As health systems deepen investments in clinical technology, leaders continue to debate how best to structure informatics teams: Should informaticists focus exclusively on strategy, governance and optimization, or should they also perform technical system build work?
Chief nursing information officers suggest there is no single model dominating the industry. Instead, organizations are balancing strategic focus, workforce realities and technical capabilities to decide whether specialized or hybrid informatics roles best support clinical and technology initiatives.
At Johns Hopkins All Children’s Hospital in St. Petersburg, Fla., CNIO Aruna Jagdeo, BSN, RN, said the organization primarily relies on specialized informaticists, with limited exceptions.
“We do not utilize the hybrid approach,” she said, noting that although a small number of informaticists have builder training, they focus only on simple enhancements. Those efforts are designed as “quick win” improvements that do not pull them away from core responsibilities.
Charlottesville, Va.-based UVA Health follows a similar structure, separating strategy and governance from technical build work.
“In my current organization, there are a few informatics nurses on the build teams who focus primarily on technical configuration, while a separate informaticist group leads strategy, design and governance,” CNIO Michelle Lardner, DNP, RN, said. That strategy team partners with build and operational groups but does not perform configuration work itself.
Dr. Lardner added that she has worked in hybrid models in which informaticists also handled system build, and she views that experience positively.
“I found it highly effective,” she said, adding that combined operational and technical knowledge can improve efficiency and impact.
One informaticist she worked with described completing configuration training as “liberating and a game-changer,” she said, highlighting how hybrid roles can empower staff while broadening career pathways.
Dr. Lardner also said hybrid models can help organizations recruit and retain talent in a competitive labor market, though resource constraints sometimes influence the decision to combine roles.
Marc Benoy, BSN, RN, CNIO at Akron, Ohio-based Summa Health, echoed the idea that organizational structure often reflects staffing realities more than philosophical preference.
“Right now, we primarily use specialized informaticists who focus on clinical strategy, design, optimization and governance,” he said, adding that the choice often depends on the technical aptitude already present within clinical teams.
Mr. Benoy said hybrid roles can create meaningful advantages when organizations find the right individuals.
“When you have the right person in a hybrid role — someone who truly understands clinical operations and can also do the technical build — it can absolutely accelerate work,” he said. Hybrid professionals can move projects from operational problem identification through design and configuration without handoffs that sometimes slow progress.
This approach can also reduce situations in which clinical designs conflict with technical system architecture, he added, tightening the connection between operational intent and system capabilities.
However, hybrid roles present challenges as organizations try to balance speed and flexibility with long-term scalability. For many organizations, the decision ultimately comes down to balancing efficiency with scalability, Mr. Benoy said.
“The challenge with hybrid roles is that true ‘dual-capability’ professionals are hard to find and even harder to keep current in both domains,” he said, adding that specialized teams offer deeper technical and operational expertise but require strong coordination to avoid disconnects between design and build.
As clinical technology initiatives expand, the structure of informatics teams — and the talent required to support them — will likely remain a key operational question for health systems nationwide.
