Case Study Template: Documenting the ROI of Migrating to a Sovereign Cloud for a European Hospital

Hook: Why a reproducible ROI case study is the first deliverable for any EU hospital migrating Allscripts to a sovereign cloud

Migrating an Allscripts EHR stack to an EU sovereign cloud is not just a technical project — it’s a legal, financial and clinical transformation. Health IT leaders in Europe face pressure from procurement, security, and clinical teams to demonstrate clear, auditable ROI before signing contracts. This template gives you a repeatable, evidence-based case study structure to quantify costs, legal benefits, technical tradeoffs and clinician impact so stakeholders can approve migrations with confidence.

Executive summary — what this template delivers (read first)

Immediate value: a reproducible framework to produce a 10–15 page senior-friendly case study that answers CFO, CISO, CIO and CMIO questions. Built for 2026 realities — including the emergence of EU sovereign clouds (for example, the AWS European Sovereign Cloud announced in January 2026) — the template aligns legal, financial and clinical KPIs into one narrative.

Actionable takeaways you should capture in the first read:

• Top-line ROI estimate (3–5 year NPV) and simple payback period
• Regulatory risk reduction quantified (e.g., breach probability reduction × expected penalty/cost)
• Clinician productivity and patient-safety KPIs pre/post migration
• Architecture alternatives and their quantified technical tradeoffs (latency, redundancy, egress)

Context: Why sovereign clouds matter in 2026

Late 2025 and early 2026 saw accelerated vendor offerings focused on data sovereignty. Major cloud providers added physically and logically segregated regions with additional legal and contractual protections to meet EU public-sector and healthcare expectations. For example, AWS announced the AWS European Sovereign Cloud in January 2026 to address EU sovereignty requirements.

Regulatory drivers are stronger than ever: GDPR enforcement continues, NIS2 has raised security expectations across EU operators, and national health authorities demand clear data residency and access controls. That means healthcare CIOs must evaluate both tangible financial impacts and less-tangible legal and reputational benefits when documenting ROI.

How to use this template — roles, frequency and deliverables

This case study template is designed for:

• Cloud architects and migration leads preparing procurement documentation
• Finance teams calculating TCO and payback
• Legal and compliance teams documenting risk reduction
• Clinical informatics leads measuring clinician experience

Produce the case study at three checkpoints: Baseline (pre-migration), Design Review (prior to cutover), and 6–12 months post-migration. Each iteration should update KPIs with empirical data.

Template structure — sections and guidance

1) Executive summary (1 page)

• Project scope and objective (migrate Allscripts production & integrations to EU sovereign region)
• Top-line ROI result (NPV, IRR if available), payback period
• Key benefits: legal assurances, measurable uptime, clinician performance metrics
• Recommendation and next steps

2) Baseline metrics and assumptions

Capture the hospital’s current state with strong, auditable metrics:

• Infrastructure costs: hosting, datacenter colocation, network, backup/DR
• Operational costs: 24x7 on-call, patching, security monitoring, middleware maintenance
• Licensing costs: Allscripts application licenses, third-party integrations
• Performance metrics: average EHR transaction latency, average login time, peak concurrent users
• Availability metrics: SLA uptime, recent downtime incidents and duration
• Clinical impact metrics: medication order turnaround time, order-entry time per clinician, user satisfaction scores
• Regulatory & legal risk indicators: unresolved DPIAs, cross-border data transfer risk, ongoing audits

3) Cost model — how to build a 3–5 year TCO

Use an itemized spreadsheet. The objective is transparency so reviewers can reproduce numbers.

1. CapEx vs OpEx: In most migrations to sovereign clouds, CapEx decreases while OpEx shifts. Document current CapEx commitments (hardware refresh cycles) and how they change.
2. Migration costs: project PM, cloud engineering, refactoring Allscripts integrations, data replication, testing, cutover support.
3. Recurring cloud costs: compute (On-demand vs Reserved vs Savings Plans), storage (hot/cold tiers), networking (egress, dedicated interconnect), managed services (databases, load balancers), security services (IDS/IPS, KMS), and compliance attestation fees.
4. Licensing and vendor costs: Allscripts licensing impact, 3rd-party middleware, API gateways.
5. Operational costs: runbook automation, managed services (if partner-managed), monitoring, and continued engineering FTEs.
6. Contingency and optimization: include a 10–15% optimization factor for cloud cost reductions in year 2+ via rightsizing and savings plans.

