and even viability. For that reason, midsize to large health facilities often choose to work directly with Epic Systems rather than using Connect. 

Epic Connect Pros

  • Good option for smaller healthcare organizations looking to cut costs and increase simplicity
  • Enhances interoperability with nearby and larger health systems
  • Allows smaller providers to access modules and features that they otherwise couldn’t afford on your own

Epic Connect Cons

  • Limited ability to customize the workflows and features of the parent hospital
  • Data is stored on a larger organization’s database with little to no isolation
  • Customer support is limited by the inability to work directly with Epic

Epic Garden Plot

Independent medical groups are on the decline. Fewer than half of U.S. doctors work in a private practice. Of those private practices that continue to operate, many see growth as their only opportunity to survive. 

That’s where Epic Garden Plot comes in. In 2022, Epic Systems launched Garden Plot, a new software-as-a-service (Saas) offering designed for independent medical groups looking to use Epic EHR tools. Epic designed Garden Plot for the 900 U.S. medical groups that have between 40 and 100 providers and don't currently use Epic software. A key difference between Community Connect and the new module is that Epic Garden Plot will allow independent medical groups to work directly with Epic.

Garden Plot gives small, independent groups access to Epic—the software and third parties they need, plus the strength of the Epic interoperability network—with minimal overhead. Epic Systems handles hosting, support, and the configuration and rollout of updates, which frees providers to focus more resources on patient care as opposed to IT support. Like Connect, Garden Plot allows organizations to access the Epic Systems software without significant capital investment. Unlike Connect, Garden Plot is a service of Epic Systems itself and therefore the customer can be assured of excellent support. 

Epic Garden Plot Pros:

  • Good option for medical groups that employ 40 to 100 doctors and don’t use Epic Connect
  • Reduces upfront investment and simplifies maintenance
  • Offers greater flexibility and scalability than on-premise hosting
  • More customizable than Epic Connect
  • Enables access to Epic interoperability network

Epic Garden Plot Cons:

  • Requires reliable internet connection to access data
  • Like with any SaaS application, data leakage is a risk
  • Users rely on Epic to keep the software running and available
  • Subscription costs are cheaper than upfront costs of maintaining software in the short term, but can become more expensive over time

On-Premises Epic

The perennial dilemma of “build versus buy” is alive and well in healthcare in the form of the key decision of whether to deploy Epic Systems on-premises or in the cloud. While healthcare is steadily adopting the cloud, on-premises deployments of Epic Systems are still common for three key reasons: cost savings, control, and security. 

Cost Savings

An on-premises deployment often can be the most cost-effective way to deploy Epic Systems – but there’s a catch. Since you only pay once for user licenses, an on-premises solution can in theory have a lower Total Cost of Ownership (TCO) than a cloud system. Of course, to achieve that potentially lower TCO, you have to invest up front in the infrastructure needed to run Epic Systems, including servers, storage systems, networking gear, and more. 


The good news: when you own the infrastructure, you can do anything. The bad news: when you own the infrastructure, you have to do everything.

In an on-premises situation, you purchase and maintain the software and the hardware – all of it. This arrangement gives you great flexibility in changing the architecture in response to changing market requirements. However, to achieve this level of adaptability means that you have to have skilled staff who can manage and maintain your data center – virtually impossible given the expense involved and the industry-wide skills shortage of IT professionals. For these reasons, many organizations engage a managed services provider (MSP) to augment their internal staff. 


Once the primary reason to choose an on-premises solution, security has done a 180 — now the security in a public cloud deployment is as good and often better than you can achieve yourself in an on-premises environment. However, some healthcare organizations still are not comfortable putting personal health information (PHI) in the public cloud

While on-premises will continue to be a viable option for existing Epic Systems deployments, most new implementations are choosing the cloud, either a private cloud with a hosting provider or one of the large public cloud providers, that is, AWS, MIcrosoft Azure, and Google Cloud. 

On-Premise Epic Pros

  • Provides complete control over the EHR system and data
  • Data is hosted locally which can improve performance
  • Allows the most customization of features, modules, and workflows

On-Premise Epic Cons

  • Capital investment: Requires significant investments in technology infrastructure and each new version increases the amount of infrastructure it requires.
  • Time to value: Building your own infrastructure and deploying Epic could take up to 24 months and require millions of dollars in upfront investment.
  • Lack of scalability: On premise lifecycles are typically 3-5 year capital investments, and can create huge hurdles if not planned perfectly. Unplanned purchases around year 3 are sometimes inevitable.
  • Management: Management and optimization of Epic resources is complex, and sufficient talent is scarce and in high demand.

