Healthcare’s getting cloudier: Tegria and Microsoft weigh in on why that’s a good thing


There are many benefits to migrating your EHR to a cloud hosting solution like Azure. The public cloud is constantly growing and adapting to meet the ever-evolving needs of healthcare. With cloud hosting, organizations can focus on transformative healthcare by ensuring that their core systems are secure, reliable, and flexible. With the many benefits of cloud hosting, come even more questions. Tegria and Microsoft have come together to help you answer those questions with our 25+ years of experience hosting EHRs with the continuous innovation of Microsoft.

Our experts:

As Microsoft’s Chief Digital Transformation Officer, US Health & Life Sciences, John Barto works closely with health organizations to facilitate the use of modern technologies in the healthcare industry.

Serving as VP Managed Services Hosting & Infrastructure for Tegria, Chad Skidmore and his team operate the core infrastructure systems for Tegria.

Why do healthcare CIOs need to develop a cloud strategy and what should they consider when choosing a cloud partner?

John: There are several reasons for needing a cloud strategy, but the most important of these is to be positioned to address the consumerization movement that has transformed other industries and is swiftly impacting healthcare. Organizations are now competing for the attention of patients, members, and even employees. The cloud provides a means to adopt the latest technological approaches and craft better consumer and workforce experiences in a much shorter timeframe. This agility around personalized health experiences will be the major factor to determine an organization’s growth potential. The choice of a cloud partner should be focused on their ability to secure health data, innovate at rapid speed, and maintain that innovation over long periods of time.

Chad: Most healthcare CIOs are probably already consuming cloud services in some form and that trend will only continue. Having a specific strategy, architecture, and operating model will help ensure that policies, procedures, and security strategies are in place and appropriate for both on-premise and cloud models. This will increase the overall efficiency of a hybrid model and, eventually, a cloud-first model.

What are the benefits of migrating an EHR to the cloud and when is the right time to think about cloud hosting for an organization?


  • Market Agility: Migrating EHRs to the cloud will provide organizations with the agility to overcome unforeseen market disruption and fend off competition. A great example of this played out during the onset of the pandemic when health systems needed significantly more resources in call centers, which depleted the performance of the frontline care workers because capacity was not elastic.
  • Better Use of Data: On the competitive side, having EHR data in the cloud allows organizations to leverage tools more quickly. In fact, nowadays many software producers only develop for the cloud.
  • Cost-Savings: On the financial side, it makes sense for organizations to start considering cloud deployment for the EHR in advance of an upgrade cycle so they can eliminate the need for significant capital expense and position themselves to more quickly incorporate future developments to their EHR.

Chad: The benefits vary from one healthcare organization to another. General benefits include the following:

  • Capital Savings: Moving from a Capex model to an Opex model effectively ties expense to usage. Not paying for capacity you do not use can yield savings and the Opex model supports a more predictable recurring cost rather than large capital purchases every three to six years.
  • IT Staff Allocation: Shift in IT staff focus to higher value work, rather than supporting and caring for a physical data center and its underlying technology. IT can focus their time on the applications providing the services that caregivers and patients need.
  • Space Gained Back: Repurpose data center space to clinical space, which drives revenue and unburdens facilities teams from supporting power-hungry data centers adjacent to clinical space.
  • Agility: React more quickly to business needs. If the business needs to expand the use of an application or roll out new features, the elasticity provided in the cloud allows for that much more quickly than a traditional IT model.

Once your strategy is developed, any time is a good time to begin migrating IT workload to the cloud to free up or relieve on-premise demands. Other key triggers are significant upgrades that may require large capital outlay and can be moved to the cloud rather than upgraded in place; new initiatives that may be better served by cloud such as analytics projects; or changes to core architecture such as a shift from IBM Power architecture to an Intel architecture for Epic.

How are healthcare organizations weighing moving to the cloud and the associated technical debt of a data center investment?

John: Some health systems move their EHR to the cloud to eliminate the endless need for data center and technology upgrade cycles. It is getting more difficult to manage data center solutions as the technology supply chain lengthens and human resources become ever scarcer. Others look to the cloud to help them improve the operational cost of their EHR. In order to achieve significant cost reductions, an organization needs to develop cloud management disciplines.

Chad: In terms of weighing the move, I think there are a few common considerations. Understanding the actual cost is one. With cloud, many services are priced based on consumption, which sometimes makes it more difficult to budget for your IT spend. Technical debt is certainly a factor and that can come in many forms. One is legacy code or applications that don’t work well in the cloud due to stringent performance requirements or uncommon architecture requirements.

Are there successful examples in the market of migrating Epic to Azure? What are some wins in this space and some learnings?

John: We have several clients engaged in various phases of cloud migration. St. Luke’s University Health Network in Pennsylvania is one example of an organization that has moved their entire EHR operation to Azure. Others, such as Legacy Health from Oregon, have migrated their EHR into a hybrid situation where their disaster recovery system runs on Azure and their desktop integration can run either on-premise or in the cloud allowing elasticity as needs scale. Stanford has migrated both EHR disaster recovery and dev/test platforms to Azure. All report reductions in capital spending and several also mention how simple it is to adopt newer compute tools in the cloud as compared to the process in an on-premise model. Another solution, of creating a read-only copy of the EPIC production environment in Azure, is rapidly growing in popularity in the boardrooms of providers to mitigate the risks of ransomware attacks providing a place to access EHR data if an organization is being held hostage.

Chad: Providence migrated a legacy instance of Epic for their Kadlec region. Kadlec had migrated regular workflows to one of Providence’s primary Epic instances but needed to keep this legacy instance up and running as they wound down financials out of it. Migrating this instance to Azure provided potential cost savings as the hardware needs were much lower and gave the Providence team an excellent opportunity to learn from the process. In addition to learning more about how Epic runs on Azure, a big takeaway for the team was how DR across Azure regions can be built out for Epic, what the challenges are around latency between regions, and how to overcome issues related to that.

Ready to learn more?  Tegria offers cloud hosting solutions for many EHR customers. By providing strategic roadmapping and migration support, Tegria enables healthcare organizations to get back to doing what they do best—delivering exceptional patient care.

Discuss how to get your cloud journey started today