Tupper, Sarah R. MS, RN-BC, LHIT-HP; Alexander, Dana MSN, MBA, RN, FHIMSS, FAAN
AWARENESS OF THE ROLE
The role of chief nursing information officer has recently gained recognition in this era of health information technology (HIT)–enabled health reform (think ARRA/HITECH 2009 and PPACA 2010) and transformation. The meaningful-use trajectory has organizations on a path of capturing and beginning to share data; 2013 will bring advanced care processes with decision support, and in 2015, the goal is improved outcomes. The Robert Wood Johnson Foundation and Institute of Medicine’s report, “The Future of Nursing: Leading Change, Advancing Health,”1 discussed the importance of having nurse leaders at all levels from the bedside to the board room. In 2011, both the Health Information and Management Systems Society (HIMSS) and the American Organization of Nurse Executives supported presentations centered on discussing the emerging role of the nursing informatics (NI) executive.2,3 So, we ask, “What are these professionals called?” What is the career path to the role? What are the responsibilities in the role and to whom are they accountable? Lastly, we offer our thoughts on the future of the role and invite you to engage in the thinking, as well.
WHAT’S IN A TITLE?
Titles include chief nursing information officer, chief information executive, nursing informatics executive, and chief clinical information officer. In our interactions with clients, executives, and various organizations across the United States and Canada, we agree that the title for the role typically follows function in the organization. For example, some organizations are approaching the title as representative of the interdisciplinary care team (eg, chief clinical information officer), while other organizations use the title of chief nursing informatics officer (CNIO). The challenge with the CNIO title is that sometimes it is interpreted by others to mean the individual represents nursing only, while actually the scope and influence are well beyond nursing and nursing practice. We have learned from our nursing executive (CNE or CNO) colleagues that even though a title may imply responsibility and accountability for only nursing, in practice many nurse executives have been responsible for the senior-level leadership of other disciplines including, but not limited to, therapies, pharmacy, radiology, chemical dependency services, and social work. In practice, the CNE/CNO position represents patient care delivery inclusive of many disciplines in the organization. We also find the title depends on the organization: size, culture, clinical information maturity, and priorities. The position is focused on getting the work of clinical information systems implementation done as well as to provide support to all caregivers in decision making using electronic information resources (journals, evidence-based guidelines, protocols, plans of care, alerts). The individual typically develops the role over time and gains trust and credibility within the organization for their overall informatics expertise. The individual organizational title may change from “director” to “executive” as the strategic importance of the role becomes clearer in the current healthcare reform climate and as the organization drives to achieve established strategic priorities and goals.
The preparation for the role remains diverse, in that some NI executives have a formal degree in NI, whereas others have a general graduate nursing degree. Swindle and Bradley4 previously indicated that preparation for a career as an NI executive included the following: nursing operations and patient care background were judged to be essential, followed by managerial and leadership skills, informatics and HIT training, professional certification (ANCC, HIMSS), and formal educational programs (MS, PhD, DNP, postgraduate certificates). We wonder if the role will become better defined in terms of preparation and certification with the recent focus on workforce development in the HIT role. The number of graduates of the university-based training and community college certificate programs entering the market is increasing. We anticipate this will be an ongoing positive step forward in the competency levels of CNIOs, in that organizations will have a larger pool of well-qualified candidates from which to choose than they have previously. Organizations are increasingly requiring informatics-specific training and certification for individuals seeking the NI executive role.
Nursing informatics executives of today report a wide range of responsibilities and scope of influence depending on the organizational size, strategy, priorities, and progress of HIT implementation. However, there are many common themes emerging among the NI leaders of today:
* Build an infrastructure for evidence-based practice: A critical aspect is to define the infrastructure to translate NI into the professional nursing practice model of the organization. Nursing informatics must be incorporated as an extension of nursing practice while defining the unique contributions that NI makes through taxonomies to the information model and transformational care of the organization.
* Define competencies and provide mentorship: Nursing informatics as an extension of nursing practice and integral part of the professional practice model must also define what the NI competencies are that should be required for every nurse in the organization as well as specialized NI competencies based on role. The NI leader is indispensable in defining and communicating the necessary competencies to the organization.
* Partner for workforce readiness and development: Health IT and informatics are part of a transformation journey; therefore, the workforce considerations around readiness, preparedness, and development are paramount. The work, skills, and competencies of today are changing, and preparing the workforce is critical to successful achievement of care transformation and adoption of technology.
