Q&A With Chris Wierz, Principle and Co-Leader of IT Practice, Witt/Kieffer
It’s one of the oldest known professions, and yet, the role of the nurse never seems to stop evolving. As technology plays an increasingly larger role in how care is delivered, the need has emerged for a leader that can bridge the interests of nursing and technology.
Enter the Chief Nursing Informatics Officer (CNIO), a role that was first designated in 1992, but is now starting to get its due — as well as a seat at the table alongside CMIOs and CIOs. According to a Witt/Kieffer report, the CNIO plays a dual role in improving outcomes by combining “traditional frontline care duties with innovative evidence-based processes and practices that are applicable to nurses and, by extension, all caregivers.”
And now, the industry finally seems to be taking notice. The report found a significant hike in respondents who hold the CNIO role (14 percent in 2014, compared with 4 percent in 2011), which Chris Wierz believes is encouraging. “I think it’s very important that nursing has a strong voice in the IT space,” said Wierz, now Principal and Co-Leader of IT Practice at Witt/Kieffer.
But the news wasn’t all great; many either don’t understand, or simply underestimate the value these leaders bring. It’s a cause Wierz is happy to take up, having served as a “computer nurse” before the CNIO term was born. In this interview, she discusses the findings of the study, why reporting relationships are so critical, how the field of nursing has evolved, and what she hopes to see happen in the future.
Gamble: I’d like to talk about the study Witt/Kieffer released last year — CNIO 2.0: What’s Next for Nursing IT Leaders. But first, to provide some background, how would you characterize the CNIO role as it stands now?
Wierz: Today, it’s an integral part of IT as it relates to nursing, but it’s also expanded into other ancillary departments like pharmacy and radiology. The primary focus of the CNIO is to help the frontline workers adapt to technology and improve workflow and efficiency. It has evolved into an important role, especially in larger organizations, as the voice of the clinical staff (excluding physicians).
Gamble: And there’s a large focus on helping to increase adoption and engagement among nurses?
Wierz: Exactly. A lot of health systems have implemented EHRs, and so much of the CNIO’s role now is around optimization. They’re getting more into the financial world as well in terms of supporting the documentation that then in turn generates a charge; that concept is really important in educating nursing staff. We’re also finding that CNIOs are getting more into legal risk assessments because they know the system so well; they’re someone the organization will turn to if there are issues with a patient and they need to do some digging in terms of the record. That has really become a big component of the CNIO role for some organizations.
Gamble: The study that was released in the fall was the second that Witt/Kieffer has done on this topic, with the first coming out in 2011. What made you want to revisit it?
Wierz: It’s interesting; I ran the 2011 study as well as the recent one. Five years had passed, and so we wanted to see what was happening in this space. And I have a personal connection to this because I’m a nurse and also was in a role like this, only with a much different title. I was a ‘computer nurse,’ and so I like say, ‘We’ve come a long way, baby.’
Gamble: For sure. One area in particular that sounds out was the significant jump in the number of CNIOs in the industry.
Wierz: We were pleasantly surprised, first, by the number of organizations that were aware of the role or were thinking about the role, and second, by the number of organizations that had actually made the decision and had gone out and recruited. We were pleased about that. It was also important to understand what types of organizations were looking at this. Not surprisingly, it’s the larger integrated delivery networks that are leading the way as far as bringing in CNIOs.
Another thing we found is that there’s still some clarity needed around titles. There are organizations that have the role, but call it a Director of Clinical Informatics. We need clarity around that, and that need is only going to increase as time goes on and as technology becomes so pervasive in all parts of clinical care.
Gamble: What do you think are the key factors in the number of CNIOs spiking so significantly in just five years?
Wierz: Technology has become so ubiquitous in healthcare that you can’t define a strategy without there being a technology component associated with it. Take that, and combine in with the fact that nurses make up the highest payroll in any organization because of the sheer numbers, and it makes complete sense that the role has come more prevalent.
And you also have to look at it from the lens of the chief nursing executive (CNE) or chief nursing operator. With a CNIO, the CNE has someone whose sole purpose is to think about technology for the clinical staff. This is critical, because the CNE has so many other things on his or her plate. It’ll be interesting to see how that changes in the next five years.
Gamble: What did you find in terms of reporting structure? I imagine that plays a key role in determining what CNIOs are able to bring to the table.
Wierz: Absolutely. We presented this study to the American Nursing Informatics Association last year in San Francisco, and there was a lot of discussion around that. Some CNIOs report to the chief medical information officer (CMIO), some report to the CIO, and there are quite a few dotted lines.
We found that more and more, the role reports to the CNE, which we’re very excited about. If you’re a CNIO, it’s critical that you have a connection with your CNE. As the role evolves, I think it will become an even more matrixed relationship, because this person is focused on IT and on supporting the nursing staff. Because of that, I think that dotted line is going to stay.
Gamble: And you saw quite a bit of variety across the industry with this?
Wierz: Yes. If you look at the CMIO role, it’s much more established. People ask if we see it becoming as prevalent as the CMIO role, and I’m not sure I see that, simply because of how long it has taken to increase the number of CNIOs. But at the same time, I’m a big proponent of this role, because I think it’s very important that nursing has a very strong voice in the IT space.
Gamble: What do you think are the most important qualities that organizations should look for in a CNIO?
Wierz: Some will say a technology background is key, but I think having emotional intelligence and being able to collaborate and build consensus are so important. I believe you can teach technology, but you can’t teach political astuteness. And that’s so important, because you’re bringing disparate people together to make a decision, especially in large integrated delivery networks where people have never spoken to each other and you have to make some decisions. It’s very much a facilitation role as well, where they have to represent their constituents, but at the same time, come to a consensus. That piece is extremely essential.
Gamble: I would think that’s not an easy balance to strike, especially when you’re talking about something as complex as workflow.
Wierz: Exactly. I can tell you from personal experience that nurses get passionate about some of these decisions, and it’s a matter of how you manage that;, how you use your capabilities, your knowledge, and your maturity to be able to make some of these decisions and know which hills to die on.