Healthcare IT, in a landscape that won’t sit still.
EHR consolidation. Relentless M&A. Hundreds of third-party systems. A once-in-a-generation shift to the cloud. And the people who determine whether any of it succeeds.
Consolidation is the story — and every deal is an IT project.
What every transaction actually means for IT: EHR consolidation, M365 tenant-to-tenant migration, identity merges, interface re-pointing, data conversion, legacy archive decisions, and third-party contract rationalization — all at once.
The third-party sprawl behind every EHR.
The EHR is the center of gravity — but it’s never alone. Every system in the portfolio carries interfaces, data feeds, user provisioning, upgrades, security posture, and a contract.
~$1.2M annual IT spend
One EHR — often MEDITECH or Community Connect — plus dozens of third-party systems: lab, imaging, pharmacy, time & attendance, billing clearinghouse.
Spend scales steeply with beds
Enterprise EHR plus hundreds of applications: ERP, RCM, PACS, LIS, cardiology, dictation, patient engagement, document imaging, interface engine.
$36M+ annual IT spend
Everything left, plus research systems, specialty clinical apps, biomed/IoT integrations, data warehouse, and multi-instance histories from prior M&A.
That’s the layer that breaks during M&A, EHR moves, and cloud migrations — and it’s exactly where we work. (IT spend: Definitive Healthcare, 2025.)
Where the value lives — and leaks.
Interfaces are the circulatory system
HL7 v2 still carries the bulk of clinical traffic — ADT, orders, results, charges — alongside FHIR APIs and file feeds. A mid-size system runs hundreds of interfaces, and every new app, deal, or EHR move touches them.
Data is fragmented by design
Clinical data in the EHR, financials in the ERP, documents in OnBase, images in PACS, history in legacy archives. Reporting only works when conversion, warehousing, and governance stitch them together.
Interoperability is table stakes
96% of hospitals run certified EHRs and TEFCA-driven exchange is accelerating — Epic alone onboarded 600+ hospitals. Regional data exchange is now a stated reason organizations switch EHRs.
The pattern across all three: this work is invisible when it’s done well and catastrophic when it isn’t. It rarely fails on technology — it fails on planning, sequencing, and ownership.
Across every major study, one variable separates projects that land: the people running them.
This is the thesis our practice is built on: senior practitioners who know the technology and the operations — from day one, not learned on your dime.
Four disciplines. One accountable partner.
Technical, advisory, and project management experts — with operational SMEs pulled in exactly when the work needs them — so strategy, delivery, and technical execution never lose each other.
Advisory Services
Strategy, discovery, business cases, and vendor selection — shaping the project before a dollar is committed. IT strategy and roadmap aligned to system growth and M&A posture, RFP development and vendor evaluation, and a baseline plan that isn’t fiction. Strategy done here is cheap; the same decisions made mid-implementation are the most expensive change orders you’ll ever sign.
Project Management
End-to-end project leadership, rescue and turnaround, PMO establishment, and vendor oversight. Our senior PMs own scope, risk, and stakeholder alignment from day one — because 37% of projects fail simply because stakeholders never agreed what success looks like.
Technical Services
HL7 integration, data reporting and analytics, warehousing, clinical data conversion, and legacy document conversion — the hands-on engineering the portfolio actually runs on, delivered under the same disciplined PM model.
Operational Expertise
Clinical and operational SMEs embedded as needed — revenue cycle, HIM, lab, pharmacy, supply chain — people who have run these exact functions inside health systems.
Built for complex solutions.
Every technical workstream runs under one owner, honest status, and no surprises.
HL7 Integration
Interface design, build, migration, and testing — v2, FHIR, and interface-engine work across every third-party connection.
Our integration approach →Data Reporting & Analytics
Operational and clinical reporting, dashboarding, and warehouse/lakehouse design — the Fabric and Power BI skill set the Cogito era demands.
Epic Technical Services
Technical build, upgrades, and support across major Epic modules — Ambulatory, Inpatient, Beaker, Cupid, OpTime, and more.
Clinical Data Conversion
Discrete clinical data conversion between EHRs — validated, reconciled, and clinician-trusted at go-live.
Our conversion approach →Legacy Document Conversion
Document and image migration out of legacy repositories — indexed, auditable, and retention-compliant, including OnBase to Epic Gallery.
The Gallery migration →Technical Project Management
Technical PM for EHR, data, infrastructure, and third-party systems implementation and support.
From the cloud platform to the long tail.
Epic on Azure
Azure is where Epic infrastructure is going — it leads in live Epic deployments, and health systems are exiting aging data centers by moving Epic and its 50+ surrounding applications to Azure IaaS. Cogito Cloud anchors Epic’s next-generation analytics on Azure and Fabric, patient-data proximity simplifies architecture and cuts egress costs, and Forrester measured a 162% three-year ROI with payback under six months. KLAS finds escaping the hardware refresh cycle is the #1 driver for the move.
We design, migrate, and stabilize these environments — and we’ve already led it: our $100M Epic project included deploying Cogito’s cloud analytics on Azure Fabric.
Cloud solutions for infrastructure
Azure landing zones, migrations from on-prem, hybrid architectures, business continuity, and the Fabric-era data platform — designed, migrated, and stabilized on Azure, with business continuity and disaster recovery built into the architecture from day one.
Our Microsoft practice →User security provisioning & management
Identity lifecycle across EHR, ERP, and third-party systems: role design, automated provisioning and deprovisioning, access reviews, and M&A identity merges.
Data solutions
The full data stack — HL7 integration, analytics and reporting, data warehousing, visualization, EHR data platforms (Clarity, Caboodle, Cosmos → Fabric), and AI-ready data foundations.
Our data integrity practice →Third-party & legacy systems support
Ongoing support for the long tail of departmental and legacy systems — including sunset planning, archive strategy, and keeping read-only history compliant and retrievable.
Legacy data archiving
When systems sunset, decades of patient and business records still have to stay accessible, compliant, and defensible — and the archiving market is anything but uniform. The mature platforms integrate directly with the EHR, putting legacy history one click away inside the clinician’s workflow, with retention schedules, legal hold, and purge built in; the rest leave you with a disconnected silo. Picking the right partner is the whole decision — we help you select, implement, and validate the archive your clinicians will actually use.
EMPI systems
The enterprise master patient index is the backbone of patient identity — one patient, one record, across every system in the portfolio. When it drifts, duplicates and overlaid records become patient-safety events, denied claims, and compliance exposure — and every merger multiplies the problem by combining patient populations overnight. We bring EMPI strategy, matching-algorithm tuning, duplicate remediation, and the governance that keeps identity clean long after go-live.
AI is rewriting the healthcare IT landscape.
- Budgets already moved — EHR purchasing fell ~40% in 2025 precisely because capital was redirected to AI and operational-efficiency tools.
- It’s inside your systems now — roughly a third of hospitals already run GenAI inside their EHR, and 40% of enterprise apps will embed AI agents by end of 2026.
- Governance hasn’t caught up — most organizations lack an AI governance policy while staff adopt tools on their own.
AI strategy, governance, and solution delivery — from opportunity review to production, all monitored in one command center.
Our AI practice →Experts in all three — with operational SMEs embedded when the work needs them.
See how this plays out on real projects.
Representative engagements across our four practices — the patterns, the outcomes, and the way we work.
The landscape won’t wait. Neither should the plan.
An EHR move, a merger, a cloud migration, or the whole portfolio — tell us what you’re facing and we’ll tell you how we’d land it.