Example calculation (illustrative):

• Current annual hosting & ops: €2.8M
• Migration one-time cost (Year 0): €650k
• Projected sovereign cloud annual ops (Year 1): €2.2M (includes managed services)
• Projected year-over-year cloud savings through optimization: 8–12%
• 3-year cumulative TCO delta: (~€400k savings) minus migration cost = net investment/payback to calculate

4) Quantifying legal and compliance benefits

Legal benefits are often undervalued. This section turns qualitative claims into numbers.

1. Map risk vectors that sovereign cloud mitigates: cross-border transfer risk, state access concerns, vendor sub-processing transparency.
2. Assign probabilities and expected costs: use historical incident data, industry averages, and internal legal estimates. For example, reducing cross-border legal risk from 6% to 2% annually reduces expected legal exposure.
3. Monetize reputational and operational damage: include estimated patient churn, fines, and remediation expenses.
4. Include savings from reduced legal controls or audit remediation overhead.

Illustrative legal ROI line:

• Annual expected legal exposure pre-migration: probability 4% × expected cost €2.5M = €100k
• Post-migration reduced exposure: probability 1% × expected cost €2.5M = €25k
• Annual legal risk savings = €75k

5) Technical tradeoffs — latency, redundancy, and integrations

Every architectural choice has tradeoffs. Use concise, quantified comparisons:

• Latency: sovereign regions located closer to end-users typically improve user experience; measure median EHR transaction latency and target <25% reduction where possible.
• High availability: determine whether sovereign provider supports multi-AZ and cross-region DR within EU boundaries; map RTO/RPO targets.
• Data egress and interoperability: sovereign clouds can restrict data egress which may increase costs for integrations with non-EU services; quantify egress costs vs. the cost of relocating dependent services.
• Managed services: some specialized managed services may lag behind global regions — evaluate maturity (DB engines, analytics, AI/ML services) and cost to refactor.
• Vendor lock-in: evaluate the portability of IaC (Terraform/ARM), container strategy (Kubernetes), and use of vendor-managed proprietary services.

6) Clinician impact — measurable patient and staff outcomes

Clinician experience drives adoption. Capture baseline and target KPIs:

• Login and loading times for Allscripts modules (seconds)
• Order-entry latency (time to place medication or lab order)
• Downtime incidents per year and mean time to recovery (MTTR)
• User satisfaction score (survey-based Net Promoter Score or SUS)
• Clinical throughput (patients processed per shift) and error rates

Translate improvements into financial terms where possible:

• Reduced average order-entry time × number of orders per year = clinician hours saved
• Clinical time saved × average clinician cost/hour = annual labor savings
• Fewer downtime incidents × avoided diversion costs = operational savings

7) Risk register and mitigation

List the top 8–12 risks with likelihood, impact, and ownership. Typical entries:

• Data migration integrity — Mitigation: end-to-end validation, checksum audits
• Integration outages during cutover — Mitigation: staged cutover, canary testing
• Unanticipated egress charges — Mitigation: traffic-analysis baseline, dedicated interconnect plans
• Regulatory questions about cross-border backups — Mitigation: explicit SOPs and legal DPA clauses

8) Migration timeline and milestone checkpoints

Produce a month-by-month roadmap. Key phases:

1. Discovery & baseline measurements (4–6 weeks)
2. Design & compliance mapping (6–8 weeks)
3. Proof of concept & pilot (4–8 weeks)
4. Full migration (phased by app-module or service, 8–16 weeks)
5. Post-migration validation & hypercare (8–12 weeks)

9) Post-migration validation and continuous ROI tracking

Establish a measurement plan with automated dashboards. Recommended cadence:

• Daily: technical availability and error rates for 30 days after cutover
• Weekly: clinician performance KPIs and user satisfaction sampling for 12 weeks
• Quarterly: cost variance against forecast and legal/compliance posture review
• Annual: full TCO and risk reassessment

Practical, reproducible ROI formulas and examples

Below are simple formulas you can embed in your spreadsheet. Replace variables with your hospital’s numbers.

1) Downtime cost

Downtime Cost = (Average revenue lost per hour + clinical diversion cost per hour + remediation cost per hour) × hours of downtime per year

2) Clinician productivity savings

Clinician Time Saved (hours/year) = (Baseline transaction time − Post-migration transaction time) × average transactions per day × working days per year

Annual Clinician Cost Savings = Clinician Time Saved × average clinician fully-burdened hourly rate

3) Legal risk reduction value

Legal Savings = (Baseline probability of regulatory incident − Post migration probability) × Expected incident cost

4) NPV and simple payback

Use standard NPV calculation with discount rate (e.g., hospital WACC or 6%). Simple Payback = Migration Cost / Annual Net Savings

Case study snippet (reproducible example)

Example hospital: 600-bed regional hospital, Allscripts production, 3rd-party lab & imaging integrations, current on-prem colocation.

