Cone Health is investing at least $40 million to rebuild the foundation of its Epic EHR after years of customization left the health system with technical debt and limited its ability to adopt newer Epic capabilities.
Mike Kramer, MD, chief medical information officer of Cone Health, said the health system’s Epic environment had accumulated years of customized build and third-party applications since the organization first implemented the EHR.
“We installed Epic back in 2012, so we’ve had it for about 14 years,” he told Becker’s. “Our Gold Stars scores are pretty low, there are a lot of concerns, and many of the features Epic has introduced over the years we’ve never implemented.”
This left the health system with a lot of technical debt, and “a highly customized build and several bolt-on applications that we no longer need because Epic now provides those capabilities,” according to Dr. Kramer.
Cone Health is now funding a $40 million project to essentially reinstall its Epic system.
“We’re expanding our teams over the next two and a half years and have developed a roadmap to replace the foundation we built 14 years ago with what a modern health system would implement today,” Dr. Kramer said.
The project kicks off with a six-month Phase Zero, rather than a traditional phased approach, that starts with Epic’s Beaker, Compass Rose and primary care enablement. Then, in September, Cone Health will formally begin Epic’s Refuel assessment, which will continue over the following two and a half years.
Dr. Kramer said Risant Health, the nonprofit that acquired Cone Health in 2024, is helping support the investment because Cone Health’s legacy Epic environment had become a barrier to the organization’s broader value-based care strategy.
“Our Risant corporate parent is really encouraging and funding a good part of it, because our Epic build was a barrier to our strategic priorities, our value-based mission and care model that we needed to adopt,” he said.
Dr. Kramer said Cone Health estimates that there’s roughly a $5 million to $10 million opportunity simply by adopting more of Epic’s best practices operationally, and another $5 million to $10 million opportunity by replacing third-party applications with Epic modules.
“We’re looking at both application rationalization and process optimization,” he said.
The project also includes changes to how Cone Health governs its EHR. Rather than IT owning governance meetings, operational and clinical leaders now lead the committees responsible for evaluating Epic enhancements and other technology initiatives, while IT staff serve as embedded advisors.
“The meetings are owned by operational leaders — primary care, cardiovascular services and others,” Dr. Kramer said. “Those leaders decide who’s at the table. This isn’t something being done to them; it’s something being done with them.”
Every project is also receiving a change management score based on how disruptive it will be to clinicians and operations. Governance leaders see those scores before approving projects.
For Dr. Kramer, the long-term goal is creating a sustainable model for continuous optimization rather than periodic large-scale improvement efforts.
“Optimization is not one and done,” he said. “If you do optimization right, you build a model where you don’t have to optimize anymore. You’re always going to have to tweak things, but now you’re not falling behind.”
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