When a hospital merger closes, one veteran CIO reaches for the exact same playbook every time, while another insists no two acquisitions ever call for the same one.
Health systems keep getting bigger. Mergers, acquisitions and affiliations have become one of the primary paths to scale, and each deal hands a CIO two organizations, two technology stacks and a clock that starts the moment the ink is dry.
That growth is not incidental. Becker’s tracked 29 large health systems pursuing mergers, acquisitions or strategic partnerships in 2026, describing a pickup in hospital consolidation after several quieter years following the pandemic.
MultiCare and UNC Health are both on that list. MultiCare is working through a planned merger with Corvallis, Ore.-based Samaritan Health Services that would create an 18-hospital system with more than 33,000 employees, while UNC Health is in the midst of the Onslow Memorial Hospital affiliation Brent Lamm, CIO of the organization described, a deal structured in phases that gives the health system a 30% membership interest in Onslow this year, rising to 49% in a second phase and full membership by 2029.
Scott Waters, interim CIO of Tacoma, Wash.-based MultiCare Health System, and Mr. Lamm have each guided their organizations through repeated rounds of growth. Their approaches to the first IT decisions after a deal closes, though, diverge in almost every respect.
Mr. Waters treats every acquisition as its own case study. The deal structure, the cultural fit between the two organizations and how much technical detail MultiCare could gather during due diligence all shape what happens first.
“If you have done one acquisition, you have done one acquisition,” he told Becker’s. “They are all slightly different in most ways, but the amount of information you are able to get during the due diligence period is widely variable. Sometimes you are going in with a full understanding of the technology, security, and application stacks, and sometimes you are not.”
That variability is why Mr. Waters said he starts with people rather than platforms.
“I generally start with determining how users are going to communicate and move between the two separate environments and for how long,” he said. “Typically, we need to have a bridge strategy for a period that allows for business-to-business connectivity for things like email, calendar, intranets and policy access.”
The EHR question follows the same case-by-case logic. MultiCare almost always runs parallel EHR systems for a period, Mr. Waters said, with the length tied to geographic overlap between the two patient populations, opportunity prioritization and cultural alignment. The more a market overlaps, he said, the more urgency there is to get both organizations onto one system, since overlapping markets mean shared patients navigating two records.
That flexibility shows up in MultiCare’s timelines. Depending on the size of the organization being acquired, Mr. Waters said full integration generally takes 18 months to three years, and even that range has shifted over time.
“This has evolved, but the pendulum swings back and forth a bit as bridging technology has evolved to make being on separate environments easier for our users,” he said.
UNC Health’s Mr. Lamm described a nearly opposite philosophy, one enterprise standard applied almost the same way every time. UNC Health recently completed its 11th go-live, absorbing Jacksonville, N.C.-based Onslow Memorial Hospital, bringing the health system to 20 hospitals across 11 go-lives.
For Onslow, Mr. Lamm said the commitment to implement UNC Health’s enterprise systems within a set time frame was written into the acquisition agreement itself, which simplified the first decision considerably.
“We committed to implement our systems within a certain time frame,” he told Becker’s. “Once everything is done, then in terms of the agreement, it’s get to work at doing our standard implementation.”
Like Mr. Waters, Mr. Lamm said the first move is about people, not systems.
“We’ve created a recipe that we believe works really well for us, and we don’t deviate from it,” he said. “One of the very first things we do is we transition the entity’s IT teammates to UNC Health Information Services teammates.”
Where Mr. Waters described running parallel EHR systems for years in some cases, UNC Health does not keep an acquired hospital on its legacy EHR long term under any circumstance. Every acquisition moves to UNC Health’s Epic build.
“It is a requirement that we move them to our Epic at UNC implementation for our electronic health record system, so we don’t take over other hospital or practice entities and keep for the long term any other EHR,” Mr. Lamm said. “It’s always assumed and always part of the arrangement that we’re going to move them to our Epic at UNC.”
UNC Health takes over an acquired hospital’s IT operations and EHR entirely on the date the two organizations sign their information services agreement.
“We run their legacy systems until we implement all of our enterprise solutions and phase out their legacy systems,” he said.
That standardization also extends to budgeting. Mr. Lamm said UNC Health builds a three-phase budget for every acquisition, starting with a full inventory of the incoming hospital’s hardware, software and contracts during due diligence, then splitting the work into three phases, one before the Epic go-live, one at the same time as go-live and one covering anything that must remain afterward.
The payoff, Mr. Lamm said, has been speed. UNC Health has completed full IT migrations in as little as eight months and as long as 18, depending on the acquired hospital’s starting condition.
“One of our entities had a situation where they were in desperate need of an IT transition, and we actually did that in eight months, end to end, full IT migration from their legacy IT service provider to UNC Health,” he said. “On the long end, we tend to see it might be more like 18 months.”
Asked what advice he’d offer other CIOs navigating growth, Mr. Lamm pointed back to consistency, even when it isn’t the popular answer.
“We don’t try to do custom arrangements for IT systems for one entity versus another,” he said.
UNC Health applies the same enterprise standards, from its Epic build to its enterprise resource planning and imaging systems, to every acquisition, with only minor flexibility at the edges.
“Overall, we’ve been very careful to stay very standardized, and I believe that’s paid off well for us,” he said.
Mr. Waters, for his part, sees that same variability as the point. With culture, deal structure and due diligence access shifting from one acquisition to the next, he said MultiCare’s first move will keep being to figure out, case by case, how two workforces keep functioning together while the rest of the integration catches up.
Between the two health systems, the throughline is the same even where the philosophy isn’t. Neither CIO waits for the technology conversation to start with the technology. Both start with the workforce that has to run it.
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