The senior clinical informatics role in patient care organizations for those with a nursing background—variously given the title “CNIO,” “vice president of clinical informatics,” and other labels—is increasingly becoming a nexus position in hospital-based organizations nationwide. Yet this position is only beginning to be standardized in terms of title, pay, responsibilities, and reporting relationships.
The necessity for nursing informatics leadership has never been more clear and present, driven by a variety of healthcare reform-related initiatives, some of them mandatory and some voluntary. Those factors are combining to force patient care organizations forward as never before to better coordinate care across the continuum, improve patient safety, and better document care delivery. Nurse informaticists, healthcare leaders are coming more and more to see, are instrumental in helping their organizations to meet a variety of meaningful use requirements. Indeed, more than ever, organizational leaders are seeing nurse informaticists as one key element in success across a variety of meaningful use-related areas, including the implementation of necessary IT infrastructure, the integration of IT systems across the healthcare continuum, and the optimization of these systems for point-of-care data collection and clinical decision support.
Yet even as healthcare organizational leaders nationwide are beginning to realize that informatics leadership is truly needed for nurses, who represent the largest volume of clinical IT users (at 3.1 million nurses nationwide), there remains a lack of any sort of consistency of title, reporting structure, or educational requirements of this senior nursing informatics role is still shaking out and heavily dependent on the organization.
The Time is Now
Industry experts and clinical informaticist leaders say that the time for nurses to get a seat at the informatics table is now, as nursing informaticists are becoming more integral to the healthcare IT puzzle than ever before with the amount of point of care documentation and care coordination mandated by the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act. Miriam Halimi, R.N., D.N.P., director of clinical informatics, at Holy Cross Hospital, an academic medical center in the Washington, D.C. suburb of Silver Spring, Md., says the chief nursing informatics officer (CNIO) needs to be prepared and have the experience to lead the care transformation by redesigning a culture and workflows, as well as understanding the impact this has on all the disciplines. “So much of what nurses do impacts outcomes and safety,” she says. “So I think the role has evolved as a result of the demand for this nursing leadership that has informatics and clinical knowledge.”
With emphasis on care coordination in healthcare, many see the CNIO role key not only in coordinating IT efforts in nursing, but also in ancillary services as well. With more and more healthcare organizations adopting electronic health records (EHRs), the reality that nurses touch more than one department is even keener. Halimi points out that through computerized physician order entry (CPOE), nurses engage with pharmacy and laboratory. “This is a new role, the chief clinical informatics role,” she says. “I think it would be a tremendous role if that person is a nurse. But I think the focus is greater than just nursing, it’s about the collaborative impact of all the areas using technology correctly.”
The Healthcare Information and Management Systems Society (HIMSS) position statement, “Transforming Nursing Practice through Technology & Informatics,” which was approved by the HIMSS board on June 17, 2011, advocates that nurse leader roles, such as the nursing informatics executive, the CNIO, the chief clinical information officer, and the vice president of nursing informatics, be true partners with the chief nursing office (CNO) and other executive leaders to transform healthcare through technology “that is interoperable, patient-centric, user-friendly and focused on quality outcomes.” Due to a breadth and depth of nursing engagement in all aspects of healthcare, the report advocated these roles to “champion the redesign of clinical workflow and processes essential for the adoption of new technology” and help disperse information and informatics literacy throughout all nursing staff.
In 2008, The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched a two-year initiative to assess the nursing profession. In October 2010, those organizations issued a report recommending that nurses’ roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by healthcare reform and that nurses should be seen as full partners with physicians and other healthcare professionals, to redesign this transformation.
The report advocated residency training for nurses and laid out a goal to increase the percentage of nurses who attain a bachelor’s degree to 80 percent by 2020, and to double the number of nurses who pursue doctorates. The IOM also sought to remove regulatory and institutional obstacles—including limits on nurses’ scope of practice—so that healthcare organizations could take advantage of the full benefit of nurses’ training, skills, and knowledge in patient care.
Nursing informatics is gaining prominence on a national scale, especially with the recent elevation of Judy Murphy, R.N., to the No. 2 spot at the Office of the National Coordinator for Health IT (ONC). As Deputy National Coordinator for Programs and Policy, she oversees the ONC offices of standards and interoperability, provider adoption support, state and community programs, and policy and planning.