From silos to synergy: integrating academic health informatics with operational IT for healthcare transformation

In this new era, there is a fundamental need for ongoing experimentation and innovation through researchers’, IT’s, and operational leadership’s collaborative efforts. Achieving this necessitates an optimized organizational infrastructure, which can be realized by fully integrating IT and health informatics. While it might be expected that this integration would naturally occur in response to technological advancements, without a deliberate and intentional shift towards unification, operational IT and health informatics convergence is unlikely to happen successfully. Such unification is essential for effectively addressing the constantly evolving landscape of health technology⁸. Recognizing this, NYU Langone Health’s (NYULH) Medical Center IT (MCIT) executed a strategic plan and intentional, collaborative system-level effort to create an integrated system that allows for advancement in real-world applications, as well as innovation at scale. This endeavor united MCIT and academic health informatics, giving operational and academic innovation teams access to the wealth of health informatics expertise and greater freedom to experiment. This deliberate restructuring has already begun to show benefits as new disruptive technologies—like generative artificial intelligence (GenAI)—have emerged, and the efforts made by NYULH may serve as a roadmap for other health systems seeking a strategy to advance their own capabilities to adapt to rapidly emerging technological changes.

As with many academic health systems, historically, NYULH MCIT and health informatics were fundamentally unrelated endeavors. Despite successfully addressing the current technological needs of a digitizing health system through progressive strategies, such as transitioning from an application-based structure to an experience-based one (i.e., project portfolios centered on the user rather than the technical system), these restructuring efforts did not fully integrate MCIT and informatics. In this context, there was a recognition that maintaining the status quo and relying on incremental changes to legacy structures that governed the relationship between IT and health informatics would constrain NYULH’s ability to maintain excellence across its tripartite mission.

The early stages of this transformation began more than a decade ago with incremental reorganization from exclusively IT application-based teams (clinical, hardware, security, etc.) to include joint structures based on shared goals around a theme e.g., a digital experience-based portfolio (patient digital experience, clinician digital experience, researcher digital experience, etc.). This shift reflected the transition to integrated digital experiences and the reorganization of MCIT’s work to better align with its fundamental roles in a large academic health system. These early steps set the stage for the recent full vertical integration of operational IT and health informatics with the NYULH MCIT Department of Health Informatics (DHI) launch in 2023. Establishing DHI within MCIT was unconventional and strategically disruptive. Unlike traditional biomedical or health informatics departments, MCIT DHI is a corporate operations department within IT, not an academic department. It does not confer academic promotion nor “own” faculty or grants—instead, it serves as an enterprise-level hub of informatics activity that spans the full breadth of the health system’s missions—clinical care, research, and education (Fig. 1). This hub integrates the domains of a CMIO and CRIO bringing together clinical and technical operational personnel, researchers, educators, and clinicians seeking to leverage technology to drive scaled innovation across the enterprise. Through this informatics structural innovation, the legacy silos between academic and operational entities within an academic health system were mitigated, amplifying the impact of informatics on clinical operations and research.

The Department of Health Informatics creates a new model to promote collaboration for integrated informatics by bringing together stakeholders in care delivery, academics, and operational resources.

The DHI comprises eight divisions—Clinical Informatics, Health IT Safety, Digital Health Innovation, Digital Health Equity, Applied AI, Research Informatics, Nursing Informatics, and Educational Informatics. However, these divisions are not formal entities like the divisions of an academic department; rather, they serve as concentration areas within a matrixed organizational structure¹². Within this matrixed structure, all core DHI faculty play multiple roles, serving IT operational roles that complement their informatics and academic roles. For example, the Director of the Division of Health Equity in DHI spearheads institution-wide efforts to leverage digital health tools in support of enterprise equity goals across all missions (clinical, research, education, community); a role that jointly reports to (and is partially funded by) the CMIO in MCIT and the Director of the NYULH Institute for Excellence in Health Equity (an enterprise-wide initiative). She is also a tenure-track physician investigator studying clinical decision support tools in the NYULH Department of Population Health (her academic home). Acting as foci of common work, the Divisions do not have their own prioritization structures or committees, instead using established decision-making bodies to facilitate knowledge sharing, remove redundancy and coordinate efforts horizontally across potential silos.

This matrixed role underscores the deliberate nature of a fully integrated health informatics initiative within an academic health system. Consistent with this approach, IT resources and staff are not assigned to specific divisions. Instead, the DHI and Divisions request and get assigned corporate IT resources (EHR analysts, reporting resources, software architecture resources) as needed. They are prioritized in the same enterprise prioritization processes that all IT requests get reviewed. Similarly, non-DHI academic faculty and staff are recruited to lend expertise to DHI initiatives. They are provided an official channel to raise their health informatics research for support from DHI. This allows projects to be easily worked on by multiple teams and divisions organized around the user experience they seek to improve at scale.