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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- One of the most important functions of the CNIO is to act as a bridge between clinical and IT. “My role is to hear what you need and help translate that back.”
- Norris predicts that in the coming years, automation will play a large role in nursing. “Whether it’s via virtual nursing or robotics, we’re looking at what tasks we can take off the plate of frontline nurses.”
- Collecting data is information, but what’s even more critical is “asking why we’re collecting this information and who is actually utilizing it” can produce tangible results in reducing the burden.
- “My goal has always been to impact patients. In the ICU, I could impact two patients at a time. As an informaticist, I can impact thousands of patients.”
- As organizations delve further into digital transformation, the triad leadership of the CIO, CMIO and CNIO need to be “working in concert to help drive forward.”
Q&A with Brian Norris, CNIO, IU Health, Part 2 [Click here to view Part 1]
Gamble: What’s your relationship with the CNO? How does that work?
Norris: I have a lot of CNO customers. At IU Health, we have a chief nursing executive and two associate chief nursing executives at the system level. Within each of our facilities, we have at least one CNO — some also have associate chief nursing officers — and we also have regional CNOs. Each one of them is a customer.
In my informatics group, we have about 80 informaticists across IU Health that work every day with them, as well as our physician leaders, to help advance our clinical workflow and practice.
Being the first CNIO here, I feel very fortunate to be part of that nursing leadership team. And so, while my role isn’t always as focused as theirs is on staffing or some of the nursing operations, I still get the opportunity to sit and listen to some of the challenges that they face. And then I can go back to the technology side and translate that back to folks that might be able to come up with solutions for those problems. I think it’s imperative no matter what role CNIOs play, that they are hyperconnected, not only with their CNO but their CME and their operational leadership.
Gamble: So there’s somewhat of a bridge effect to what you do.
Norris: For sure. Our CNOs do amazing things every single day. A lot of their focus tends to be more operational. We have a huge scope and span at some of our facilities. As CNIO, I always tell them my role is to help listen and hear what you guys need, and then help translate that back. And vice versa; when there’s initiatives that are happening on the IS side, to be able to translate that ‘why’ back to them. I might say, ‘I know staffing is tight right now, but I need 10 nurses to come help validate this, and here’s why that’s important to you.’ We do have those types of conversations.
Automation and robotics
Gamble: You mentioned the virtual RN initiative — it seems like that could help make an impact with the shortage by trying to automate. Can you talk a bit more about that?
Norris: There are a few things. One is automation; whether that’s via virtual nursing or robotics, we’re looking at what tasks we can take off the plate of the frontline nurse while still delivering good or better outcomes to our patients. There are a lot of them. You’ve got the virtual RN type modalities and then we’re starting to see a lot of potential in robotics as you think about the ability to go fetch something — for example, go get chemotherapy from the pharmacy or go ‘get bed 2 a blanket,’ and start to move some of that support mechanism into nursing.
The second is around the staffing itself. Nursing has had a very traditional model around hours per patient day; budgets are set well in advance, and we measure and monitor to that. Less traditional has been the ability to see the variance and actually be able to predict what skillsets we might need nursing-wise and how best to match that. And so, we’re thinking about and focusing on each one of those areas as we move forward as a system.
Finding a “meaningful impact”
The third is just understanding where your nurses are and measuring, monitoring and understanding burnout and the drivers of burnout — and it’s not always technology. Sometimes it is, but not always. Reducing burden within the EMR is one example. If you can take 5, 10, or 15 precent of that time back from charting and give it back to the frontline, that’s a meaningful impact.
We continue to comb through and try to understand ways we can reduce that burden as we move forward. Because we’re not unique; a lot of systems put in EMRs and now they’re in an optimization phase. I still think there’s a lot of low-hanging fruit in terms of give-backs not only to nursing, but to all of our clinicians, in optimizing some of the things that they do.
Gamble: Is it almost like a chicken and the egg effect where you have to get people off the floor to really get them accustomed to technology and get their input?
Norris: Yeah, there’s a little bit of chicken and egg, but I would say that the systems have evolved where you can look at data and you can start to understand who my outliers might be — who is like charting 3, 4 or 5 times the amount that somebody else is, and then be able to start to understand why. You need ask the questions of why are we collecting this information, who is actually utilizing it and how often is it being accessed. Those types of very basic questions could produce very tangible results for the frontline as you start to reduce some of that burden.
The other thing is learning fatigue. There’s been a lot of literature on learning fatigue for both nursing and providers. If you step into any monitored unit, you’ve got monitors going off, you’ve got mobile phones that clinicians have to answer instead of the front desk line, because they’ve got alerts going to those phones. Sometimes you’ve got alerts going to several different places. And so, we need to be mindful and thoughtful about those workflows. It comes back to centralization; if you can find somebody to monitor that more centrally, you start to take some of the burden off the frontline. I think those are all opportunities that every CNIO or informatics leaders across the country should be asking what they’re doing within their organization to think about these things.
Gamble: It’s telling that you’re using words like ‘mindful’ and trying to understand those pain points. I would think that’s really important for them to really understand that you have the same goals.
Norris: I think what’s really important with any role you take is having humility in the sense of understanding what those frontline nurses and clinicians are going through. It’s having the humility to take the time to understand and then come back with solutions. And you’re not always going to fix everything and not always is everyone going to be happy about a change, because sometimes change in general can be challenging. It’s being thoughtful about that.
Leading with ‘why’
Another thing I think is helpful — and we’ve talked a lot about it as a team — is leading with the why. Why are we making this change? This change is to help reduce your EMR time, or this change is a regulatory change, or we’re not really sure how this is going to end up. This is what we think will happen and here’s our backup plan. Or, we need you to put this piece of information here because it’s going to help us better predict X, Y or Z. Being very clear about the why sometimes helps people understand what exactly it is you’re asking them to do.
