Written by Technical Team | Last updated 04.12.2025 | 11 minute read
Epic integration is no longer just a technical experiment or a single-hospital project. For many digital health vendors and healthcare providers, the real challenge is deploying Epic integrations at scale: across multiple NHS Trusts, integrated care systems, and international health networks with different regulations, workflows and infrastructure. The stakes are high. Done well, a multi-site Epic strategy enables consistent, safe, and reusable digital health capability that can be rolled out rapidly. Done badly, it leads to fragmented implementations, duplicated effort, mounting technical debt and strained relationships with both clinicians and IT teams.
Epic itself is built to support large, complex organisations, but that doesn’t automatically make your integration scalable. The difference lies in how you approach architecture, configuration, governance, and rollout across sites. A proof-of-concept that works in one hospital may be completely unsuitable for a ten-hospital network, or for a mix of UK and international customers with very different expectations.
This article is aimed at digital health innovators, product leaders, CTOs and integration teams who want to move beyond one-off Epic projects and build a repeatable, scalable model for Epic integration—spanning NHS Trusts and international systems.
At a single-site level, Epic integration is usually driven by a handful of high-value use cases: embedding a digital health application into clinician workflows, exposing data to a patient-facing app, or connecting specific services such as virtual wards, diagnostics or remote monitoring. These projects often focus on “getting it to work” for that particular organisation, with local configuration and one-off decisions that feel pragmatic at the time.
The problem appears when you try to replicate that integration across multiple sites. What was hard-coded or locally configured in one Trust doesn’t necessarily translate to the next. Local code sets, simple assumptions about identifiers, different deployment models (on-premise vs hosted), and variations in how Epic modules are configured can all combine to make a second or third deployment feel like a completely new project. Without a deliberate multi-site design, each rollout becomes slower and more expensive, and your product ceases to look scalable.
A multi-site strategy forces you to think in terms of repeatability. Instead of building a one-off interface for “Hospital A using Epic”, you design for “any Epic customer with a defined set of capabilities”, with clear levers and configuration points. That means consciously separating what is universal (FHIR interactions, core workflows, launch patterns) from what is local (code mappings, branding, feature flags, consent rules). This is just as true for international health systems as it is for NHS Trusts: a hospital in the Middle East or Scandinavia may use Epic, but operate under completely different regulatory, funding and cultural contexts.
For NHS organisations, scale also means alignment with national priorities. An integration that works for one Trust but does not align with wider standards, information governance guidance or national digital initiatives will be harder to adopt elsewhere. For international deployments, scale means being able to respect regional regulations—such as GDPR in Europe, HIPAA in the US, or country-specific privacy rules—without completely rewriting your integration each time.
Ultimately, a robust multi-site Epic strategy is about protecting your investment. If every new Epic site feels like starting from scratch, the cumulative cost and lead time will erode the commercial viability of your product. A carefully designed, multi-tenant integration model allows you to scale out in a predictable way, reduce per-site effort, and focus on genuine innovation rather than rework.
The foundations of multi-site success are architectural. You need an Epic integration design that can be replicated, configured and governed across organisations, rather than a tangle of bespoke connections. That starts with a clear separation of concerns: what runs inside Epic, what runs in your own application stack, and how those two worlds communicate.
Most modern Epic integrations use a combination of Epic on FHIR, SMART on FHIR launch, Interconnect APIs, and, where needed, legacy standards such as HL7 V2. A multi-site architecture should treat these not as one-off interfaces but as reusable patterns. For example, if your app is launched from Epic using SMART on FHIR, the launch sequence, token handling and FHIR resource interactions should be the same across all customers, with only a small set of configuration changes per site (such as issuer URLs, client IDs and branding).
For digital health vendors and providers planning to scale, it helps to frame architectural decisions around a few key principles:
A practical multi-site architecture often centres on a cloud-based integration layer that acts as the “home” for your Epic integration. It can expose your own APIs to front-end or partner applications, while managing all communication with Epic as a separate responsibility. This allows you to evolve your internal products without constantly touching the Epic-facing side, and vice versa.
Within this architecture, tenancy and security become crucial. Each site must be logically isolated, both for data protection and for operational safety. You may choose to have a dedicated tenant per Trust or health system, with separate keys, client credentials and data stores. For international deployments, you might also need regional data residency—such as EU-only data stores for European sites—while still reusing the same core integration platform.
Designing for reporting and observability from the start is another enabler of scale. With multiple Epic sites and different time zones, you need aggregated and per-site visibility into performance, error rates, and usage. Central dashboards and alerting, segmented by tenant, help both your team and your provider customers understand how the integration is behaving—and where to focus improvement efforts.
As soon as you move beyond a single site, governance becomes as important as code. Each new Trust or health system will have its own committees, clinical safety officers, information governance teams and security stakeholders. The challenge is to create a governance model that can be adapted to local processes without reinventing your story every time.
