2026 Predictions – What’s Next for Epic® on Public Cloud

Epic® on public cloud has moved past the “can it work” phase. The next few years will be defined by scale, standardization, and harder financial decisions. Based on what we’re seeing across health systems, cloud providers, and Epic’s own roadmap, here are eight trends we expect to shape 2026.

1. Azure Virtual Desktop (AVD) Will Become Epic Target Platform

Health systems have felt the pressure of rising licensing costs from legacy application delivery platforms like Citrix and Horizon. That pressure has accelerated interest in alternatives that can support Epic’s Hyperdrive delivery model at scale.

In early 2025, Epic listed Azure Virtual Desktop (AVD) as an exploratory platform, encouraging customers to begin testing in non-production environments. Microsoft paired this with targeted incentive programs to reduce adoption friction, while Epic and Microsoft continued joint development and testing.

Those efforts have expanded AVD’s ability to support Epic workloads and third-party integrations. While Epic typically waits to see multiple production deployments before formally designating a target platform, momentum is building. In 2026, expect a meaningful increase in production Epic environments running on AVD – enough to move AVD from exploratory to target platform.

2. Adoption of Cogito Cloud Will More Than Triple

One of the advantages of public cloud is access to modern analytics and data services that cannot be accessed on-premises. Epic’s Cogito Cloud offering – its SaaS-based analytics platform – represents a clear shift away from legacy, infrastructure-heavy Cogito deployments.

Today, two health systems are live on Cogito Cloud with several others actively migrating to it. As Cogito Cloud nears feature parity and more referenceable use cases emerge, adoption and live deployments will accelerate substantially, especially as Cogito Cloud becomes a central focus at Epic forums and conferences.

3. Rural Health Systems Will Move to Public Cloud and Lean on Managed Services

As more Epic on public cloud success stories emerge, rural and community health systems are beginning to follow suit. For these organizations, cloud adoption is both about modernization and sustainability.

Talent acquisition and retention remain persistent challenges in rural markets. As a result, cloud migrations are often paired with a growing reliance on managed services to maintain operational stability. In 2026, we expect increased cloud adoption among rural health systems alongside rising demand for partners that can provide long-term operational support.

4. Epic Will Add Functionality to Isolated Recovery Environments

Extended downtime scenarios and recent platform-level outages have prompted health systems to reevaluate whether Isolated Recovery Environment (IRE) capabilities are sufficient to support minimum viable hospital operations.

Epic has already made progress, including limited write capabilities introduced in 2025. However, many organizations believe additional functionality is required – particularly to support critical workflows beyond basic clinical access.

Customer feedback has historically played a significant role in shaping Epic’s roadmap. In 2026, we expect continued enhancements to IRE, with particular attention to operational and revenue cycle capabilities.

5. Hyperscaler Funding Will Tighten as Cloud Adoption Matures

Early Epic on public cloud adopters benefited from significant financial incentives from hyperscalers, including funding that offset large portions of migration costs. These investments were designed to accelerate market adoption and drive long-term platform consumption.

That phase is largely behind us. With multiple years of successful production deployments now in the market, health systems are no longer viewed as early adopters. As a result, we expect public cloud providers to become more selective and conservative with funding, particularly for smaller or non-production environments.

For health systems considering a move to public cloud, timing and deal structure will matter more than ever.

6. At Least One Health System Will Transition from Epic Hosting to Public Cloud

Epic Hosting continues to be a strong option for health systems seeking a fully managed service for their Epic instance under a single contract. However, some health systems are increasingly sensitive to rising costs and limited flexibility.

As more approved Epic on public cloud partners demonstrate the ability to deliver comparable managed services on public cloud – often with greater transparency and access to cloud-native capabilities – we expect at least one organization to transition away from Epic Hosting in favor of a public cloud model.

7. Health Systems Will Re-Evaluate Hyperscaler Relationships as Incentives and Contracts Expire

Many early Epic on public cloud contracts included multi-year consumption credits and migration incentives designed to accelerate adoption. As those agreements approach renewal, health systems are entering a more normalized cost structure that requires a closer eye on total cost of ownership and long-term ROI.

In response, we expect at least one organization to formally evaluate alternative hyperscalers as part of broader financial and architectural review. Whether or not a platform change ultimately occurs, the willingness to re-shop reflects a more mature market – one where cloud decisions are driven less by incentives and more by long-term value, operational fit, and cost predictability.

8. The First Multi-Cloud Epic Deployment Will Be Contracted

Platform-level outages have reinforced a reality that applies to both on-premises and cloud environments: downtime will happen. The differentiator is preparedness.

In response, health systems are exploring multi-cloud strategies designed to reduce dependency on a single provider. While full production multi-cloud Epic environments remain complex, we expect the first deployment to be contracted in 2026 – with go-live likely in 2027 or 2028. This will mark an important inflection point in how resilience and risk are addressed in Epic architecture decisions.