Hosted Epic

Private cloud is for organizations that cannot or will not put PHI on a shared infrastructure, as is the case with the public cloud providers. Hosting providers offer single tenancy, that is, the Epic System software runs on dedicated hardware and software maintained by the provider. They also have specialized talent with expertise in both private cloud infrastructure and Epic software requirements and therefore can accelerate the standup process and shorten the deployment time.

Let’s look at a hypothetical case study (the names aren’t real): HeathWatch, a growing midsize clinic, has been accessing a commercial EHR system via a joint operating agreement (JOA) with a larger healthcare organization, but now needs to step into its own system to support continued growth. After a thorough evaluation of EHR vendors, HealthWatch selects Epic Systems as its best option. With the JOA business arrangement expiring in eight months, the race to host the Epic software is on. 

HealthWatch first looks at the on-premises option. Building out its own infrastructure and standing up the Epic software could take up to 24 months and millions of dollars in investment – both out of the question for HealthWatch. Public cloud is an option, but HealthWatch lacks the internal expertise in public cloud infrastructure. 

Enter Hosting Systems, a leading data center and network solutions provider, with a proposal for a hosted private cloud. Working closely with the HealthWatch team, Hosting Systems builds out dedicated infrastructure  in its existing data center. This process goes quickly because the physical facilities, networking,  security, and disaster recovery are already in place – all that’s necessary is to provision servers, storage systems, and virtualization software to HealthWatch’s requirements. Hosting Systems works closely with the technical staff at Epic Systems  to stand up the Epic software in a single-tenancy configuration for HealthWatch. The combined efforts of HealthWatch, Hosting Systems, and Epic Systems brings the EHR software online within the eight-month window. Best of all, HealthWatch avoids the expense and management distraction of running such a complex project – Hosting Systems and Epic do the heavy lifting. 

Hosted Epic Pros

  • Reduces upfront investment costs and timeline when compared with on-premise hosting
  • Simplify management and optimization by leaning on vendor talent and resources
  • Can be customized to meet organizational needs

Hosted Epic Cons

  • Ongoing maintenance and support costs for hardware and software can be prohibitively expensive
  • Requires reliable internet connection to access data
  • Users are at the mercy of the hosting provider to ensure high availability and performance, as well as infrastructure security

Public Cloud Hosted Epic

If public cloud were a horse race, win, place, and show would go to AWS, Microsoft Azure, and Google Cloud, in that order. Each of these giants has a dedicated healthcare practice and a formal business arrangement with Epic Systems. AWS has been the public cloud of choice for most Epic deployments in the past, but the other two are coming on strong. 

Microsoft Azure’s Health and Life Sciences group recently announced that Accenture and Microsoft will assist Mount Sinai in a five-year transformation journey to the cloud. This win reflects the software giant’s determination to compete in this lucrative market – and no one should ever count out Microsoft. 

Google Cloud has had a rocky relationship with Epic Systems, which as recently as June 2020 considered ending support for Epic on Google Cloud. However, cooler heads prevailed, and in November 2022 Google Cloud and Epic signed a deal that will allow health systems to migrate their Epic EHRs to Google's cloud. 

Public Cloud Hosted Epic Pros

  • Reduce costs: Organizations that utilize public cloud infrastructure reduce IT operating costs by 30% in three months on average.
  • Stop guessing capacity: Adjust resources on an as-needed basis rather than acquiring long-term IT assets.
  • Reliability and disaster recovery: Spread EHR across multiple data centers in a matter of minutes to maximize availability.
  • Ransomware resilience and business continuity: Host a read only copy of Epic production on the public cloud to be accessed during a ransomware attack. Learn more here.
  • Speed to value: Get up and running in days instead of months.
  • Scalability, Performance and Optimization: Allow the four layers of Epic to scale for performance and be optimized independently.
  • Simplicity: Reduce overhead required for infrastructure operations management

Public Cloud Hosted Epic Cons

  • Need internet connection to access data
  • The necessary talent and skills for public cloud management are often difficult to find

Get Started with Epic on AWS

Healthcare organizations now have three viable options for deploying Epic in the public cloud. However, migrating Epic to any of the three major public cloud providers is a complex and time-consuming process, one that requires specialized expertise. To learn more, download the white paper The Challenges of Migrating Epic to AWS – and how to overcome them.

Most healthcare organizations choose a managed services provider (MSP) to help with Epic on AWS or another cloud service provider. If you are considering a migration or greenfield deployment in the public cloud, look for an MSP with a sharp focus on healthcare IT, a proven track record, and the willingness to transfer knowledge during the project. Cloudticity is just such a company. Reach out for a free consultation today!

Five Things You Need To Get Right For Epic on AWS


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