"If you ask an IT person, 'Hey, how do you think this whole informatics thing should be structured?' I think more often than not they'll say, 'We can all work in the same structure: The clinical informaticists can report to their chief clinical informaticist, and that person can report to the CIO. Keep it all in one simple structure.'"

On the other hand, "The informatics folks would probably say, 'We need to be a separate, equal department. We can work with you, confer with you, but we need to be very clinician-facing in order to effect this change.'"

Morgan points to the recent resignation of the CEO of Georgia's Athens Regional Health System, after receiving a vote of no confidence following a botched EHR rollout, as the kind of thing that could be avoided with the proper vision, leadership and cooperation between IT staff and clinicians.

"If you have the clinical leadership, and you're willing to make those cultural changes, Epic is going to work, Cerner is going to work, Meditech is going to work," he says. "The technology is there. It's about the comfort level with redesigning some of your processes to take advantage of the advanced technology. But if you're not leading change and looking into the future, you're not going to be successful."

Ask for his advice for other health systems thinking of forging a similar path, Morgan says empathy and perhaps a bit of humility are essential.

"We, the IT people, are the standard-bearers for major systems initiatives within healthcare," he says. "But we have to be willing to give up a little control, work collaboratively with our informatics counterparts and understand that that's not going to somehow diminish our standing.

"I can't tell you how many people are afraid you're going to come in and mess with their process," he adds. "But you just have to understand that this is how healthcare is being provided, and to be effective you need to make those changes. Take your pick of any health IT initiative: I'm here to tell you, if you can't have a dedicated clinician- and physician-facing capability, you're running the risk of failing at the cultural level, and that's gonna sink your project."

Stearman has a couple tips of his own.

First, a sea change such as this can only happen with everyone on-board: "The organization's readiness for the change is vital," he says.

Second, "Have clear vision of the lanes that you want informatics to operate in, because it's very easy to have lots of shades of gray between the informatics and information technology," says Stearman. "When I first arrived at CHRISTUS Spohn there were a lot of questions: 'What do you do? What's Bill Morgan going to do? We put together some talking points, and a slide so we could very clearly articulate to senior leadership who does what and who owns what."

"There are some basic rules of the road," says Morgan. "Around budgeting. Around HR and talent management. An anti-poaching statute – if you want some of my people, let me know! Let's talk about it. Regardless of how many rules you have, you're still going to have conflict. But you need to work as much of that out in advance if you can."

For all the challenges inherent in the process, Stearman says the reorganization has so far been "very successful" and has already brought about clinical and financial ROI.

"On the first attempt, we met all of our Stage 1 initial attestation and successfully entered the second year of Stage 1," he says. Informatics folks "were integral to the way that the systems and technology would be designed to complement clinical workflows; we had our subject matter experts on the ground, providing that at-the-elbow support to nursing and provider staff."

Now, as the health system heads toward its Stage 2 attestation period this summer, "I've got my teams out and about, constantly working with our physicians on the CPOE compliance, with the nurses on some of their documentation compliance," says Stearman. "I think as a direct result from the informatics group, we hit all of those financial incentives around meaningful use."

The benefits are enterprise-wide, and go beyond meaningful use, says Morgan.

"We are improving processes through the use of advanced clinical technologies: Look at one congestive heart failure readmission, and the cost of not getting reimbursed because it's inside of 30 days. We have a much greater level of detail for our clinicians and more information at their fingers – a sepsis initiative, medication verification – and we're able to provide a more holistic view of the patient. It allows for better care, and helps us avert some serious safety events that have dollar amounts attached to them."

By enabling a robust informatics capability to help steer these major IT initiatives, "we're enabling those things to actually happen," says Morgan. "I've seen us move the needle clinically, from a safety standpoint, and also achieve some financial benefits because of it."