The question of where to host Epic in a hospital and health system is a really important decision. It’s hard to argue that any system is more important to the operations of a healthcare organization than their EHR. For the longest time, the Epic hosting decision was easy. Everyone hosted Epic in their own data centers. As time has gone on, many people started moving Epic to various private cloud environments including an Epic hosted cloud option. Now we have some organizations choosing to host Epic in the public cloud.
A little over a year ago, we hosted an episode on our Healthcare CIO Podcast discussing the Epic Cloud Migration along with Michigan Medicine’s decision to go all public cloud. Our guest on that podcast episode was Dr. Tim Calahan. He recently decided to leave his position as CTO at Michigan Medicine to work full time as the Founder and Managing Member at EHC Consulting which focuses on hosting healthcare solutions like Epic in the public cloud.
In the interview below, we learn more from Dr. Calahan about his decision to work at EHC Consulting full time. Plus, we dive into hosting Epic on the public cloud along with his experience moving other applications to the public cloud.
Tell us a little about yourself and EHC Consulting.
Dr. Tim Calahan: I began my technology career in the U.S. Marine Corps within the Judge Advocate General’s Office, where I was famously told to “fix the computer.” That directive launched a career spanning more than three decades in healthcare technology. Over that time, I’ve been privileged to witness — and help lead — the evolution from on-premises computing to modern cloud-based healthcare ecosystems. That constant state of change is what continues to energize and motivate me.
We founded EHC Consulting to address a clear gap we’ve seen across the healthcare industry over the past decade. Many health systems recognize the strategic advantages of the public cloud — agility, resilience, scalability, and innovation — but lack a clear roadmap, governance model, and execution playbook to migrate complex clinical workloads safely and effectively.
At EHC, our core focus is helping organizations move Epic EHR to the public cloud, but our expertise extends well beyond that. We also support migration and modernization of Epic third-party applications, imaging platforms, analytics environments, and general enterprise workloads. Our goal is not just to move technology, but to help organizations transform how they deliver care through modern infrastructure.
Why did you decide to leave your position as CTO at Michigan Medicine and go full time at EHC Consulting?
Dr. Tim Calahan: I am immensely proud of what our team accomplished at Michigan Medicine. During my tenure, we defined a comprehensive cloud strategy, began executing it at scale, and — most importantly — successfully migrated Epic to the public cloud, which is a significant milestone for any academic medical center.
Equally important, we built a strong, capable technology leadership team that I trust deeply to continue this journey. The organization is in excellent hands.
Ultimately, my decision comes down to impact. While I was able to drive meaningful change at Michigan Medicine, EHC Consulting allows me to bring that same experience, expertise, and approach to multiple health systems nationwide. By focusing full time on EHC, I can help accelerate cloud transformation across the broader healthcare ecosystem — which I believe is where I can have the greatest positive effect.
What are some of the big lessons learned while CTO at a health system when it comes to IT infrastructure?
Dr. Tim Calahan: There are three key lessons that stand out from my time as CTO at Michigan Medicine:
First, traditional on-premises infrastructure is increasingly inadequate for modern healthcare. Legacy architectures struggle to support real-time analytics, interoperability, AI, and the scale of data that today’s clinical and research environments demand. These limitations don’t improve over time — they compound.
Second, cloud transformation is not a quick project; it is a multi-year journey that requires disciplined leadership, patience, and trust in the long-term value of cloud. Organizations that lack consistent executive sponsorship or strategic clarity often stall or backslide. At Michigan Medicine, we were fortunate to have strong, unwavering leadership — particularly from Dr. Marshall Runge — which was critical to our success.
Third, your partners matter. Selecting the right cloud provider and systems integrators is one of the most consequential decisions a health system can make. You need partners who deeply understand both healthcare and large-scale cloud transformation, not just generic IT migration.
As CTO you decided to go all in on public cloud — what were the pros and cons of that decision?
Dr. Tim Calahan: Going all in on the public cloud was a straightforward decision for me, and one I would make again without hesitation.
The benefits are extensive: improved reliability, faster innovation, better security posture, elastic scaling, and the ability to integrate modern data and AI capabilities that are simply impractical in traditional data centers.
The primary “con” isn’t technical — it’s cultural. A transformation of this magnitude inevitably creates resistance. Some stakeholders are understandably cautious, and some incumbent vendors are invested in preserving the status quo. Throughout our journey, we encountered skepticism, fear, uncertainty, and doubt from various corners of the organization and industry.
Strong leadership and a clear vision were essential. We had to consistently remind people why we were doing this: to modernize care delivery, improve resilience, and position Michigan Medicine for the future of digital health.
Why are you so bullish on Epic in the public cloud?
Dr. Tim Calahan: I’ve been working on moving Epic to the cloud for nearly a decade, and I’ve seen firsthand how transformative it can be.
At a surface level, Epic performs well in the cloud, can be more cost-effective to operate, and allows for more flexible capacity planning. But the deeper benefit is organizational.
When Epic is delivered via cloud and managed services, IT teams are freed from routine operational maintenance and can focus more on innovation, clinical collaboration, and strategic initiatives that directly impact patient care. I’ve seen this shift dramatically change how IT functions within health systems — from infrastructure caretakers to strategic enablers.
That track record of real, measurable transformation is why I remain so confident in Epic’s future in the public cloud.
How have you seen Epic evolve in its approach to the public cloud?
Dr. Tim Calahan: When we first explored moving Epic out of traditional data centers, it was considered nearly impossible — and Epic initially told us as much.
Over time, through collaboration, engineering investment, and persistence across the industry, that mindset changed. What began as experimental architecture evolved into a validated, scalable model.
Today, Epic has fully embraced the public cloud. They’ve developed strong engineering capabilities, standardized best-practice architectures, infrastructure-as-code frameworks, and operational playbooks tailored specifically for cloud environments.
A great example of this evolution is Epic’s Cogito platform on Microsoft Fabric, which represents a truly cloud-native analytics strategy. This shift reflects a broader recognition that the consistency, scalability, and innovation velocity of the public cloud align better with Epic’s long-term roadmap than fragmented on-premises environments.
Are you concerned about cloud vendors raising prices once organizations are locked in? What can be done to mitigate that risk?
Dr. Tim Calahan: One of the advantages of the public cloud market is that it is competitive. There are three major cloud providers, and none can dramatically raise prices without risking significant customer migration.
While moving Epic between clouds is complex, it is absolutely feasible — and can be done without clinical disruption. That reality keeps pricing in check. If one provider acted in bad faith, others would quickly step in with incentives to attract customers.
Health systems can also hedge risk by designing architectures that are not overly dependent on proprietary services, negotiating strong contracts, and maintaining strategic flexibility. The key is thoughtful cloud governance, not avoidance of cloud altogether.
How do you see “AI at the edge” fitting with a public cloud-first strategy?
Dr. Tim Calahan: There is a lot of discussion about AI today — much of it still theoretical. What we do know is that effective AI depends fundamentally on data. Organizations that have centralized their data in the cloud are far better positioned to take advantage of AI at scale.
As AI tools mature, they will require ongoing monitoring, governance, and validation to ensure outputs remain accurate, ethical, and clinically reliable. That kind of oversight is far easier to manage from a centralized, cloud-based platform than from fragmented on-premises environments.
I do believe we’ll see more AI user interfaces and applications deployed at the edge — for example, in clinical workstations or medical devices. But the underlying data, analytics, and computational infrastructure will remain best suited for the cloud. In that sense, “AI at the edge” complements — rather than contradicts — a cloud-first strategy.
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