How the CNIO role has evolved

Like many tech-focused healthcare leaders, the role of chief nursing information or informatics officer has evolved quite a bit in recent years.

CNIOs have not only grown in number, but their role has expanded to have more strategic importance and into additional technology initiatives beyond just the EHR, several of the nursing leaders told Becker's.

Becker's recently asked 12 CNIOs what has changed most about their jobs in recent years.

Note: Their responses have been lightly edited for clarity.

Valerie Fong, MSN, RN. Providence (Renton, Wash.): The CNIO role certainly continues to evolve. While the role definition has not changed over the last few years, the specific outputs, deliverables and successes continue to be organization- and environment-dependent where the role exists. For example, there is a CNIO at a competing healthcare delivery organization less than 25 miles away who does not have any direct reports and therefore a different set of accountabilities than I have at my organization. The CNIO at a vendor organization (e.g., software, hardware) has a completely different set of responsibilities.

From my perspective, the largest change in the CNIO role over the last few years is the requirement for the incumbent to have a higher level of agility and skills than ever before in developing, executing and resourcing clinical informatics strategies that align within the constraints of continuously changing organizational operational priorities and infrastructure.

The COVID-19 pandemic crisis-mode environment revealed the breadth of CNIOs' knowledge and skill set to operational executives, highlighting the versatility and depth of their clinical and professional expertise in co-creating clinical practice solutions incorporating existing technologies with fast-track speed. The pandemic also exposed the key CNIO role success factors of tomorrow — demonstration of excellent change management, transparency of communications, prioritization (and re-prioritization) during times of significant ambiguity, and leading of people at all levels of the organization through unprecedented change.

The role has undoubtedly matured since the early years and primary focus on EHR implementation. Today, individuals functioning in the role must move significantly farther away from transactional (tactical) to much more transformational (strategic) work, to serve as one of the organization's most trusted and valued partners in transforming clinical practice.

Becky Fox, MSN, RN. Atrium Health (Charlotte, N.C.): The CNIO role has expanded focus on improving the work and workflows of all clinicians and teammates involved in the patient's experience. The role has been called upon to make an impact on larger, systemwide initiatives and challenges, from communitywide vaccine distribution to addressing supply chain, staffing, recruiting and retention opportunities.

Now, more than ever, the CNIO role calls for business, strategic and financial skills, in combination with strong collaboration attributes, to help drive innovation, challenge the status quo and ensure costs are manageable, while improving outcomes.

Sarah Hughes, APRN. Olinqua: The CNIO role was historically in the hands of the CMIO. Over time, senior nurses have advanced into the informatics space and been recognized as key leaders in healthcare to work alongside CMIOs.

A CNIO is also now responsible for leading digital health teams — project rollouts in digitizing the healthcare environment and training staff on the key requirements for successful adoption. We serve as the bridge in communication between the software and technical staff and clinical.

It is a position gaining traction, and you will most likely find a CNIO in almost every hospital within the next five years. They are key leaders and sit on the executive team and are pivotal to successful hospital operations.

You will find most CNIOs within a hospital also are in a dual role as director of nursing or director of nursing and midwifery, overseeing the entire nursing workforce. This means if there are workforce shortages, you will find them on the floor with the staff helping where needed.

They are a much-loved and respected team member and are keen to educate others on system adaptations, with strong messaging behind "what the new system is, why we need it and how it can help" to enhance both patient care and the staff throughout their shifts.

CNIOs are now starting to be seen also in the vendor space, as I am. Our role is to work with business development and align cross-communication between highly agile cross-functioning teams. We assist with product development and are placed as key clinical advisors, on the healthcare system, hospital operations and clinical knowledge to help with innovations in this space, such as with Microsoft Health.

CNIOs either within the hospital or the vendor space are responsible for digital leadership across workflow efficiencies, improving interoperability and clinical communications within the organization. You must have had a quite lengthy experience in nursing (15-plus years) to be in a role such as this given the complexity of knowledge, learning and understanding required to be a clinical expert. You must also have a strong focus on outcomes and patient safety and align this with integrating technologies to assist.

Diane Humbrecht, DNP, RN. Virginia Mason Franciscan Health (Seattle): One of the biggest changes I have seen as a CNIO is the ability to adopt change quickly to support pandemic needs. Traditionally, change takes time over a long period of planning. We have had to pivot quickly with all of the moving parts surrounding the pandemic. This has led us to implement many tools such as video visits, creative staffing models that are supported by our technology, as well as thinking outside of the box on what we thought was traditionally achievable. This work will change our future permanently, and technology will be a key to this work.

Remote work of our teams and supporting staff in their home has actually been a satisfier for clinical informatics teams. Creating new work models has supported these teams during a pandemic and into our future.

Adapting to change and seeing that we are able to be agile in our work to accomplish significant change has been an achievement that demonstrates we can work differently yet efficiently utilizing technology.

Lastly, partnering with organizations outside of healthcare (Amazon/Microsoft) has proven to be a productive partnership to advance healthcare technology that needs further exploration.

Sharon Kirby, MSN, RN. Denver Health: What has changed in recent years in the CNIO role is how much it has grown in popularity where previously an organization might only employ a CMIO. Nursing and other ancillary roles were underrepresented, which was unfortunate because nursing represents the largest population of healthcare providers. Nurses are best suited to understand hospital operations and workflows and are very valuable contributors to our healthcare ecosystem.

