Each major EHR platform has distinct infrastructure requirements. Epic requires dedicated fiber, Active Directory integration, and 99.9%+ uptime SLAs. athenahealth is cloud-native and tolerates consumer-grade internet but requires end-to-end encryption and SOC 2 Type II compliant endpoints. eClinicalWorks requires specific Windows versions and SQL Server configurations for on-premise deployments. All three require HIPAA-compliant IT oversight of the supporting infrastructure.
Why EHR IT Requirements Are Different From Other Software
Standard business software fails and you lose productivity. EHR software fails and you lose access to patient records during care delivery. That risk changes the calculus for every IT decision around your EHR — redundancy, uptime, security, and support response times all need to be set higher than you'd apply to your accounting software.
Most EHR vendors will happily sell you a license without auditing whether your infrastructure can actually support it. Understanding these requirements before you go live — or before you switch providers — can prevent months of downtime and compliance exposure.
Epic Infrastructure Requirements
Epic is the dominant platform for hospitals and large health systems, and its infrastructure requirements reflect that scale:
- Network: Epic strongly recommends dedicated fiber or MPLS circuits to hosting environments, not shared consumer broadband. Latency under 50ms to the Epic hosting data center is a baseline requirement.
- Active Directory: Epic requires Active Directory (or Azure AD) for single sign-on. Every clinician needs a domain account.
- Workstation specs: Epic Hyperspace clients require Windows 10/11 Pro, 8GB+ RAM minimum (16GB recommended), and SSD storage. Thin clients work only with specific Citrix/VMware configurations.
- Downtime procedures: Epic requires documented downtime procedures and offline backup workflows — your IT provider should test these quarterly.
- Security: Epic's Community Connect and hosted models require SOC 2 Type II documentation from your IT environment. Endpoint detection and response (EDR) is effectively required to meet the security posture Epic's hosting agreements assume.
athenahealth Infrastructure Requirements
athenahealth is a cloud-native SaaS platform, which makes it more forgiving on the infrastructure side — but introduces different risks:
- Internet dependency: athenaNet is entirely cloud-based. Any internet outage means no access to patient records, scheduling, or billing. Redundant internet connections (primary + LTE failover) are effectively required for patient care settings.
- Browser and endpoint requirements: athenahealth supports Chrome and Edge. Outdated OS versions (Windows 7, unsupported macOS) are not supported and create HIPAA exposure.
- Integration engine: If you're connecting athenahealth to lab systems, imaging, or pharmacies, you need an HL7 or FHIR integration — typically requiring middleware software and IT configuration.
- Mobile device management: If staff use the athenaOne mobile app, MDM (Mobile Device Management) software is required for HIPAA compliance.
eClinicalWorks (eCW) Infrastructure Requirements
eClinicalWorks is popular with independent practices and offers both hosted and on-premise options. On-premise deployments have the most complex IT requirements:
- Server hardware: eCW on-premise requires Windows Server 2019 or later, SQL Server 2019, and dedicated server hardware (not virtual machines in most configurations).
- Database maintenance: SQL Server databases require regular maintenance — index rebuilds, integrity checks, backup verification. If your IT provider doesn't know SQL Server administration, your eCW performance will degrade over time.
- Backup requirements: eCW on-premise requires both local and offsite backup of the SQL database, tested monthly. Restoration failures are one of the most common causes of significant practice downtime.
- Remote access: eCW's remote access requires proper VPN configuration — not just any VPN, but one configured to eCW's supported specifications.
Cerner (Oracle Health) Infrastructure Requirements
Cerner's PowerChart platform is common in community hospitals and health systems moving away from legacy systems:
- Requires dedicated Citrix or VMware Horizon virtual desktop infrastructure for most deployments
- Network requirements include QoS (Quality of Service) configuration to prioritize EHR traffic over other network activity
- Millennium installations require Oracle Database administration expertise, which is specialized and not held by generalist IT providers
The Four IT Questions to Ask Before Any EHR Implementation
- Can your current internet support it? Run a bandwidth test during peak hours, not after hours. If you're sharing a 100Mbps connection across 20+ workstations, you're likely undersized for a cloud EHR.
- Who handles EHR-specific issues? EHR vendors typically only support the application layer. Your IT provider handles everything below — network, workstations, servers, printers, scanners. Make sure they've supported your specific EHR platform before.
- What's your downtime procedure? Every EHR has scheduled and unscheduled downtime. Your clinical staff need documented workflows for continuing care without system access.
- Who performs integration testing? Lab interfaces, imaging, e-prescribing, and clearinghouse connections all require IT configuration and testing. Many practices discover at go-live that these were never fully tested.
A qualified healthcare IT provider should have specific experience with your EHR platform — not just general networking and desktop support. Ask them to name the last three practices they've supported on your platform and what issues came up at go-live.
Frequently Asked Questions
Can I run Epic on a standard business internet connection?
For small Epic implementations (under 10 concurrent users) accessing Epic's cloud hosting, standard business fiber can work if latency is under 50ms. For on-premise Epic or larger implementations, dedicated circuits are typically required.
How often does eClinicalWorks require server maintenance?
SQL Server maintenance (index rebuilds, database integrity checks) should run weekly via automated scheduled tasks. Full backup verification should be tested monthly. Server OS patching should follow a monthly cadence aligned with eCW's tested patch list.
Does switching EHR platforms require new IT infrastructure?
It depends on the switch. Moving from an on-premise system to a cloud EHR typically requires upgraded internet and endpoint standardization. Moving between cloud platforms usually requires minimal infrastructure changes but significant data migration planning.