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Scottsdale Institute 2018: CNIOs Managing Change and Optimizing Clinical Innovation

July 24, 2018
by Duncan Moore
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Executive Summary

Eight nurse executives fulfilling the functional role of chief nursing informatics officers (CNIOs) at major health systems and Scottsdale Institute member organizations met in Scottsdale to discuss “Managing Change and Optimizing Clinical Innovation” on April 27-28, 2018. They talked about such topics as mentorship, encouraging more women to take on IT leadership roles, good hospital citizenship, tamping down the proliferation of one-off apps, dealing with financial pressures and growing this group. This report captures their discussion and shared insights. 

Attendees: Judy Blauwet, R.N., chief clinical information officer, Avera Health; Jennifer Carpenter, R.N., vice president, IT clinical systems, University Hospitals; Darby Dennis, R.N., vice president, clinical information technology, Houston Methodist; April Giard, system vice president, chief nursing informatics officer, Eastern Maine Healthcare Systems; Sherri Hess, R.N., chief nursing informatics officer, Banner Health; Candice Larson, R.N., interim chief nursing informatics officer, HonorHealth; Ellen Pollack, R.N., chief nursing informatics officer, UCLA Health; Rosemary Ventura, R.N., chief nursing informatics officer, NewYork-Presbyterian Hospital

Organizer: Scottsdale Institute

Sponsor: Wolters Kluwer

Writer: Duncan Moore

Moderator: Pam Holt, R.N., director, clinical effectiveness operational consulting, Wolters Kluwer and Emmi Solutions

What is the Role of the CNIO in Your organization?

While there is a standard definition of the CNIO role offered on the HIMSS website, in real life their duties and obligations vary from institution to institution. In some cases, they embrace responsibilities that might be assigned to the chief medical information officer or the chief information officer at another organization. In other cases, the individual might not wear the title of CNIO but have all the responsibilities that come with that role as generally understood. At Houston Methodist, for example, the hospital administration limits the number of roles that have “Chief” in their title. Darby Dennis, the current incumbent, says the chief nursing officers regard her as CNIO even though her title is vice president of clinical information technology. She is looked at as “that nurse technical expert within the organization.” However, she has broader responsibilities that include management for all clinical systems. “System CNOs felt the nurse informaticists from all hospitals (they are decentralized) would have a dotted line to me.”

CNIOs serve the distinct role of supporting nursing and their technical needs, but with varied titles across hospitals and health systems. There is a desire to 1) clearly identify the function of this role in organizations and 2) clearly define the role to deliver excellent service to the nurses and clinicians across each organization. This will allow hospitals and health systems to support the technical needs of nursing in a consistent manner.

Describe Your Reporting Lines

CNIOs have a variety of reporting lines and responsibilities. According to a 2016 HIMSS survey, 34 percent of CNIOs report to the chief nursing officer, 25 percent to the Chief Information Officer and 16 percent to the CEO. About 5 percent report to the chief medical officer and another 5 percent report to the CMIO. Of the remaining 15 percent, additional roles include chief operating officer, chief clinical officer and other senior-level executive positions.

Ellen Pollack at UCLA Health, likes working with her CMIO, “but I don’t want to report to him. I feel very strongly about this. Our team wants to own the customer experience and the work flow. I want those people reporting to me. We don’t need to have the people actually building the systems and apps.”

Proliferation of EMRs, One-Off Systems, and Apps

Many hospitals, especially those that have undergone mergers and successive waves of combinations or affiliations, now find themselves with legacy IT systems that are not compatible. In some instances, departments or clinics have purchased niche applications or specialty add-ons that clinicians in those departments have requested, or prefer to use. Keeping all these systems running can feel like a herculean labor. Yet it can be a thankless task to attempt to persuade that user group that the niche application requires more expense or time investment than it merits. Most people in IT would prefer to move toward a system-standardized EMR platform, and reduce the number of independent apps, even if they are regarded as best of breed.

At HonorHealth, clinicians are still accessing those one-off systems. Therefore the system has to continue supporting them, Candice Larson says. After the system’s merger, “we had Noah’s Ark—two of everything, or three in some cases.”

Very often the internal process is part of the problem. People have to be trained to not say “Yes” to the first thing that comes in the door. In some cases, a vendor has approached a unit and the unit wants to buy it, Sherri Hess, Banner Health, explains. There’s already a relationship. “You have to have finance on your side to say, ‘Wait, is this a technology request? Then it has to go through our process.’ “

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