Why the CNIO Is Critical: From Tactician to Strategist to Superhero

During the pandemic years, while forced to socially distance ourselves from one another, we became significantly more dependent on technology. The healthcare industry has followed this trend with an increased reliance on digital tools such as video appointments with physicians and home-based electronic monitors to care for patients. Even though these tools have been beneficial, they also come with consequences that the industry is grappling with, including an increase in documentation, untenably cluttered inboxes and an overabundance of alerts, data and devices.

While these challenges impact the entire healthcare industry, nurses are particularly at risk. A recent study from KLAS Research showed that, compared to other clinical backgrounds, nurses are the most likely to leave the profession in the next year. In the 2023 State of Nursing report from Nurse.org, 91% of nurses believe the nursing shortage is getting worse and that burnout, poor working conditions and inadequate pay are the primary causes. In the Fall of 2022, 15,000 nurses went on strike in Minnesota, making the largest strike ever of private sector nurses in the U.S.

Technology is seen as a solution but can also be responsible for exacerbating existing problems and therefore decreasing quality, safety and overall employee engagement. One nursing informatics leader we spoke with recently said her organization's IT systems were so poorly designed that it was causing "cognitive dissonance" for their nursing teams. A 2022 study in Critical Care Nurse showed that full-time intensive care nurses spent 17.5% of their shifts on electronic medical records.

Healthcare leaders are continuing to take notice of this need for a leader who can bridge IT and nursing and materially alleviate the burden on nurses. In the past several years, we have seen an increase in recruitments for nursing informatics leadership positions. We have recently worked on three inaugural Chief Nursing Informatics Officer (CNIO) searches at leading academic medical centers. We're finding that organizations are continuing to elevate and expand the role of their nursing informatics leader or are bringing in an inaugural leader to fill this critical role. CNIOs can be instrumental change agents in addressing the myriad of challenges nurses and other clinicians face.

Tracking the CNIO's Evolution to Superhero

While the CNIO role began as a critical leader in implementing electronic health records, it has since evolved to be more focused on strategy, optimization and transformation. Sean Michaels, CNIO at Health First, explains, "The role was created to meet a specific need; that specific need was to give an executive nursing presence in implementing an EMR. It has grown organically beyond that specific need. Over the years, leaders understood having the clinical perspective in digital transformation is not only a necessity but a fundamental requirement."

Several years ago, our team wrote about how the CNIO role had evolved from "tactician to strategist". One might say that, as responsibilities have continued to multiply, the CNIO has taken on the persona of a healthcare IT superhero.

While areas of responsibilities differ from organization to organization, we have seen the following changes emerge:

Ongoing Optimization of Workflows: Improving efficiency is a strategic objective for nearly all healthcare organizations these days. CNIOs are leading efforts around strategies to decrease the time spent in an EMR without sacrificing quality, safety or necessary documentation. Nurses' documentation is dependent on dropdowns, checkboxes and data entry. While each answer might be brief, the amount of documentation needed continuously expands.

In 2022, UCHealth shared that optimization efforts within their EHR saved 64,800 hours annually for their nursing staff and reduced 360 million clicks a year. This is the kind of work that CNIOs can spearhead.

External Focus and Partnerships: The sphere of responsibilities for the position is continuing to expand and diversify. Organizations are looking for their CNIOs to be the oracles in identifying new trends and technologies that will improve existing practices. One recent job description includes the following responsibility: "Identifying and engaging in healthcare industry partnerships enabling innovation, research and access to emerging technology while advancing the overall reputation of the informatics program."

The role is no longer confined to the patient room and IT department– it has an external focus to identify solutions that will give hospital systems a leading edge in improving clinical outcomes and retaining their workforce. In some organizations, the CNIO is driving the patient room of the future and reimagining the future of care delivery.

Expanded Technology Stack: CIOs and CNOs we and our colleagues have spoken with indicate the need to have a leader at the table that understands not only the EMR but all the other applications that clinicians use. Smart pumps, wearables, ambient listening devices, tablets and smart phones are now part of clinicians' toolkits. The technology stack of applications and infrastructure that CNIOs are managing has expanded significantly. As a result, the focus has also expanded to include technology solutions outside of the EMR.

Because of this increase, some CNIOs have had to develop enterprise architect-like skills in order to develop a technology ecosystem that is tenable and leads to positive improvements in quality, safety and efficiency. Telehealth and virtual nursing have also increased, leading to an entirely new way of delivering care with new applications and devices needed.

Dr. Anita Harris-Brown, an informatics leader most recently at Texas Children's Hospital, shares that her organization set up a simulation lab to test out the functionality of various applications and to observe the interoperability between various devices and applications. These observations have been instrumental in designing workflows that leads to better care for patients.

Building a Network of Bridges: We often hear informatics leaders describe themselves as bridges or translators. Gretchen Brown, CNIO at Stanford Healthcare, describes the role as being "a grand connector." Earlier in the CNIO's existence, this primarily happened between IT and clinicians. This remains an enormously important gap to minimize. Still, in many healthcare organizations and systems, the CNIO is being asked to extend their change management superpowers to unite other disparate groups.

In a recent CNIO search, one of the hiring organization's strategic priorities was to unify care between ambulatory and inpatient; in another the nursing informatics lead is responsible for developing care standards across a system that includes both academic medical centers and community-based hospitals. Often new technology systems are a catalyst to bring in greater levels of standardization and consistency to an organization's practices. The CNIO is often the point person in leading these change efforts.

Sending a Message

We all can agree that nurses are essential in the health system ecosystem. We can also all agree that informatics and technology have become critical in improving healthcare. Health systems need a nursing informatics leader to develop strategy, lead consensus and facilitate integration. Hiring a CNIO sends an important message – that an organization values nurses' voices in the process. (Not having a CNIO can send the opposite message: One executive confided to us that her nurses were shocked and saddened when their CNIO role was terminated.)

The CNIO is a consensus-builder and integrator in ensuring a forward thinking and integrated relationship between nurses and technology. This role brings an invaluable perspective and fills an indispensable function of identifying solutions and leading change based on patient care and clinicians' feedback and concerns.

About the Authors

Wendy Kerschner is a senior associate in WittKieffer's Information Technology Practice. Hillary Ross, J.D. is managing partner and leader of the Practice.