Like many leadership positions in healthcare, the role of the CNIO is constantly evolving. Whereas in the past, the conversations revolved primarily around workflow, now it’s about being a “thought leader” — someone who can help influence decisions as organization delve further into digital transformation.
And while this certainly requires a deeper skillset than in the past, one criterion has remained the same: the ability to listen. As leaders are learning, moving the needle forward with value-based care and creating a better experience for both patients and providers can’t happen without building buy-in. And that, according to Brian Norris, means taking the time to truly understand pain points and explain why metrics are being collected — and how they will be used. “There’s a lot of low-hanging fruit in terms of optimization.”
During a recent interview, Norris talked about how his team is leveraging data to help improve ease of use and reduce burnout; the challenges leaders face in meeting the changing needs of consumers; the non-traditional path that led him to the CNIO role; and his bold prediction for the future.
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- As health systems reach the “pivotal moment” of how to effectively utilize the data that’s been collected, informatics leaders have an opportunity to “become a thought partner” and help influence decision-making.
- It’s not enough just to focus on workflows; nursing leaders need to be thinking (and talking) about how to leverage analytics to reduce length of stay, and the role informatics can play in redesigning care models.
- Something as simple as leveraging virtual nursing to automate the admissions process can have a big impact, said Norris. Changing the modality “just a little bit” has created a ripple effect” across the system.
- When the pandemic hit, IU Health was already equipped to offer virtual visits. “We didn’t have to go out and buy any new technology; we just needed to change the process a little bit and then measure it.”
- Norris’ prediction for 20 years from now: “I bet we’ll see a lot of informatics and clinical professionals who are much more data savvy than they are today, helping move the needle along in those arenas.”
Q&A with Brian Norris, CNIO, IU Health, Part 1
Gamble: Hi Brian, thank you for taking some time to speak with us. Can you start by giving a high-level overview of Indiana University Health?
Norris: Sure. IU Health is Indiana’s largest health system. We have about 17 hospitals that serve tens of thousands of patients across northern, southern, and central Indiana. We’re a vertically integrated organization. We have a health plan, acute care facilities, home health, and hospital-at-home programs. We’re home to Riley Children’s Hospital as well as IU School of Medicine.
We’re constantly growing; we have a lot of specialties and a lot of growth.
Gamble: One thing I’m learning from doing some research into the CNIO role is that it can differ quite a bit depending on the size and scope of the organization.
Norris: For sure. I’ve been in informatics for a long time. This is my second CNIO role and my third CNIO-like role. I had an entrepreneurial stint in the middle. And so, I know that each one is a little bit different.
The role has evolved over time. In many ways, nursing informatics — if you go back 20 years or so — is synonymous with electronic medical records. As you go through the HITECH Act and the infuse of capital to beef up EMRs across the country, you start to see the informatics profession evolve and emerge.
“What do we do with it?”
Now, we’re in this pivotal moment of we’ve done a good job; we have lots of data. The big question is, what do we do with it? We’re starting to see CNIOs — and even CMIOs or any informatics leadership roles — evolve past electronic medical records and workflow and really becoming a thought partner to clinical and operations in digital transformation activities, both front and backdoor, and patient experience activities. And more importantly in the post-Covid era where there really aren’t any more troops coming for a while on the healthcare side, it’s thinking about what can we digitize? What can we start to move in different ways in a care-model redesign?
Building “the healthcare of the future”
The role is evolving; but it also depends on the system. For me at IU Health, it’s exciting. I’m the first one in this seat. They’ve never had a CNIO before. In terms of the structure, my role sits between IS and nursing leadership, and then I have dyad partnerships with two CMIOs who have similar reporting structures. Together, we cover the gamut of clinical operations and informatics.
We’re embarking on some robust plans to build the healthcare of the future. And so, we split the roles between what I call ‘keeping the lights on, keeping the EMRs running, and keeping data coming in,’ and the other, which is focused on what do we do with that — how do we begin to move the needle forward?
Changing the discussion
I’d love to see the profession continue to evolve. I was involved with the ANIA (American Nursing Informatics Association) board when they merged with CARING to form the biggest nursing informatics professional group. There was a lot of discussion around how do we drive the best workflows and how do we do med admin barcode scanning. I think if we look to today and tomorrow, the discussion should be around how do you use predictive analytics to drive down length of stay? What are you doing to keep patients out of acute care arenas and in their homes? How does your team play in value-based care? How are you helping move that needle forward? What does it look like in terms of care model redesign and how your informatics team is playing in that? I think we’re starting to see early indications of those shifts in the profession.
Gamble: What’s the EHR environment at Indiana University Health? What do you have in place?
Norris: We have Cerner in both our ambulatory and acute care environments, and we have IDX for revenue cycle. Like many other systems, we have a host of other third-party apps that function in the secure messaging or patient messaging space. We use Salesforce for our CRM. And so, a lot of the discussion is in how do you begin to tie all of that together in this next-generation patient experience?
The pandemic taught us a lot. One of the things the pandemic highlighted is the need for ease of use for patients. I started at IU Health in the middle of Covid. Prior to that, I was SVP of Population Health at a company called Marathon Health, which is in the primary care space. When the pandemic hit, every organization, whether you’re IU Health, a primary care clinic, or a specialty clinic, had to pivot almost overnight to create easier access to care because of the unknowns.
It also created this laser focus within organizations and translated into a singular mission of bringing all these camps together. That’s where we’re headed, and I think it’s where we need to go. It’s interesting because a lot of organizations asked, how do I deliver virtual care? How do I get reimbursed for virtual care, and what is that going to look like? They were delivering maybe 5, 10, or 15 percent of total ambulatory visits virtually, and then overnight, the equation flipped to where it was 5, 10, or 15 percent in person.
