Nonprofit integrated health system operating 7 acute-care facilities (1 academic medical center, 4 community hospitals, 2 specialty clinics) across the Pacific Northwest. Generates revenue through inpatient care, outpatient services, emergency medicine, surgical programs, and specialty care. The network employs 8,200 staff including 1,100 licensed physicians and runs a full Epic EHR platform across all facilities following a $45M enterprise deployment completed in 2021–2022.

1. 1Unlock $8M–$12M in latent value from the existing Epic deployment — currently using less than 40% of licensed modules despite a $45M investment.
2. 2Achieve full CMS interoperability compliance (FHIR R4) by Q3 2026 to avoid automatic Medicare payment adjustments beginning FY2027.
3. 3Deploy AI-assisted ambient clinical documentation to 620+ physicians, targeting a 90-minute/day reduction in EHR documentation burden worth $4.2M annually.
4. 4Reach 85% active utilization of Epic workflows across all 2,400 licensed users by Month 12 of the optimization engagement.
5. 5Establish Cascade as the Pacific Northwest's lowest-cost, highest-quality health system by 2028 — Epic optimization is the single most important enabling investment in that plan.

• Northwest Permanente Medical Group — averaging 4.2 CMS Quality Stars vs. Cascade's 3.5; already running advanced AI-driven quality analytics on their EHR platform.
• Providence Health & Services — broad regional footprint with deployed predictive analytics and ambient documentation tools system-wide.
• MultiCare Health System — strong Tacoma/Pierce County presence; recently completed Epic optimization and AI documentation rollout.

• Epic module utilization audit across all 7 facilities — identifying which of the licensed modules (Ambulatory, OpTime, Radiant, Cantata, MyChart, Cheers, Cadence, Prelude, Resolute, Happy Together) are actively configured vs. sitting idle.
• ONC information-blocking compliance gap analysis — line-by-line audit of every HL7 feed, FHIR endpoint, and third-party integration against current CMS interoperability mandates.
• Ambient documentation AI vendor evaluation — structured RFP process across 6–8 Epic App Orchard-approved vendors with proof-of-concept pilots at 2 facilities (40 physicians).
• Physician workflow redesign — 60+ hours of direct clinical observation across ED, inpatient, outpatient, and OR settings to redesign SmartText, order sets, and In Basket routing.

Decisions are governed by a phase-gate steering committee co-chaired by the CIO and CMIO, with monthly executive briefings to the CFO and CEO and quarterly board-level strategic reviews. Vendors are evaluated across 4 weighted criteria: Technical Capability (35%), Healthcare Domain Expertise (25%), AI & Analytics Depth (20%), and Project Management (20%). Contract execution requires CIO written approval; downtime changes require written sign-off. Phase go/no-go decisions are made at the end of each phase based on formal completion sign-off and measured adoption metrics.