From a clinical safety perspective, your integration must have a clearly defined purpose and set of boundaries. You should be explicit about what decisions your application supports, what data it presents, and what it does not do. This clarity helps local safety leads assess whether your Epic integration is safe for use in their particular clinical environment. It also reduces the risk of “scope creep” where local teams try to extend the integration beyond its originally intended use without appropriate review.
Information governance and data protection requirements will differ between NHS and international customers, but the underlying themes are consistent: data minimisation, clear legal basis for processing, robust security controls, and transparent audit. To support multi-site adoption, your integration platform should provide a standard set of artefacts—such as data flow diagrams, records of processing activities, DPIA-style risk summaries and security architecture overviews—that can be adapted, rather than rebuilt, for each new customer.
In practice, a scalable governance strategy for Epic integration often includes:
Cross-border deployments introduce extra complexity. A deployment in an NHS Trust will be shaped by UK-specific frameworks, whereas a European or Middle Eastern site may have their own regulatory regimes and working practices. Building flexibility into your governance documentation—separating the core model from jurisdiction-specific overlays—allows you to respond to these differences without derailing your overall strategy.
Data residency and cross-border transfer constraints can also influence how you design tenancy and hosting. Some customers may insist that their Epic-integrated data remains within a specific geography or cloud region. Your multi-site architecture should allow you to meet these demands while still remaining maintainable.
Once you have a scalable architecture and governance model, the question becomes: how do you actually sequence and deliver multi-site Epic rollouts in practice? The answer is less about raw code and more about structured, repeatable implementation playbooks.
For NHS Trusts, there is often a natural first “anchor” site where the integration is designed, developed and proven in real clinical workflows. This initial deployment is the hardest: the place where your conceptual model meets the reality of live data, clinicians under pressure, and local configuration choices made during Epic implementation. Treat this first site as your reference implementation and invest the time to document everything—what worked, what did not, what compromises were made, and what should be standardised before you move on to the next Trust.
When moving to a second or third site, resist the temptation to treat them as entirely bespoke projects. Instead, work from your reference model and ask, “What genuinely needs to be different here?” This might include local branding, which specialties initially go live, or small variations in workflow. Where differences emerge that are likely to reoccur—for example, specific regulatory requirements or language localisation—pull those into your global design as new configuration options.
International rollouts add layers of complexity. Time zones, different patterns of clinical practice, varying levels of digital maturity, and local infrastructure can all affect how Epic is implemented and used. Rather than trying to impose an NHS-centric design, successful international strategies start with discovery: understanding how Epic is configured and used locally, and then mapping that back to your core integration model. In some cases, it may make sense to pilot a slightly narrower feature set in a new country and expand once you have confidence in the local context.
Operationally, you should think in terms of waves of deployment. This might mean starting with a small number of early adopter sites or departments, then expanding once you have validated the integration under real load. For example, a Trust might start with a single speciality using your Epic-embedded app, then roll out across other areas over successive months. This phased approach balances speed with safety, and generates real-world evidence you can use to convince further sites.
Communication and change management are crucial. Epic integration affects clinicians and operational teams as much as it affects IT systems. For each site, you should work with local champions to explain what the integration does, how it benefits clinical care, and what changes clinicians will see in their day-to-day workflows. Training materials, short explainer videos, and clear “how to get help” routes all make adoption smoother and reduce friction during go-live.
Deploying across multiple sites is not the end of the story; it is the beginning of continuous optimisation. At scale, your Epic integration becomes a living service that must adapt to evolving clinical needs, platform changes and regulatory expectations. Without ongoing measurement and feedback, it is easy for performance to drift, user experience to degrade, or local workarounds to accumulate.
Measurement should span both technical and clinical dimensions. On the technical side, monitor response times, error rates, timeouts, authentication failures and usage patterns by site and by key workflows. This helps you identify configuration issues or capacity constraints before they turn into incidents. On the clinical side, work with customers to define meaningful indicators of impact—such as time saved per patient, reduction in duplicate data entry, or improvements in compliance with certain pathways.
At scale, you will also find that sites diverge over time. Different hospitals or regions might request specific enhancements, integrations with other local systems, or custom workflows. A sustainable strategy involves channelling these requests through a structured roadmap process. Some changes become part of the global product and are available to all sites; others remain local configurations. Being explicit about this distinction prevents your platform from fragmenting into a patchwork of bespoke deployments.
Finally, sustaining a multi-site Epic integration means staying aligned with Epic’s own roadmap. As Epic evolves its FHIR capabilities, SMART workflows, interoperability tooling and deployment models, your integration needs to evolve in step. Maintaining a close relationship with Epic’s vendor-facing programmes, and with your key customer organisations, will help you anticipate change rather than constantly reacting to it.
In the end, deploying Epic integration at scale is as much about strategy and discipline as it is about interfaces and APIs. With a well-designed architecture, robust governance model, thoughtful rollout approach and ongoing optimisation, digital health innovators and healthcare providers can turn Epic integration from a one-off project into a repeatable capability—supporting NHS Trusts and international health systems with a resilient, high-impact digital foundation.
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