Now, we’re in this area of stabilization now where you’re seeing those percentages start to normalize. There’s more virtual care than there was pre-pandemic, but not as much virtual care as there was during the pandemic. And so, there’s a big push to think through what is the right balance? What’s the right mix? How do I make sure the right modalities are available to the right care sets, and make sure we’re not taking our eyes off outcomes as well?
IU Health’s core objectives
Gamble: So in terms of moving the needle forward and where to go from here, what are some of your core objectives right now?
Norris: There are a few. One is our long-range plan at IU Health, which isn’t specific to nursing informatics — it’s a set of initiatives that will help advance our total digital footprint in the next 5 to 10 years; not just to support what we need today, but to support the digital hospital of the future and our ability to provide value-based care better than we do today. That’s one.
The second, which is more centric to nursing and nursing informatics, is around care model redesign. We’re thinking differently about how we deliver care and what those teams look like.
I’ll give you an example. We’re in the process of rolling out across our entire ecosystem a virtual RN that’s doing the admission work. At IU Health, the admission process usually takes around 20-30 minutes. We want to get to know you, but it doesn’t always happen in a timely fashion, especially if nursing is under-staffed.
“Virtual nursing pod”
And so, it’s thinking differently about productivity and how work happens. It’s easier to do admissions when you have a virtualized nurse serving multiple hospitals. With that in mind, we launched a pilot program. Over the course of about 9 days, we were able to get some advantageous data and bring it back to our nursing leadership team. Now, we’re rolling it out across the whole organization.
It’s a virtual nurse pod, if you will, doing admissions across our system. Our target is doing about half of our admissions that way — which, the data tell us, is not only good for the nurse, but also ensures that his or her other patients receive care. And so, that one interaction, just by changing the modality a little bit, creates a ripple effect across a whole bunch of patients and clinicians.
That’s another example.
Thirdly, as we think about the use of advanced data in analytics and robotics, we have a whole bunch of initiatives going on in that space to get better data to our clinicians and/or improve our processes.
Gamble: With something like the virtual RN, can you talk about what had to be in place to roll that out?
Norris: It’s interesting. Because of the pandemic, we — like many organizations — already had the technology. We had the ability to deliver a virtual visit between a provider and a patient. We just needed to flip who was involved. We didn’t have to go out and buy any new technology; we just needed to change the process a little bit and then measure it.
It made it easier for us to pilot something, do it rapidly, learn whether it’s going to work, and then start to expand that out. Like many organizations, we already had virtual technology in place; we just leveraged it for a different process, and it worked.
Gamble: Anytime you don’t have to make a big purchase, that helps.
Norris: Right. The last thing is that we’re working with Google; we’re one of a few organizations leveraging their healthcare data engine. We’ve rolled out a few initiatives around social determinants of health, and we’re working on some nurse demand models to help with burnout. I’ve been very fortunate to be able to lead that here at IU Health, along with several others on our IAS team. I see CNIOs fitting into those roles more in the future as well and bridging those gaps. If you think of it from a product development perspective, they understand the product requirements that are needed, and they know how to connect all the dots.
Gamble: You mentioned predictive analytics. What are some of your thoughts on how that can be used effectively?
Norris: No single nurse or nurse administrator could churn through all the information to make the types of decisions they have to make all day. If we stepped out of healthcare and into manufacturing 20 years ago, it’s the same problem. They were trying to automate factory lines and get data on things that were happening to improve processes and move their products forward, increasing the reliability and quality of their products while getting more proficient at delivering.
It’s the same thing with care delivery. We want to make sure the patient has a good outcome and a phenomenal experience, but we want to do it in the most proficient way with our clinicians practicing at the top of their licenses.
The two problems, in my mind, may seem synonymous, but they’re also very different. One is a widget and the other is health; but they’re close in nature. For manufacturing, it was better use of data, better predictive analytics, and better ability to connect data back to the process. We’ve gone through a decade of collecting information in healthcare — now it’s the time to figure out how to best leverage that information to drive insight and drive change.
Gamble: If you look back 5 or 10 years, it would be strange to imagine CNIOs having these types of conversations. Now it seems there’s more willingness among a lot of CNIOs and those in similar roles to have conversations about new care models. What are you finding?
Norris: I would say it’s probably mixed within the profession. The CNIO role is so broad. It’s kind of like the CIO; they’re responsible for so much that you do have specialization within it. I would say there’s probably one camp that says, ‘Hey, we really should still be very much focused on practice and workflow.’ And there’s another that says, ‘We have a huge opportunity to drive this.’ The challenge is that the skillsets are different.
For example, my master’s is in business, and I have experience in machine learning, artificial intelligence, and analytics, and I think that we’ll want more CNIOs in that camp. I don’t think everyone has to be because it’s good to have a variety, depending on what the system wants. But I think if we look 20 years down the road, I bet we’ll see a lot of informatics and clinical professionals who are much more data savvy than they are today, helping move the needle along in those arenas and leveraging data to get the job done. Not that it hasn’t happened in the past, but I don’t think it’s been the primary focus.
Gamble: I would also think that the whole idea of going electronic was so all-consuming that it’s probably tough to get out of that mode.
Norris: Yes. And each person walks their own path. Some who move into these roles have had formalized training and have walked the traditional path. Some have fallen into the informatics role. Some came from CS backgrounds and then got nursing degrees and got into the role that way.
I do think the CNIO role has evolved. I do feel like the role itself is being seen more and more as a thought leader and a partner within the organization. I think we’ll see more CNIOs move into CIO and CDO-like roles as healthcare evolves because those two roles are more and more on the hook for the patient experience in the digital transformation. Having a clinical background mixed with that technical background puts not only the CNIO, but the CMIO role as well, in a prime seat for that evolution.