Epic Garden Plot

What is Epic Garden Plot?

Epic Garden Plot is a software as a service offering from Epic for independent medical groups. Epic announced it in March 2022 as a shared, hosted environment in which Epic handles hosting, support, and the configuration and rollout of updates, so the group's providers can focus on patients instead of running an EHR.

In Epic's launch announcement, JP Heres, Epic's vice president for Garden Plot, said it gives small, independent groups access to Epic, the third parties they need and Epic's interoperability network with minimal overhead.

Who is Garden Plot for?

Garden Plot is for independent medical groups that want Epic but are not joining a health system's instance. At launch, Epic said it was available to primary and specialty care groups with more than 40 providers, with the first customer implementations starting in May 2022.

Epic framed the launch around the scale of independent practice. It cited American Medical Association findings that, in 2020, nearly half of US physicians worked in independent medical groups, and noted that the cost and effort of changing software can make a move seem out of reach for those groups.

• Independent groups: Practices that want to stay independent of any single hospital system.
• Primary and specialty care: The group types named at launch.
• Groups without large IT teams: Since Epic runs hosting, support and updates.
• Groups where Connect is not an option: Epic positions Garden Plot as the route when Community Connect does not fit.

Eligibility rules may have changed since 2022, so groups should confirm current criteria with Epic directly rather than relying on the launch figures. Smaller groups that fall below any size threshold still have Community Connect or other EHR vendors to consider.

How does Garden Plot differ from Community Connect?

The main difference is who hosts the group. In Community Connect, a health system extends its own Epic instance to nearby groups; in Garden Plot, Epic itself provides the shared environment. Epic says almost 40,000 providers use Epic through Connect, which has run since 2007.

• Host: Connect groups join a hospital's instance, while Garden Plot groups join an environment run by Epic.
• Shared record: Connect creates shared patient records with the local hospital, which Epic cites as a reason it recommends Connect.
• Independence: Garden Plot lets a group use Epic without aligning with one health system.
• Recommendation: Epic's own announcement says it recommends Connect to medical groups where possible, with Garden Plot as the route when Connect is not an option.

In practice, Garden Plot works like Community Connect with Epic itself as the host. That matters in a market with several hospital systems, where joining one system's Connect instance can look like picking a side.

Funding also differs. When a hospital subsidizes a Connect arrangement for referring physicians, the donation has to meet the electronic health records exception to the physician self-referral law at 42 CFR 411.357(w). In Garden Plot the shared environment comes from Epic, so there is no hospital donor in the arrangement.

How does Garden Plot compare with Epic Hosting?

Garden Plot is a shared environment, while Epic Hosting runs an organization's own full Epic instance in Epic's data centers. Epic Hosting takes servers and operations work off the organization, but not the cost of licensing and building a full instance.

• Own instance, self-hosted: The organization licenses, builds and runs Epic itself.
• Own instance, Epic Hosting: The organization licenses and builds Epic, and Epic runs the infrastructure.
• Community Connect: The group uses a health system's instance and build.
• Garden Plot: The group uses a shared Epic environment run by Epic, with hosting, support and updates handled by Epic.

The options trade control against effort. An own instance gives the most control over build and configuration, and a shared environment gives the least work. Groups should ask which configuration decisions are theirs to make in Garden Plot, and which follow the shared model.

Which third-party products come with Garden Plot?

Epic's launch announcement lists integrated products from a set of third parties as part of the Garden Plot service. The named vendors were Availity, Biscom, Change Healthcare, Healthwise, Intelligent Medical Objects, Iron Bridge, Lyniate, OSG Billing Services, Solarity, Sphere, Surescripts and Wolters Kluwer.

These cover common practice needs such as clearinghouse and eligibility services, e-prescribing, faxing, payments, patient education, clinical terminology and interface tooling. Including them in the service is part of how Garden Plot reduces the setup work a group would otherwise do itself. The list reflects launch in 2022, and some of those companies have since been acquired or renamed.

How widely has Garden Plot been adopted?

Public adoption data is limited. Epic's launch announcement gives eligibility and the first implementation date, but Epic has not published a current Garden Plot customer count in the sources cited here.

Treat any count as a rough indicator rather than a market share figure. For a group considering Garden Plot, the more useful step is to ask Epic for reference customers of similar size and specialty mix, and to speak with their operational and billing leads about the first year after go-live: what went well, what took longer than planned and which requests were hard to get through a shared model.

What does moving onto Garden Plot involve for a group?

Moving onto Garden Plot is still an EHR conversion, even if Epic carries the hosting and much of the build. The group has to move its data, retrain its people and rewire its outside connections, and those tasks sit largely with the group.

• Data conversion: Decide which history moves into Epic, such as problems, medications, allergies and recent notes, and how older records stay available.
• Open balances: Plan how accounts receivable in the old system are worked down while new charges flow from Epic.
• Interfaces: List every lab, imaging center, registry and payer connection the group uses today, and confirm how each will connect after the move.
• Training: Schedule time for every provider and staff member, since productivity dips in the first weeks.
• Reporting: Rebuild the reports the group uses for quality programs and payer contracts.

Groups that prepare a clean inventory of their interfaces and reports before signing tend to move faster. The shared model removes infrastructure work, not the need to understand how the practice runs today.

What does Garden Plot mean for software vendors?

For software vendors, Garden Plot means another Epic environment where customers may want their product to work. Because the environment is shared and run by Epic, integration decisions may involve Epic as the operator as well as the medical group as the customer.

• Ask who approves: Confirm whether the group, Epic or both approve a new app or interface.
• Prefer standard APIs: FHIR and SMART on FHIR apps are easier to enable across shared environments than custom builds.
• Check overlap: Some needs may already be covered by the bundled third parties, which affects your value case.
• Plan per tenant: Even in a shared environment, each group's data and consent must stay separate.

Vendors that already integrate with Epic through standard interfaces are in the best position. The work is usually less about new technology and more about understanding who owns the configuration in a hosted, shared model. Keep a short integration summary ready that explains the data your product reads and writes, the interfaces it uses and how access is limited to one group, because that is what both the group and the operator will want to review.

What should a medical group ask before choosing Garden Plot?

A group should ask about eligibility, configuration control, integrations, data access and exit terms. The answers decide whether a shared environment fits the way the group practices and plans to grow.

• Eligibility: Current size and specialty criteria, which may differ from the 2022 launch figures.
• Configuration: Which templates, workflows and reports the group can change, and how requests are handled.
• Integrations: Which third parties are included, and how to add a product the group already relies on.
• Data access: How the group gets its own data for analytics, quality reporting and payer programs.
• Exchange: How records are shared with local hospitals that run their own Epic or other EHRs.
• Exit: How data is returned if the group later joins a health system or changes vendors.

How Agnotic can help

Agnotic Technologies builds Epic integrations for software vendors and medical groups. We help vendors design products that work across Epic environments through standard FHIR and HL7 interfaces, and we help groups plan the integrations, data access and reporting they need around their EHR.

We are an independent engineering firm and do not resell Epic. Our work starts from the public interfaces and the organization's own configuration, whichever hosting model the group chooses.

Sources

• Epic: Garden Plot, a shared environment where independent medical groups can grow
• 42 CFR 411.357: Exceptions to the referral prohibition related to compensation arrangements