Nursing, IT combo makes for healthcare power team

WASHINGTON– What is a chief nursing informatics officer (CNIO), some people ask, and how important is one? In this era of healthcare payment realignment and evidence-based medicine, key stakeholders say the CNIO position is critical.

According to the American Nurses Association (ANA), nursing informatics (NI) is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice. NI supports consumers, patients, nurses, and other providers in their decision-making in all roles and settings.

Though the title of chief nursing informatics officer is a relatively new one, CNIOs can already be found in health systems, at health IT vendor companies, in the government and as policymakers in nursing associations.

For this story, Healthcare IT News interviewed one of each and found them all to be seriously devoted to nursing, on the cutting edge of what IT has to offer healthcare as a whole, and fiercely committed to making IT work for better workflow and patient care.

Florence Nightingale: the first CNIO?

The concept of nurses as collectors of patient data is not new. Most people have heard of the famous nurse from the 1800s, Florence Nightingale, also known as “the Lady with the Lamp,” who went tirelessly from bedside to bedside. But not many realize she was a precursor to the modern-day CNIO.

Nightingale (1820-1910), the originator of modern nursing, meticulously collected data on healthcare and used it to improve outcomes. She was the founder of several data analysis tools still used today, according to ANA. That’s why in 2008, the ANA designated Nightingale’s birthday – May 12 – as Nursing Informatics Day, making it part of the annually recognized Nurses Week.

If she were alive today, Nightingale would likely be pleased to find that in 2012, the CNIO position is growing in popularity, but at the same time, she may be dismayed to find the role still faces some barriers after all these years.

CNIO recruitment gaining traction

Linda Hodges, vice president and leader of information technology search practice at executive search firm Witt/Kieffer says more and more organizations are recruiting CNIOs. An increasing number of nurses are setting their sights specifically on attaining a CNIO position, and prominent nursing schools have added courses designed to train them.

“This is something that has become a passion for many people who went into nursing but also love IT,” she says. “They can see how this role can impact care, especially with the evolving new role of accountable care organizations.”

“Nurses can see the need for an executive nurse focused on nursing needs and nursing practice, so that when health IT solutions are crafted for an organization, they will work for the nurses,” Hodges says.

According to Hodges, the title of chief medical information officer (CMIO) was 10 years in the making. It wasn’t readily accepted at first. And so, she expects the CNIO title will also take some time to become accepted.

Academic institutions and large integrated health systems are the main organizations hiring CNIOs today. A CNIO at a large system can expect to make from $200,000 to $250,000 in base pay annually. Nurses pursuing this position need a master’s degree in nursing informatics and in some cases a PhD, Hodges says.

Bridging gaps in a major health system

Mary Beth Mitchell is the CNIO at Texas Health Resources, a large health system based in Dallas. She oversees the nursing adoption, utilization and optimization of the electronic health record. She also serves as the liaison for all information technology-related nursing projects.

Mitchell has worked in nursing informatics for more than 10 years and has been the CNIO at Texas Health Resources for the past year and a half. She says the work she is doing now is an expansion of what she’s done in the past, though now at the executive level.

“I’m the voice of nursing for IT and the voice of IT within nursing,” she says of her role. “I bridge that gap so finally both sides can get their needs met.”

Mitchell explains that she is deeply involved in the “whole process around resources, time, costs, and wants” when it comes to IT for the health system. She is responsible for training and leading nurses who are becoming IT experts at each of the system’s 24 hospitals.

Mitchell says she and the system’s CMIO work closely, but serve two different purposes. Together, they try “to come up with middle ground.” Evidently it’s working, because some of the system’s hospitals were among the first to receive meaningful use Stage 1 incentives. “It’s important to make sure that IT purchases are vetted by someone representing doctors, and someone representing nurses, keeping in mind their different workflows,” Mitchell says.

“CNIOs put a lot of pride and value on being out there on the leading edge,” she says. “At the end of day, we’re driven by the desire to improve patient care.”

Mitchell says there’s no “right way” to fulfill a CNIO role because it’s taking on a lot of different forms.

“Certainly a lot of us are trying to connect and learn from each other,” she adds.

Ferdinand Velasco, MD, vice president and CMIO for Texas Health Resources says hospitals that have yet to create a CNIO position should seriously consider doing so. “The emerging role is a good indication of the significance in the nursing dimension in the healthcare role and IT,” he says. “With the way workflows are being transformed with meaningful use, it’s even more apparent that [CNIOs and CMIOs] have to work together.”

Government CNIO groundbreaker

Murielle S. Beene, CNIO and acting director, Office of Informatics and Analytics, Department of Veterans Affairs, is the first CNIO for the Veterans Health Administration. She’s been a CNIO since 2009 and a nurse since 1996.

Beene says she is glad to see the role is becoming more recognized, but that hasn’t always been the case.

“What concerns me is when someone says we already have too many ‘chiefs,’ and we don’t need CNIOs.”

She fears this is coming from “negative baggage” that sometimes surrounds the nursing profession, she says, “and it’s going to be my life’s work to figure out why.”

She has found that sometimes a nurse could hold the CNIO title, but still not gain entrance to key conversations within an organization. This is a loss, Beene says, because CNIOs can provide unique insight. “Nurses are trained to be systematic thinkers. We’re very inclusive in our care for the patient,” she says. “This is a professional management position that definitely deserves a seat at the table.”

A CNIO helps vendors design nurse-friendly IT

Anyone who thinks healthcare IT vendors don’t need a CNIO haven’t talked to Cheryl Parker, CNIO for Rubbermaid Medical Solutions.

Parker has been a registered nurse for 35 years and became involved in informatics 15 years ago. She’s been in the vendor industry for the past five years – not something she planned, she says. Last summer, Rubbermaid recruited her.

Her role is different than a hospital-based CNIO, she explains, and after doing just about everything that can be done in nursing, she finds she has a knack for what she’s doing now.

“I’m the voice of the nurse within the company. I understand the clinical world,” she says. As such, Mitchell works with research and development and sales to inform them of what nurses need and what they want in workflow.

“I work with connections in the hospital world and help [Rubbermaid’s R&D department] understand how something might work, or might not work, in the real world,” she says.

Parker says she’s “the premier speaker at quarterly sales meetings.” She helps the sales department understand workflow for nurses, barriers nurses face and how best to interact with nurses and help them.

She works with reseller companies, as well. “None of these guys have a clinician’s viewpoint, an understanding of how an IT product impacts us. That part of it is a lot of what I do,” she says.

American Nurses Association at the forefront

Carol J. Bickford, senior policy fellow for the Department of Nursing Practice and Policy at the American Nurses Association, says ANA has been the key leader in moving the nursing informatics role forward.

In 1992, ANA developed the scope and standards of the CNIO position, and has revised it every five years. The position has seen “tremendous changes” in the past few years, she says.

Though the ANA has designated the chief nursing officer (CNO) as the top nursing executive, “it only makes sense that the CNIO is a key partner in that leadership shop,” Bickford says.

“The need for a CNIO at the top is more than a design; it’s advocacy,” Bickford says. “CNIOs advocate for nurses and other supporting staff for a system that supports 24/7 care.”

According to Bickford, the latest ANA survey estimates there were about 8,700 CNIOs in 2008, up from 7,000 in an earlier survey “But, there’s no real way of knowing,” she adds. A lot of nurses have moved into this role in the meantime by being in the right place at the right time, and are called by different names, including director of nursing informatics and senior clinical analyst. Bickford says she is optimistic that the number of CNIOs will mushroom in 2012.