• Baseline annual hosting & ops: €3.1M
• Migration one-time cost: €800k
• Projected sovereign cloud annual ops: €2.5M (first year), €2.3M (year 2)
• Projected clinician time savings: 4,200 hours/year → €210k/year (based on €50/hr fully-burdened)
• Reduced legal risk value: €90k/year
• Net annual savings year 1 = €3.1M − €2.5M + €210k + €90k = €900k
• Payback = €800k / €900k = 0.9 years (approx. 11 months)

This simplified snippet is intentionally conservative — adjust for local costs and vendor discounts.

Data collection checklist — concrete fields to capture

When you run the baseline and post-migration assessments, collect these fields programmatically where possible:

• Network: round-trip latency per site, packet loss %, bandwidth utilization by service
• Application: average API response time, median Allscripts transaction latency
• Operations: number of security incidents, time to patch critical vulnerabilities
• Cost: monthly cloud invoice broken by service tag, historical colocation invoices
• Clinical: transaction counts per clinician, orders per day, survey responses

Advanced strategies and 2026 trends to include in your case study

In 2026, several advanced patterns are becoming standard and should be evaluated:

• Hybrid sovereignty: Use sovereign regions for PHI while keeping non-PHI analytics workloads in a cost-optimized region. Document integration and egress controls.
• Confidential computing: Evaluate TEEs for extra protections on sensitive workloads; this often demonstrates strong compliance posture to regulators.
• API-first integration with FHIR: Migrate existing Allscripts integrations to well-defined FHIR interfaces to reduce integration debt and improve portability.
• Managed migration bundles: Some providers offer pre-built migration paths for EHR vendors. If available, quantify the reduction in migration cost and risk.
• Cost governance with FinOps: Implement tagging, automated rightsizing, and reserved capacity strategies from day 0 to protect ROI projections.

Common objections and how to answer them with data

Procurement and executives will push back. Use data-driven responses:

• Objection: sovereign cloud is more expensive. Response: Show TCO over 3–5 years including legal risk reduction and productivity gains; include sensitivity analysis.
• Objection: vendor lock-in risks. Response: Demonstrate portability via IaC, containerization, and a clear rollback plan; quantify migration rollback cost.
• Objection: performance concerns. Response: Present latency tests and network designs; include a pilot report with clinician-facing latency improvement metrics.

"Decision-makers buy certainty. A reproducible case study turns opinion into quantifiable certainty — and that’s what accelerates procurement for critical EHR migrations."

Deliverables checklist — what to hand to the board

• One-page executive summary with payback and recommendation
• 3–5 year TCO spreadsheet with assumptions (editable)
• Risk register with ownership and mitigations
• Clinician KPI dashboard screenshots and raw data files
• Legal/compliance mapping and DPA drafts
• Migration runbook and rollback plan

Postscript: sample metrics to report at 6 and 12 months

• Availability: target 99.95% — report actual
• Average Allscripts transaction latency: baseline vs current
• Number of security incidents and time to contain
• Actual cloud spend vs forecast (variance %)
• Clinician satisfaction (NPS or SUS delta)
• Realized legal savings vs forecast

Final recommendations — practical next steps

1. Run a 6-week baseline collection exercise with tagged monitoring for Allscripts and integrations.
2. Use the provided cost model to produce a conservative 3-year TCO and present to finance and legal.
3. Run a small pilot migration (non-critical Allscripts environment or read-only replica) into a sovereign region and capture clinician-facing metrics.
4. Create a binding DPA addendum and operational playbook that addresses national authority access and cross-border recovery.
5. Commit to FinOps and continuous measurement: publish quarterly ROI results to stakeholders.

Closing: why documenting ROI this way wins approvals

Hospitals cannot buy compliance promises alone — they need evidence that migration secures patient data, improves clinician workflows, and delivers measurable financial returns. Using this reproducible case study template you can unify legal, technical and clinical conversations into a single, audited narrative that executive committees can approve.

Ready to start? If you’re planning an Allscripts migration to an EU sovereign cloud, use this template as your baseline. Run the baseline data collection now and book a technical workshop to map integrations and run a pilot.

Call to action

Download the editable case study template and TCO spreadsheet from Allscripts.cloud or contact our EU healthcare cloud team for a complimentary 2‑hour ROI review and migration roadmap tailored to your hospital. Let’s convert risk and complexity into measurable benefits.

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