* Support and optimize evolving care delivery models: Care delivery is transforming to include a focus on patient-centeredness and leveraging the interprofessional care team. Informatics and technology are key components in this change, and care delivery models must be continuously optimized as the environment changes.
* Blend business and clinical intelligence and analytics: Optimization of care delivery and achieving accountable care require a blend of business and clinical intelligence and analytics. Nursing informatics leaders are in prime position to assist their organizations in determining the business and clinical analytics needs. The NI executive can provide valuable input regarding the blending of the intelligence to provide the best information for surveillance, monitoring, and capture and reporting.
* Incorporate human factors concepts and usability for transforming care delivery: Lack of technology adoption remains a significant issue for organizations. As a result, more awareness and appreciation for human factors and usability concepts are growing. Informaticists are developing specialty expertise in these areas, but the NI leader for the organization is becoming a focal role to identify and communicate human factor and usability issues to vendors and developers, while assisting the organization to translate human factors concepts into usability and workflow, thereby supporting adoption.
* Educate organizations about informatics: Awareness and understanding about informatics and differentiating NI competency from “nurses in IT” are much greater today than in previous years. The NI leader provides ongoing education to the organization regarding incorporation of advancements in informatics and technology into the care delivery and/or professional practice model.
* Communicate and sustain the vision: Nursing informatics executives must partner with other organizational leaders to lead the vision for NI and define the infrastructure to translate NI into the professional nursing practice model and communicate the vision for transforming care delivery.
Past organizational charts have depicted the NI executive as reporting to the CNO or CIO with dotted lines to the other (CNO or CIO) and, in some cases, to the CNIO. With the increasing focus on quality reporting (driven by meaningful use and value-based purchasing) and increasing competition (driven by more informed and engaged consumers), we predict there will be increased alignment to quality or clinical transformation pillars within the organizational structure. Whether or whomever the NI executive reports to, one fact remains: it is imperative that this individual develop relationships beyond the CNO, especially with the CMIO, CIO, and extending to the entire C-suite. The work of leading an organization’s informatics strategy is a transformational journey that touches every aspect of an organization whether directly or indirectly.
The political reality that exists today is that chief nursing informatics officer is frequently not a well-accepted term. The title can become a barrier or limit the sphere of influence (eg, viewed as “nursing-only”), reflecting the political landscape of the organization. Perhaps, a title such as chief knowledge executive will prove to be both more reflective of the role and more palatable politically.
We believe that analytics is the next evolution in informatics extending beyond the current pressures and challenges of EHR implementations today. Analytics supports informed decision making, and we foresee that the NI executive role will become more focused on data warehousing, ensuring that the clinical data are appropriately tagged data and organized against industry standards to support appropriate capture, meaningful retrieve-ability, and use. The focus on technical and practice standards, as well as analytics strategy, will ultimately support organizations’ drives toward accountable care and achievement of the goals and priorities of the National Quality Strategy.
In closing, we would like to note that the Institute of Medicine called for a focus on patient safety and a new standard of care in their 2003 report.5 In the report, they outlined five core health professional competencies that are centered on meeting the patients’ needs. Note that “use IT” was a part of this list, and the IOM recommendation is that all clinicians (regardless of discipline) should be educated in and practice the following competencies:
* deliver patient-centered care,
* practice evidence-based medicine/nursing,
* focus on quality improvement,
* use IT, and
* work in interdisciplinary teams.
We encourage and invite healthy discussion about if and how our colleagues in NI leadership see the role of the NI executive contributing to these competencies and, most importantly, to the improved outcomes for all of the patients we serve.
2. Alexander D, Hart M, Frink BB. Partners in practice: the chief nurse executive and nursing informatics executive. Presented at The American Organization of Nurse Executives (AONE) 44th Annual Meeting and Exposition, April 2011, San Diego, CA; 2011.
3. Alexander D, Schleyer R, Campbell RC, Willis J. Emerging nursing leadership roles. Presented at Health Informatics Management Systems and Society (HIMSS) 11th Annual Conference and Exhibition, February 2011, Orlando, FL.
4. Swindle CG, Bradley VM. The newest O in the C-suite: CNIO. Nurse Leader. 2010; 8 (3): 28–30.
5. Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington, DC: The National Academies Press; 2003.
© 2012 Lippincott Williams & Wilkins, Inc.