Oakland, Calif.-based Kaiser Permanente recently completed one of the largest EHR consolidations in healthcare history, migrating about 40 million patient records.
In early 2025, the 40-hospital system merged 12 instances of its Epic EHR into two: in its Northern California and Southern California markets. In each case, the health system transferred roughly 20 million patient records with less than three hours of downtime and no canceled appointments or delayed procedures.
Becker’s reached out to Neil Cowles, chief information and technology officer of Kaiser Permanente, to learn more.
Question: Why did Kaiser Permanente decide to consolidate the 12 EHR instances to two?
Neil Cowles: The consolidation of our 12 EHR instances into two, one for Northern California and one for Southern California, was part of Kaiser Permanente’s broader IT strategy to standardize, simplify and modernize our capabilities. By consolidating into one instance per region, Kaiser Permanente simplified workflows, improved data consistency, and enabled more seamless access to patient records across facilities.
This project reflects our commitment to delivering more value and higher-quality solutions to support our mission to provide high-quality, affordable healthcare services and to improve the health of our members and the communities we serve.
Q: Why did having multiple EHR instances used to be a best practice? What’s changed?
NC: Previously, Kaiser Permanente operated 12 distinct EHR instances — six in Northern California and six in Southern California — which was due to scalability limitations at the time of initial deployment. These instances had different configurations, workflows and patient data to fit their local service areas, which created complexity for physicians and care teams.
By consolidating into one instance for Northern California and one instance for Southern California, Kaiser Permanente simplified workflows, improved data consistency, and enabled seamless access to patient records across facilities.
Q: Why did Kaiser Permanente decide to keep two instances rather than one for all of California (and does KP have instances in other states)?
NC: As of now, Kaiser Permanente operates eight clinical EHR instances, each aligning to one of our eight markets where Kaiser Permanente provides care. Kaiser Permanente continues to evaluate our long-term deployment architecture to meet our business needs. In this stage, the best approach was to consolidate each of the California multi-instance deployments to one for each California market, due to scalability considerations and alignment with business goals.
We continue to evolve this strategy and are working on future stages to further align our deployments to improve member experience and support operations.
While this project focuses on California, the success of this initiative demonstrates what’s possible at scale and sets a strong foundation for future modernization efforts. This achievement positions us well to explore similar opportunities in the future as part of our ongoing strategy to simplify, standardize and transform our innovative use of technology across the organization.
Q: What benefits have you already experienced — and do you expect to experience — from the consolidation?
NC: The EHR consolidation significantly streamlined operations by unifying multiple systems into a single, standardized platform for each region. This simplification has made it easier for care teams to access patient records, coordinate care, and complete tasks efficiently.
Key improvements include:
— Simplified scheduling: Members can more easily schedule appointments across hospitals and medical offices, and staff can manage those appointments more efficiently.
— Improved data access: Patient records are now centralized, allowing care teams to quickly retrieve complete medical histories, regardless of where the patient received care.
— Reduced maintenance: Previously, configuration and code needed to be deployed six times in perfect coordination; now all of this is done once.
— Consistent workflows: Clinicians now use the same interface and processes across all facilities in their region, reducing confusion and training time.
— Reduced technical complexity: Consolidation eliminated multi-instance complexity that included custom code, complex routing and led to additional IT costs and time to deliver value to our members.
Ultimately, this consolidation empowers our care teams to focus more on patient care and less on navigating complex systems.
Q: During the cutovers, were your EHRs essentially offline? Were you back to paper during that time period (if so, how did you manage)?
NC: During the cutover, inpatients were virtually discharged and then readmitted into the new EHR instance. This was a technical workflow only — patients did not have to physically leave, change rooms, or experience any interruption in care. The purpose of this step was to ensure continuity of care and accurate record-keeping as we made a clean transition between the old and new EHR instances. Kaiser Permanente’s downtime procedures, which are regularly rehearsed, help ensure there is zero interruption to care during system transitions.
Q: How much did this project cost? What’s the ROI?
NC: The consolidation significantly streamlined operations, making it easier for care teams to access patient records, coordinate care, and complete tasks efficiently. Ultimately, it empowers our care teams to focus more on patient care and less on navigating complex systems, supporting our mission to provide high-quality, affordable healthcare services and to improve the health of our members and the communities we serve.
Q: What were some lessons learned from this project that you’d tell other organizations thinking about doing something similar?
NC: One of the most important lessons is that success requires close alignment between doctors, clinicians, IT and other business functions to ensure any technology change does not interrupt care, preserves clinical workflows, and provides the best experiences possible. At Kaiser Permanente, every decision throughout the EHR consolidation was guided by a shared focus on patient safety and clinician usability. When everyone aligns around those outcomes early, the technology becomes an enabler — not the driver — of change.
The second lesson is rigorous preparation and testing. Kaiser Permanente conducted over 25 dress rehearsals before go-live, which allowed teams to refine processes, identify potential issues, and build confidence in the execution plan. This level of preparation was critical to completing the consolidation with less than three hours of downtime and zero canceled appointments or delayed procedures.
These practices, combined with a culture of continuous learning and innovation, enabled Kaiser Permanente to execute one of the largest EHR consolidations in healthcare without any disruption to patient care.
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