With the unprecedented nursing shortage, it is imperative we in nursing informatics leadership be a catalyst for creative care models that leverage technology and decrease the burden on the nursing profession. It will be important to represent nursing at the executive table and ensure its voices are heard. We are challenged to address clinician burnout by improving our technology usability and employing technology to automate processes wherever possible. The CNIO role of today expands well past just the nursing profession and is poised to be the linchpin between IT and multidisciplinary roles as well as patients in the future.

Another challenge that has shifted our attention is the very real threat of cyberattacks on healthcare organizations and the call to action to mitigate and prepare for such a catastrophic event. Being prepared for a short downtime is no longer sufficient; rather, preparation needs to include plans for prolonged disruptions in our technology as we have seen at several healthcare organizations recently.

Julie Luengas, DNP, RN. Stony Brook (N.Y.) Medicine: The CNIO has transitioned from the responsibility of day-to-day operations to a strategic member of the executive team. The CNIO is responsible for identifying, developing and implementing informatics solutions, which support the goals of the organization and the population served. The CNIO collaborates with the CMIO, nursing and ancillary teams to ensure the informatics solutions selected align with the goals of the organization and the population served. The CNIO understands the importance of data to support population health initiatives for the healthcare system.

Kathleen McGrow, DNP, RN. Microsoft Health and Life Sciences: The chief nursing information officer has always played a role in using evidence-based techniques to leverage technology to improve the quintuple aim. What has changed the most for the CNIO role in recent years is the expansion of responsibilities to disseminate information obtained using technology for clinical practice and to ensure clinicians have the tools and solutions necessary to apply the scientific process. This is done through critical thinking, analysis and application of standards necessary to care for patients.

The CNIO advocates the use of people, processes and technology to translate knowledge and skills to solve health information technology problems. As more data has been amassed, there is the required need to leverage the data for insights that can drive interventions. CNIOs are strategic leaders and key to ensuring evidence-based nursing practice and technology are utilized to measure impact and outcomes for clinical practice.

Rebecca Mitchell-Perry, MSN, RN. WVU Medicine (Morgantown, W.Va.): The focus of the role is no longer just about implementing and maintaining the electronic medical record. In addition to this, it is about being at the table and being a key partner with executive leadership in the delivery of high-quality patient care initiatives.

Innovation is on a steady and fast-paced roll. CNIOs of today have to ensure that there is a governance model in place to ensure that requests for new technology and enhancements are supported by evidence-based data and practice to positively impact clinician workflow, safety and outcomes rather than hindering them.

Teresa Niblett, DNP, RN. TidalHealth (Salisbury, Md.): The CNIO role and nursing informatics team have had to draw on their clinical roots to support nurse leaders, staff nurses and other allied health professionals to survive the terrible seizes experienced in healthcare. Strategic initiatives were abandoned to tackle critical initiatives, such as stand-up patient care areas in conference rooms or parking garages using mobile technology, or creating vaccine clinics with clinical and nonclinical volunteers and new technology designs and workflows. Some CNIOs found themselves and their teams providing direct patient care. The CNIO is a vital partner in reacting to crisis and proactively improving healthcare delivery and outcomes.

Brian Norris, RN. Indiana University Health (Indianapolis): The CNIO role is evolving quickly. Many CNIOs were once laser-focused on implementing the EMR and the clinical workflow change that goes with it. Today, many are starting to shift focus to leading digital transformation and analytics efforts, shifting their mindset from how we collect data to how best to use it. I foresee over the next decade we will continue to see CNIOs take strong roles in their organizations' digital journeys, including in how their organizations leverage advanced analytics such as predictive analytics within clinical workflows.

Ruth Schleyer, MSN, RN. Legacy Health (Portland, Ore.): The past decade has seen the CNIO role evolve from one focused on EHR implementation and adoption to the CNIO as a strategic and operational senior nurse leader who brings unique informatics expertise to their focus on improving health and transforming healthcare. Today's CNIOs are interprofessional leadership partners in co-creating safety, quality and value for patients/citizens and clinicians in current and future technology-rich health and healthcare delivery environments.

CNIOs help ensure nurses have the informatics competencies and technologies to practice safely and efficiently wherever they are. In recent years, this approach has found new meaning — from implementing "virtual everything" to reducing EHR-related cognitive burden and burnout. CNIOs today are called to navigate the world of disruptive, innovative technologies mindful of their impact on the health and well-being of nurses and the entire care team (including patients/citizens). More than ever before, CNIOs bring strategic vision and creativity to connect evidence with equity, care and health for all.

Donna Woelfel, MSN, RN. MultiCare Health System (Tacoma, Wash.): There is increased prevalence and support for adding a vice president CNIO leadership role at the executive table.

The scope has also expanded from acute and ambulatory to include digital, virtual, artificial intelligence, robotics, mobility, integration, alarm fatigue and decision-support.

The focus has changed from implementing to optimizing, enhancing workflow, patient engagement, digital front door and population health. There are also enhanced analytical tools and an increased ability to use data for decision making in supporting best practices.

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