Inside Mount Sinai's Epic EHR Cloud Migration for Health IT Scalability

As the digital health transformation progresses, healthcare organizations are increasingly looking to EHR cloud migration as a cost-effective strategy for health IT scalability.

According to Forbes, the market for cloud services in healthcare is expected to exceed $79 billion in the next five years. 

Mount Sinai Health System recently completed an Epic EHR cloud migration, marking the largest production instance of Epic running on Microsoft Azure.

According to Kristin Myers, MPH, executive vice president and chief digital and information officer of Mount Sinai, the migration was part of a larger cloud-first strategy to drive efficiency across the academic medical system.

"It started beyond Epic," Myers told EHRIntelligence in an interview. "Looking at all our applications, we took a step back and thought, 'How do we create more of an adaptable, enabling modern platform to support our organization's needs?'"

Prior to its cloud migration, Mount Sinai had 13 data centers and server rooms across the health system.

"Healthcare is rapidly shifting in terms of the landscape," said Myers, who also serves as dean for digital and information technology at the Icahn School of Medicine at Mount Sinai. "If we were going to remediate all those data centers, constantly, with staffing and make sure that it was best-in-class, it would've taken sizable investments and effort."

After conducting a risk review, the health system made the strategic decision to begin its cloud transformation for cost avoidance around data remediation, as well as additional benefits like increased security and improved uptime.

As an academic medical system, Mount Sinai is not a stranger to the cloud, Myers noted.

"Because we're a research institution, our researchers expect, and so does the NIH, a multi-cloud environment," she said.

A multi-cloud strategy implies the use of various public clouds to match clinical, business, and research workloads with the environment best suited for them.

When deciding which provider to partner with for the Epic migration, Mount Sinai assessed services from three major cloud players: Google Cloud Platform (GCP), Amazon Web Services (AWS), and Microsoft Azure.

"We had exposure to all three vendors, and we still work with them in the research arena, but for the majority of our clinical application and business application portfolio for the hospitals, we decided to move forward with Microsoft," Myers explained.

"The technology of all of these vendors is excellent," she emphasized. "It was really about who was going to provide investment, a focus on innovation, and a business case that made sense to us. In that realm, Microsoft was able to do that."

Myers pointed out that, as a bonus, the EHR cloud migration will lessen the health system's carbon footprint.

"The power consumption of our data centers is definitely going to decrease," Myers said. "Microsoft is optimizing their data centers with energy-efficient designs, efficient cooling techniques, and improved power management."

Moving the Epic EHR to the cloud is also set to advance innovation, including the use of artificial intelligence (AI) technology.

"Since we have migrated many of our applications to the cloud, there was the release of ChatGPT and generative AI, which is integrated with Microsoft Azure," Myers said.

In the coming weeks, Mount Sinai will bring some Epic generative AI features live.

For instance, the health system is piloting a generative AI feature for draft patient communication. 

If a patient sends a secure message to a physician via the patient portal, GPT in Epic will draft a response for the physician to review. Myers expects that the tool will make physicians more efficient and reduce administrative burdens.

"Anything that we can do to make the workforce experience much more positive is definitely well worth it," Myers said.

Mount Sinai is also focused on administrative use cases for generative AI, including the generation of letters to healthcare payers regarding denials.

"We are not looking at generative AI, necessarily, for patient diagnosis," Myers explained. "We're looking at use cases around the administrative areas to develop our core competencies in those arenas first, and also looking at: how do we improve the workforce experience and some of our patient experiences through the use of technology?"

"It's a very exciting time in healthcare, but we also need to make sure that we're getting the return on investment and making the right investments," she pointed out.

Myers said that while the use of cloud services can provide benefits, each healthcare organization's journey will be different.

"The circumstances for Mount Sinai moving to the cloud are going to be different than other organizations," she said.

For example, if a health system just opened state-of-the-art data centers, it may not make sense for them to move their entire portfolio to the cloud immediately. Instead, they may look to begin the migration over the next five to 10 years.

"Every organization has to review what their true business driver is to move to the cloud," Myers noted.

When it comes to cloud migration, Myers emphasized the importance of ensuring applications are cloud-ready, completing end-to-end testing, and focusing on cybersecurity.

"There are tools that each of the vendors have that give a security score, and where the areas are that you need to focus on,” she said. “Just having that data is a game changer, quite frankly."

While on-premise EHRs have been the mainstay of health IT for years, cloud-based EHRs offer cost-effectiveness and scalability that can significantly benefit healthcare organizations and ultimately improve patient care.