Is your healthcare organization using Epic to its full capacity? While many hospitals and health systems turn to Epic for their electronic health record system (EHR), a gap occurs between implementation and adoption. However, Epic’s Gold Stars program provides a roadmap that can help healthcare organizations bridge this gap and maximize their investment.

Epic’s Gold Stars program evolution includes two scores—for configuration and usage expose a gap. An organization can configure nearly every applicable capability and still fail to make those capabilities normal practice.

The criteria expanded at UGM 2024, and organizations began reporting the two scores separately through 2025. What is new is the comparative evidence. At Epic’s 2026 UGM, QuadMed earned a 10 out of 10 for configuration and a 9 out of 10 for usage. That’s top 8% worldwide for configuration and top 1% on usage. Others have publicly reported Level 10 configuration alongside usage scores in the sixes.

Which means the gap has been visible for over a year. For most organizations, it has not closed.

Why Do Epic Gold Stars Matter?

Epic’s Gold Stars program is a 10-level program to help healthcare organizations understand the usage of their EHR system. Designed to measure the implementation and adoption of Epic, each Gold Star level represents an organization’s use of key features as well as adherence to best practices across the following specific focus and areas, which are each scored out of ten:

Focuses:

• Physician Productivity & Joy of Use
• Operating Margin Success
• Population Health Management
• Patient Engagement & Self-Help
• Value from Data
• Nursing Productivity
• Mobile
• Community & Affiliations
• Patient Access
• Quality and Safety
• Research

Areas:

• Enterprise
• Ambulatory Care
• Acute Care
• Emergency Department
• Surgery
• Revenue Cycle
• Scheduling, Registration & ADT
• Beyond the Walls
• Cogito & Healthy Planet
• Specialties & Ancillaries
• MyChart

On the configuration side, Level 10 has corresponded to roughly 95% of applicable items and Level 9 to 90%. Tiers one through four cover core Epic components and functionality. Tiers five through seven represent optimized use, and tiers eight through ten leading practice.

The usage score asks a harder question: of everything you configured, how much is actually being used in daily practice. Thresholds are refreshed annually, so the bar moves even when your build does not.

The individual levels matter less than the spread between them. Configuration is something a capable IT team can largely drive. Usage requires clinical leadership, workflow ownership, training and sustained accountability. Usage reveals gaps that configuration alone can hide.

Why Organizations Stall

The obstacles are consistent, and only one of them is technical.

• Nobody owns the activation decision. This is the most common and the least discussed. A feature sits available and the value is understood. But no single person has both the authority to say yes and accountability for the outcome.
• Change reads as disruption. Clinicians with a workflow that functions have little reason to adopt one that might not. Especially if nobody has explained what the new one does for them.
• Executive sponsorship is nominal. Sponsorship that exists on a slide but not in a governance calendar sends staff a clear signal about priority.
• Capacity is already committed. Between upgrades, security patching and the standing build queue, the team that would drive adoption is the team already underwater.
• Fear of breaking something. In a system where a bad change reaches patients, caution is rational. Absent a validation path people trust, caution wins.

Notice what these have in common. Four of the five are governance and operating-model problems. None of them is solved by the next release.

4 Ways Hospitals and Health Systems Can Leverage Gold Stars to Drive Operational Excellence

When it comes to achieving long-term value from Epic, it’s important to remember that results require intentionality. For healthcare organizations looking to achieve a higher Gold Star level, here are a few key strategies to keep in mind:

1. Baseline with the right instruments.

The Executive Packet is the standard starting point. It contains the Fast Lane items, the ones that can be configured in a week or less. Start there, but don’t stop there.

For the Physician Productivity and Joy of Use focus areas, Signal is the more precise instrument. It shows actual provider efficiency, time in system and after-hours documentation rather than whether a feature is switched on. For Value from Data, look at whether SlicerDicer is genuinely adopted for self-service. Or whether every question still routes through a reporting queue. Those two tell you more about usage than a configuration report will.

2. Fix governance before you fix features

If nobody owns the activation decision, activating features individually just moves the bottleneck. A structure that works has three tiers:

• Operational workgroups, meeting weekly, organized by application. Analyst-led with clinician participation. They own build requests, break/fix triage and workflow questions, and they produce prioritized change requests with clinical validation already attached.
• Advisory councils, meeting every two to four weeks, organized across applications — clinical informatics, revenue cycle, patient experience. Director or VP-led with physician champion participation. They own cross-application impact decisions and resource prioritization.
• Executive steering, meeting monthly during an activation push and quarterly once the roadmap is stable. Quarterly-only during mobilization turns a governance structure into a well-organized parking lot. It owns the tradeoffs nobody below it can make: what gets funded, what gets deferred, unresolved risk. And which of the two scores you are actually trying to move.

Most organizations have the first tier. Fewer have a functioning second. The third is usually where the gap is, and it’s the one that determines whether the other two matter.

3. Sequence across twelve months, not all at once.

A roadmap that works has a shape. Months one through three, quick wins and governance standup — the Fast Lane items plus the councils that will carry everything after. Months four through six, strategic initiatives and training redesign. Months seven through nine, module activation and deeper optimization. Months ten through twelve, reassess and build the sustainability plan.

The sequence matters more than the speed. Quick wins fund credibility. Governance makes the rest repeatable.

4. Invest in training for roles not software.

Adoption problems are usually operating-model problems that surface through training, workflow and support. That is where you see them, not where they start. It is also where the usage score is won. Role-based paths beat one-size-fits-all. Super users need materially more preparation than end users. And training after go-live stops being optional once a quarterly release carries what an eighteen-month release used to. If your team is stretched across upgrades, patching and the build queue, adoption needs its own owner. A dedicated partner focused only on that work is often what moves the plan into practice.

What the Scores Don’t Cover

The two scores give you two views of the same investment: what is available, and what has become normal practice. That is genuinely more useful than one number was. It is still not the whole picture.

It doesn’t measure whether your governance can approve an AI agent. Or whether change control can absorb a security fix without a six-week queue. Or whether your architecture and interface layer can support what you want to activate next. Or whether the analyst whose job used to be build research has a defined role now. Epic ships tooling that does part of it.

Those aren’t Gold Stars questions. They’re the questions that determine whether you can act on what Gold Stars tells you. And they are getting more consequential. Epic’s release cadence is compressing, and AI capability arrives faster than most operating models can absorb it.

The Bottom Line

As more hospitals and health systems turn to Epic for their EHR needs, it’s important to remember that there’s a difference between implementing a system and using it to its full potential. Fortunately, Epic’s Gold Stars Program is a fantastic way for healthcare organizations to ensure they’re getting the most out of their EHR investment—and a path to remedy the situation if they aren’t.

If you want to learn more about the Epic Gold Stars Program, contact us today to schedule a review of your healthcare organization’s current Gold Star level.

LET’S TALK
Brady Defibaugh is VP, EHR and RCM for Healthcare IT Leaders.