“Non-traditional” path to CNIO
Gamble: Looking back at your career, you were previously with Marathon Health but came here about a year and a half ago. What made you want to come to this organization and get back into the provider side?
Norris: That’s a good question. I’ve had a very non-traditional path. My first foray in informatics was with Lutheran Health Network in Fort Wayne, Ind. I was a floor ICU nurse, and when they opened an informatics role, I kind of fell into it. I actually didn’t know what the profession was, but I loved computers and I love the ICU, and I got to do both, which was great.
They were owned by a much larger health system called Triad Hospitals, and I ended up the Director of Informatics for Triad. That’s where I got a taste for big systems. They were a very large IDN and we were trying to do work that was well in advance of the HITECH Act. I learned a ton there.
My goal has always been to impact patients. In the ICU, I could impact two patients and their families at a time. As an informaticist, I can impact thousands and thousands of patients. And so, that’s how I look at the profession. I left that role and spent some time on the consulting side with Deloitte and then I came back full circle into a regional CNIO role, working for Catholic Health Initiatives.
After that, I took a break from IDNs. The value-based care arena was really exploding, and so I spent some time at a company called Aledade in the Medicare ACO space, and then I worked at Marathon Health, which was in the value-based care arena. Part of what led me to take this role here was my hypothesis that you could take somebody with a background in value-based care and entrepreneurial spirit, bring them back full circle into the health system and have them help drive rapid change, creating the CNIO of the future.
That’s what really excited me about this role; there really wasn’t a set path because it’s the first in the organization and there was a desire from the leadership to try and change and do something different.
Gamble: That’s really interesting. It’s like you’re rewriting the script or at least offering another take on what the CNIO can look like because there’s just so many different great opportunities. And when you talk about population health and value-based care and having expertise in those areas, it really shows how this role is evolving.
Norris: I think so, and I think we’ll see more and more of it. I’ve been lucky enough to get to know some of the leaders that helped forge CNIO roles in the industry. They’ve always seen informatics as part of the role, and they were doing population health before it was even called population health. Even if you look all the way back to Florence Nightingale, she was doing data analysis in the middle of a war. And so, I think we’ll continue evolving.
Gamble: It seems to be more typical than not for people to have a non-linear traditional career path, whether it’s the CIO, CMIO or CNIO, and I think it’s only going to benefit the industry.
Norris: I think you’re going to see more diverse backgrounds in all of those roles especially as you’re starting to see organizations like Amazon, Google, and Wal-Mart and the non-traditional health systems of the world coming into the value-based care arena and offering different models. We’ve got to think differently. We’ve got to have a different mindset. In a lot of ways, health systems haven’t always thought that way. I think there’s a huge opportunity.
Now, one role in an organization of this size isn’t going to change that dynamic — it takes a village. But I think the CNIO can be a good thought partner, especially to the CME of an organization. As you’re making these changes and having them navigate these new care models, here are some things that could help benefit that and some technologies that might be able to ease that burden along the way.
“Triad leadership” of the CIO, CMIO & CNIO
Gamble: Looking at the CIO role, how can they work with CNIOs more effectively?
Norris: That’s an interesting question. More and more systems are starting to have CNIO roles. And the reporting lines are all different; sometimes they report to the CNO, sometimes they report to the CIO, sometimes they report somewhere else.
I think the best way to think about it is a partnership. That triad leadership of the CIO, CMIO and CNIO working in concert together to help drive things forward. Each brings a unique perspective, and they should respect that, but at the same time I think what we’re going to continue to see as an evolution of those three partnering together. And I actually think you’re going to start seeing more CNIOs in particular start taking like CDO and CIO-like roles.
We’ve seen that in the CMIO space; now we’re starting to see more physicians in that CIO role. I think we’ll start seeing some more of that on the nursing side as well.
Gamble: And then you have digital, which is a whole other animal.
Norris: Yes. If you think about it, health systems have made multi-million and sometimes multi-billion dollar investments in EMRs. And now, consumers want Uber. They want it fast. They want it now. They want it where they are. They want to be able to access their records in different ways. They want their providers to have that information. They don’t want to wait 3 weeks for an appointment. They want to get instant access and get their problems solved. And so, the CIOs of the future are going to have to deliver that point. It’s not just about how do I keep the infrastructure moving or how do I keep the EMR going. There’s a lot around security and privacy, certainly, but by and large, it’s going to be about how do I create this consumer experience that’s digitally driven in a lot of ways to help support the expectations of an evolving consumer base.
My kids are 13, 8 and 5 — they don’t know a world without some form of digital capability. They expect a different experience and I imagine that when they become constant and hardcore healthcare consumers, if I told them they couldn’t get an appointment for a month or that they had to print off their paper record, they probably wouldn’t be consumers of that organization anymore.
We have to think about what’s this next generation is going to want; what they’re going to need. And the technologies they’re growing up with that don’t have anything to do with healthcare are bleeding into their expectations of their healthcare.
Gamble: Absolutely. I have twins who are 10, and when we went through everything with COVID, getting used to doing things online was a snap for them.
Norris: Yes. My kids go online and they play Roblox and videogames, they interact socially — they have a very different expectation.
If we think about who we’re building for, not only now but in the future, that’s the consumer market we’re going to have. We thought the age 65 and up crowd wasn’t digitally savvy, and as it turns out, they’re some of the biggest users of technology because they’ve had to learn how to use it to stay connected with their families during the pandemic.
Consumers expect the ability to virtualize care when they need it. They’re going to choose people who will provide that care. We spend a lot of time thinking about it. I don’t think any organization in the world has fully solved it, but there’s a lot of opportunity.