May 15 2020

What Is a Chief Nursing Informatics Officer?

The role, which involves acquiring technology and measuring outcomes, has been growing in number and influence for years. It’s now a crucial part of any hospital.

Editor’s note: This content series, featured in your Insider dashboard, will be rolled out over the coming weeks to offer advice on driving collaboration between IT teams and clinical staff. (If you’re not already an Insider, sign up for free here.) The associated articles explore why nurses should be included in the decision-making process for purchasing new equipment and how to develop this relationship as part of your IT strategy.

When the COVID-19 pandemic struck, Atrium Health rapidly expanded its virtual capabilities. The Charlotte, N.C.-based organization needed to manage a wave of low-acuity patients while increasing touchpoints with staff. 

“We had to leverage technology in a way that enhanced the patient experience but didn’t disrupt the clinicians’ normal workflow,” says Becky Fox, a vice president and chief nursing informatics officer at Atrium Health.

A new virtual platform allows Atrium Health patients recovering at home to text, call and videoconference with their clinicians. Nurses can monitor progress using GetWell — an interactive system that prompts a patient for responses and can alert teams to intervene if needed.

Such complex efforts require collaboration with a chief nursing informatics officer (or CNIO) — a senior executive who helps set the strategy for the use of technology, data and evidence-based information systems to enhance processes and improve patient outcomes.

These leaders bring "strategic vision and informatics knowledge, but also knowledge of clinical workflows to make that happen,” says Patricia Mook, Atrium Health’s system vice president of nursing operations.

MORE FROM HEALTHTECH: Discover how to make the most of your IT strategy.

Nursing Informaticists Drive Telehealth Expansion

The CNIO’s ability to sit in both worlds — technological and clinical — will become only more vital as telehealth affects a widening range of medical specialties.

This spring, Atrium Health’s ambulatory video visits increased by more than 500 percent in a matter of weeks. “Our consumers are loving having their care at home; that’s the wave of the future,” Mook says. “Our informatics team will support that.”

The need is massive: Cheryl D. Parker interviewed about a dozen nursing informatics leaders about their organizations’ responses to COVID-19 and found a common thread: “Telehealth exploded,” says Parker, president of the American Nursing Informatics Association and clinical assistant professor at the University of Texas at Tyler. 

Patricia Mook, System Vice President of Nursing Operations, Atrium Health
CNIOs are strategy interpreters. They’re able to speak the languages of both nursing and informatics in discussions about strategic initiatives.”

Patricia Mook System Vice President of Nursing Operations, Atrium Health

One informatics leader told Parker that, prior to COVID-19, her organization had an average of 150 weekly telehealth visits — and now handles 10,000 visits each week. 

“Too many patients and providers are in love with telehealth,” Parker says. “There’s no going back.” The CNIO, then, will have to help an organization standardize this shift — for instance, by implementing drive-through lab tests.

Chief Nursing Informatics Officers Grow in Number and Influence

Response to a global health emergency has shined a spotlight on the CNIO, but the informaticist role has been steadily gaining in importance for more than 25 years. 

The nursing informatics discipline was first recognized by the American Nurses Association in 1992. Back then, informaticists focused mostly on implementing electronic health records and making the technology work for clinicians. 

“Clinicians were needed who understood both the technological and clinical components and could serve as interpreters, because there was a big communication gap between the clinicians and the technologists and engineers,” Parker says.

As EHR systems became standard — more than 95 percent of hospitals now have EHRs — technology and data became more integral to care delivery. The need grew for executive informaticists who could communicate with other executives about technology implementation and the organizational changes it required. 

“It became apparent we needed a senior informatics nurse specialist at the executive table for their depth of understanding and experience,” Parker says. “Because if that person wasn’t at the planning and strategizing stages, comprehensive decisions were more difficult.” 

Following a 2009 legislative push for meaningful adoption of EHRs, the first CNIO positions began to emerge, becoming more common in the 2010s. By 2016, 14 percent of hospitals had CNIOs — a big jump from 4 percent five years earlier.

“You need that person to support you with the strategic planning,” Mook says of operational leaders’ dependence on CNIOs’ informatics expertise. At the same time, the CNIO relies on operational leaders to ensure that any tech initiative serves to benefit patients and providers.

Data-Driven Leadership Culture Supports Nurses and New Technology

After Sherri Hess began working as an informaticist in 2007, she oversaw teams that implemented or supported more than 200 EHRs. Today, she and other CNIOs are less involved in straightforward EHR implementation. 

“We’re more driven by data and outcomes to ensure that what we’re implementing makes a difference,” says Hess, CNIO at Banner Health in Phoenix. That goal, she notes, entails measuring everything from sepsis rates to patient satisfaction.

Yet respect for the CNIO role hasn’t always matched its importance. A 2016 report co-authored by Mook, of Atrium Health, found that most healthcare executives surveyed said the CNIO role was not understood or respected in their organizations. 

That has changed, Mook says. “We’re in a different time today. The value of the knowledge that CNIOs bring to the table has risen because of the need and value for innovation and technology to do our work.”

Still, CNIOs agree that nurses should have a bigger voice in executive decisions. “We’re not playing enough of a role,” says Hess, who notes that some healthcare organizations have chief medical informatics officers but not CNIOs. “We have to change that.”

It’s why Hess has been soliciting her nursing leaders’ priorities at Banner Health. At the top of their list: providing nurses with smartphones. Hess recently built a business case with the executive leadership team, justifying the smartphones’ cost by pointing out their potential benefits, such as greater efficiency. 

This year, Banner Health provided smartphones to all of its clinicians, including more than 17,000 nurses at 28 hospitals. 

“If we’d only had a technology focus without the nursing perspective, the smartphone project could have been nixed because it’s costly,” Hess says. “I wouldn’t have been able to get funding for it if I had not tied it to efficiency and outcomes.”

Still, effective technology doesn’t have to be cutting-edge. Atrium Health recently realized it could facilitate communication between patients and providers and conserve personal protective equipment by using a surprisingly simple tool: baby monitors. 

“We shared that story with the IT folks so they understood how valuable their work is, but also with our clinicians to make sure they know how technology can make a difference,” Fox says. 

Helping Nurses Balance Documentation and Workflows

Just as in the early days of the informaticist, the CNIO continues to serve as translator between the clinical and technical staff. 

“CNIOs are strategy interpreters,” Mook says. “They’re able to speak the languages of both nursing and informatics in discussions about strategic initiatives.”

For all the reliance on data, the CNIO also has to avoid documentation overload. “Since the implementation of EHRs, there’s been an exponential growth of the things that clinicians are required to document,” Parker says. 

The CNIO should determine the minimum amount of documentation necessary to ensure patient care and safety and to meet regulatory and accreditation requirements, she adds. 

The documentation burden has fallen mostly on nurses “because we’re the ones who are with the patients the most,” Hess says. At Banner Health, “we’re documenting what we have to and not allowing more things into the records unless nurses approve them,” she adds.

For CNIOs and for nurses, “that will be a huge issue going forward,” Parker says.

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