Accenture · Tech Consulting · Hard · 35-45 min

US Health System — Epic, Cloud, and Information Blocking

US Health System — Epic, Cloud, and Information Blocking is a hard Accenture tech consulting case interview that runs 35-45 min. A US nonprofit health system: 22 hospitals, 180 clinics, Epic everywhere clinical, a 2009 PACS for imaging, and a patient app almost nobody opens. A strong answer works through 5 phases: State the outcome; Split the estate: what stays in Epic, what leaves the PACS, what is exchange (TEFCA / FHIR) versus a new data platform; Set the HIPAA and information-blocking constraints: BAAs, minimum necessary, and what 'blocking' looks like if data is slow or paywalled; Sequence the $85M so clinical risk falls early; Name the operating model at go-live: who runs the integration, who answers a blocking complaint, what nursing will not absorb.

Last updated 2026-09-05

The brief

A US nonprofit health system: 22 hospitals, 180 clinics, Epic everywhere clinical, a 2009 PACS for imaging, and a patient app almost nobody opens. The 21st Century Cures Act information-blocking rules are already in force; TEFCA exchange is how referring systems and payers now expect data to move. A board member wants 'everything in the cloud' after a ransomware scare at a peer. HIPAA, BAAs, and a strained nursing workforce bound the program. Budget is $85M over three years. You are the delivery lead asked for an architecture and a sequence that a CIO can actually run.

How to approach it

  1. State the outcome — chart availability at the point of care, imaging access, a patient app people use — before picking a cloud region
  2. Split the estate: what stays in Epic, what leaves the PACS, what is exchange (TEFCA / FHIR) versus a new data platform
  3. Set the HIPAA and information-blocking constraints: BAAs, minimum necessary, and what 'blocking' looks like if data is slow or paywalled
  4. Sequence the $85M so clinical risk falls early — backup and restore, then imaging, then patient-mediated access
  5. Name the operating model at go-live: who runs the integration, who answers a blocking complaint, what nursing will not absorb

What a strong answer does

  • Treats Epic as the clinical system of record and designs around it instead of a rip-and-replace
  • Separates resilience (ransomware, backups, downtime) from analytics cloud
  • Uses TEFCA and FHIR for exchange and does not build a private network of point-to-point interfaces
  • Puts a clinician workflow change in the plan, not only an interface inventory
  • Stages spend against a three-year cash envelope with a year-1 outcome the board can see

Red flags interviewers score down

  • Recommends moving Epic to the cloud as the first move
  • Ignores information blocking and HIPAA and talks only about data lakes
  • Adds a second EHR or a custom chart to 'get off Epic'
  • No owner for exchange failures after the systems integrator leaves

Cases are written in each firm's style, written and reviewed by working consultants; they are not the firms' own published cases.

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