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Informatics leadership: The role of the CNIO

Kirby, Sharon B. MSN, RN-BC

doi: 10.1097/01.NURSE.0000462394.23939.8e
Department: TECH NOTES

Nurses in the role of CNIO

Sharon B. Kirby is a CNIO at Centura Health in Englewood, Colo.

The author has disclosed that she has no financial relationships related to this article.

ALTHOUGH THE NURSE informaticist role has existed for some 30 years, the demand has gained momentum recently. This demand necessitates leadership from an executive level, which is why the role of the chief nurse informatics officer (CNIO) was established. This article explains the role of a CNIO and its growing popularity in the informatics field.

Let's begin by reviewing how nursing informatics (NI) evolved. It may be surprising, but the concept of informatics isn't new; it can be traced back to Florence Nightingale during the Crimean War when she recognized the need to document patient care in order to track a patient's progress.1 Although this simple concept may have seemed radical at the time, we now know how important it is to document patient care and collect patient data.

If we fast forward to today, we see the nurse informaticist role experiencing an unprecedented upward trajectory fueled by two specific events in the last decade. In 2004, President George W. Bush's administration challenged the healthcare industry to migrate from paper charts to electronic health records (EHR) within 10 years. This called for a patient's medical record to be documented electronically in a way that could be shared throughout the patient-care continuum no matter where the care is delivered. Although the Bush administration carved out this technology plan some time ago, there was no true rigor underpinning its implementation.

It wasn't until the next iteration of the plan, which included financial incentives, that the healthcare market was more receptive to fully adopting EHR systems that would enable interoperability throughout all phases of a patient's care. This financial incentive was contained in the American Recovery and Reinvestment Act that called for the adoption and meaningful use of an EHR.

These two initiatives in 2004 and 2014 spurred the rapid growth of nurse informaticist positions across the country. It's the nurse informaticist, in essence, who brings together the clinician's workflow as it interfaces with the information technology systems.

This alignment of the two different domains isn't easily accomplished, which is why the specific skill set a nurse informaticist brings to the table is essential to bridge the gap. The goal of NI is to drive successful implementations by mapping current clinical workflows and incorporating the technology into those workflows. Never before in healthcare have we seen such a transformation in the way we document, collect data, communicate, and care for our patients. As all this transformation is simultaneously occurring, the need for strategic nursing leadership in the specialty of NI has come to the forefront, which is why the role of the CNIO was established.

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What's in a name?

The CNIO isn't the only title we see related to informatics these days. Myriad new leadership titles cropping up in Healthcare IT (HIT) recently can be confusing. One healthcare system may employ a nurse in a CNIO position while another has someone in a very similar role titled vice president of clinical informatics. Some institutions don't have an executive-level nurse informatics role at all, but a director of clinical informatics may perform much of the same functions as a CNIO.

The CNIO role has often been preceded by a chief medical informatics officer (CMIO) role at most organizations. This physician executive position has evolved over the past 10 years and has gained much popularity. Some healthcare systems have created another title of chief clinical informatics officer (CCIO), which may be filled by either a physician or nurse.

Despite the multiple titles and roles, one thing is essential: collaboration between the CMIO, CNIO, and chief information officer (CIO) of the healthcare organization. Clinicians and HIT departments may not always coordinate their strategic visions. The alliance of these roles working in tandem will invariably shape a healthcare system's adoption of the EHR.2

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Why a CNIO?

The rapid growth of HIT and EHR adoption necessitates executive informatics representation for the nursing profession. Why the emphasis on nursing? For one thing, nurses make up over 3 million EHR end users across the country.3 Nurses are also the most frequent users of HIT given the very nature of covering hospital shifts 24/7. They're often early adopters of EHR documentation and optimize its collective information to support clinical decisions in the delivery of their patient care. Nurses also have a unique, global understanding of the various workflows that exist within a hospital or clinic. However, the CNIO sphere of influence isn't limited to nursing representation, but rather represents all clinical members of the care team.

The CNIO is best poised to understand the operational and strategic vision of the organization while leveraging technology integration to improve patient safety, quality care, and positive outcomes. The CNIO also ensures that the design and build of the EHR is interdisciplinary, with sufficient end user input, and that no unintended consequences occur as a result of the implementation. The CNIO is key to engaging other nurse leaders and promoting clinician adoption, which is vital to successful EHR implementations.4 This executive should work closely with the CMIO to ensure clinical decision support is placed at strategic points in the workflow to best support evidence-based patient care.

An equally important role for the CNIO is to ensure HIT aligns with the nursing strategic goals of the organization. The chief nursing executive (CNE) or CNO working closely with the CNIO allows for integration of different nursing perspectives to further clinician efficiencies and improve patient care.5

The CNIO also is in a unique position to represent not only what the technology can do but also what it can't do.6 An EHR that exists without proper protocols, policies, processes, and human accountability can lead to dangerous workarounds or errors.

Lastly, the CNIO represents nursing and other clinicians at the executive table to ensure their voices are heard in all phases of project planning, design, and implementation.

The CNIO is a transformational leader who will promote the reengineering of nursing practice from an illness-focused patient model to an outcome-focused paradigm by leveraging analytics procured from the EHR.7 These data will support the care continuum model not only in the acute care setting but in the ambulatory and postacute care as well as we shift to more outpatient healthcare in the communities we serve. The CNIO will provide the global perspective needed to drive workflow efficiencies, eliminate duplication and clinical variance, and improve transitions of care across an integrated healthcare network.

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Bright future for the CNIO

The exponential growth of the CNIO role shows no signs of slowing. It's evolved into a necessary, well-respected leadership role in the nursing profession.

As a career choice, it offers a satisfying path that supports patient care as well as an avenue to nurse executive leadership roles. Nurses who aspire to this leadership role should hold a master's degree in nursing, preferably one with an informatics focus, as a minimum. Some would recommend a PhD or a DNP in the field as well. All in all, the future looks bright for NI as well as the CNIO role in the new model of healthcare delivery.

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1. Kirchner RB. Introducing nursing informatics. Nursing. 2014;44(9):22–23.
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