From Tactician to Strategist: The Evolving Role of the CNIO

By Tammy Jackson and Hillary Ross

As most hospitals and healthcare systems have moved past their initial EMR implementation, there is a clear need for a strategic Chief Nursing Informatics Officer (CNIO) who can support the interdisciplinary informatics team to health IT transformation and the innovative utilization of data. Nurses can play an important role innovating change.

Most clinical education tracks have recognized the need for interdisciplinary teamwork and the incorporation of informatics as a core competency of practice. To that end, the next phase of healthcare must be supported by an organization structure that is both interdisciplinary in nature and designed to allow operational ownership of IT, supported by a high-functioning CMIO/CNIO team.

We have found that many health systems do not have a nursing informatics role at the executive level; for systems that do have a CNIO, their reporting structures and job responsibilities vary widely. This is especially true in organizations where a director-level informatics leader has been elevated to the title of CNIO but continues to function as a manager/director. This is not the most ideal structure; many organizations are finding that in order to gain full value of their clinical information systems, it is becoming crucial to elevate this role in order to maximize the unique benefits that a strong CNIO can bring to a health system.

Defining the Role

The primary role of the CNIO is to serve as the strategic liaison between IT, nursing and ancillary departments to identify, develop and implement informatics strategies to support the highest quality continuum of care. The CNIO should work in close partnership with the CMIO to ensure that IT strategies align with organizational priorities and strategic goals, especially for ancillary departments, which often contain their own informatics staff.

The CNIO is responsible for integrating technology to improve outcomes, particularly around patient care and safety. They serve as the voice of nursing and allied health with regard to the electronic medical record while continuing the optimization of the system. Finally, efforts are underway to reduce documentation burden and this work requires a strong CNIO/CNO partnership as well as a CNIO who supports in those efforts to improve interoperability and provide a more efficient, standardized EHR for bedside nurses.

Having a CNIO at the table with other strategic executives is invaluable, as nurses are closest to the point of care and better understand how to implement systems that are patient focused. At the CNIO level, organizations should also expect guidance on workflow optimization, population health, community-based care and care coordination … care models where nurses play a critical role in patient care and data acquisition.

It is imperative for organizations to realize that the CNIO role goes beyond the importance of optimizing clinical systems to reduce errors and the burden of cumbersome and sometimes redundant data entry. While those efforts allow clinicians to spend more time with patients and potentially increase the quality of care, they are very EHR-specific. In the next generation of informatics, operational ownership, and health IT optimization, executive CNIOs should help to guide all business decisions and strategies, including care model design and population health initiatives, at the highest levels.

From Tactical to Strategic

Dr. Rebecca Freeman, former CNO for the ONC and currently interim CNIO at University of Vermont Health Network, explains: “The role of the CNIO should be evolving well past the tried-and-true ‘firefighter’ position of implementations. However, the ability of a CNIO to shift focus from a tactical to a strategic perspective is wholly dependent on the maturity of the informatics, IT, and operational leaders at a given facility.

“In my perfect world, the CNIO is a high-level SVP/VP position where there is less tactical and more significant strategic input required,” Freeman continues. “Organizations should expect more than the ability to adjust flowsheet rows and reports; as CNIOs, we understand that informatics is a key component of daily practice and we are well-versed in many topics: workflows, emerging payment models, research, evidence-based practice, national initiatives to standardize documentation, etc. We can partner with our CNOs to help to engage staff and increase job satisfaction, not just at the level of technology.”

With experienced nursing informatics leadership, health systems benefit from having a translator who can bridge the gap between nursing and technology, which in turn improves care delivery. They act as a change agent for health system leaders and clinicians to promote adoption of new processes, technologies and standards of achievement that result in highly quality patient care and, equally important, greater staff efficiency because they’re evolving professionally. This is critically important for organization initiatives around innovation.

In this era of healthcare transformation, key stakeholders agree that the CNIO position is critical. We are seeing more health systems elevating their nursing informatics leaders as a vital strategic partner with a seat at the leadership table. What’s the state of nursing informatics at your organization and how are you giving nurses the tools needed to enable change and transform healthcare?

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