Role of the CNIO in Nursing Optimization of the Electronic Medical Record (EMR) Mary Beth Mitchell, MSN, RN, BC CNIO, Texas Health Resources

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1 Role of the CNIO in Nursing Optimization of the Electronic Medical Record (EMR) Mary Beth Mitchell, MSN, RN, BC CNIO, Texas Health Resources 1

2 Conflict of Interest Disclosure Mary Beth Mitchell, MSN, RN, BC Has no real or apparent conflicts of interest to report. 2

3 Objectives Learning Objective 1 Describe how the CNIO role can support key HIT state and federal initiatives. Learning Objective 2 Discuss the importance of the Nursing Informatics leadership role in educating and informing nursing and healthcare leaders in use of EHRs and other technologies. Learning Objective 3 Identify ways in which Nursing Informatics leaders contribute to adoption and optimization of the EHR and other technologies. Learning Objective 4 Recognize challenges of the CNIO role in supporting both IT and Nursing initiatives. Learning Objective 5 Explain role of the CNIO in promoting professional development of Nursing Informatics 3

4 Overview of NI 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. This support is accomplished through the use of information structures, information processes, and information technology Nursing Informatics: Scope and Standards of Practice, ANA

5 Background of Nursing Informatics NI has been an emerging discipline since the 1960 s, but has become more and more prominent since the 1990 s. Recognized as nursing specialty by ANA in 1992 NI Certification since the RN s certified in NI by end of % increase in NI Certification from 2009 to over 3000 Informatics Nurses participate in HIMSS or other NI activities Increase in formal education in Nursing Informatics At least 75% of Nursing Informaticists are developing or implementing clinical systems, often within IT (Information Technology) More roles defined for Nursing Informatics HIMSS Leadership Survey in 2011 indicated CNIO role in 8% of organizations 2008 Nurse Leader Survey 2011 HIMSS Workforce Survey 5

6 CNIO Role CNIO Role is a relatively new, emerging role within organizations. Bridges Nursing and Information Technology together. The CNIO is a Nurse Leader with variety of key responsibilities Strategic direction of nursing s use of technology Operational oversight of clinical application implementations Relationship building between key leaders and departmentsi.e.: Nursing, IT, Medicine, Quality Professional Development of Nursing Informatics Swindle & Bradley,

7 CNIO Responsibilities EHR Implementation and adoption Regulatory requirements compliance Infrastructure/Integration Managing the Corporate Vision Emerging Technologies Analytics- Answering the question. Professional Development of staff in Nursing Informatics 7

8 Benefits of the CNIO Role The role of the CNIO is both strategic and operational in developing programs to impact the adoption of the EMR Translator of the technology and understanding of risks and benefits Understanding of organization and factors impacting nursing Understanding of regulatory requirements especially around HITECH Act and Meaningful Use CNO does not have to worry about technology impact on nursing Professional development of Nursing Informatics Swindle & Bradley

9 What Others are Saying Nationwide, CIOs are in consensus: the success of large IT implementations will depend not only on the willingness of floor nurses to accept new technology, but also on the strength of the IS-nursing executive management connection. CIOs across the country are finding that getting top nursing executives to take ownership of clinical information systems initiatives is no longer a luxury, but a necessity. Virtually every hospital or health system that is succeeding with its clinical IS rollouts has hired or internally promoted a chief clinical informatics officer of some sort The clinical informaticist executive job is becoming one of the hottest positions in the industry, and executive recruiters are having a hard time keeping up with the demand. CNIO role, because it encompasses implementation, optimization, training, change management. Nurse Leader

10 Chief Nursing Officer Key Relationships Chief Information Officer Chief Medical Informatics Officer All 3 reporting lines are optimal For CNIO effectiveness. 10

11 Why is This Role So Critical Now? EMR/EHR Mobile Technologies Connected Health Growth of Nursing Informatics in professional practice 11

12 Implementation Adoption Optimization Value Creation & Transformation 12

13 HIMSS EMR Adoption Model 13

14 THR s Experience Background of CNIO Role Hospital specific Nursing Informatics at some hospitals since 2000 Need identified during EHR implementation for a more centralized, cohesive focus between nursing and ITS. ITS Leadership recognized need for clinicians within IT. EHR optimization a key driver- problematic workflows, non-compliance, perceived lack of support by nursing. 14

15 Implementation Adoption/Usability Optimization Regulatory Compliance Clinical Decision Support Nurse-Physician Relationship Training Policy and Procedure Management CNIO Role in EHR 15

16 2011 Usability Survey- 5 point Likert Scale 705 RN s 98% >1 year with THR Item Agree Neutral Disagree Ability to document completely to meet all required documentation 77% 11% 12% I feel there is adequate communication about changes 77% 11% 12% I can navigate through the EHR easily 76% 12% 12% Provides, detailed, easily accessible patient information 76% 10% 14% I am satisfied with support to help with problems 75% 14% 11% Complete picture of my patients condition 68% 11% 18% Overall, I am pleased with the EHR 60% 15% 23% Helped me be more efficient and effective in my work 58% 13% 27% I feel patient care improved 39% 31% 29% 16

17 Nurse Champions Purpose to optimize the EHR to meet the needs of nursing throughout our health system Staff Nurse representatives from all hospitals, and all nursing areas. Chaired by Nursing Super-User and RN Builder/Analyst Meet 1-day per month to make decisions about changes to the EHR. Supported by CNO s, and funded within each hospital. Totally driven by RN s Recommendations were processed through the IT Change Management process 17

18 Nurse Champions Reworked Admission History- 286 rows to 130 rows Blood Administration Navigator Assessment Flowsheets Patient Hand-Off Report ifreq- Rounding Flowsheet Discharge Instructions Patient Summary Reports Standardization of Patient View Dashboard Group worked totally by consensus Changes approved by CNOs 18

19 CNIO Role For Training and Support Superusers Nursing Informatacists Customer Engagement Clinical Staff ITS Directors Training Development Hospital Trainers Work with Hospital and IT Staff to support clinicians with EHR use Manage various stakeholders with diverse training, competencies, and reporting structures Bring cohesion and consistency Participate in decisions for change management 19

20 CNIO Role in Management of Regulatory Requirements Involvement with committees and decisionmaking groups: Core Measures Steering Committee Clinical Decision Support Meaningful Use Committee HIMSS Stage 7 Oversight Ensure Nursing requirements are met within the context of managing workflows of clinician. Ensure Policies and Procedures reflect workflows and documentation. 20

21 Documentation and Alerts to Support Core Measures 21

22 CNIO Role In Meaningful Use (MU) Compliance Monitoring Work with CNO s, SuperUsers, Physicians and Quality to monitor and optimize workflows Discharge Instructions CPOE and Verbal/Telephone Orders Monitor user of paper Bar-Code Medication and Blood Administration MU Dashboard 22

23 Compliance Reports 23

24 Meaningful Use Reports 24

25 Challenges What are the challenges facing the CNIO? Diverse and disparate projects Integration Infrastructure and Devices Strategic Direction Competing Initiatives Keeping Up! Innovator Innovator 25

26 2011 Projects Bar-code medication administration OB System Implementation Radiology System implementation Summer 09 Upgrade to EHR Medical Device Integration (1 hospital) Staffing Acuity System Data Sharing between Dallas-Fort Worth Hospitals (Vendor Specific) Bed Tracking Nurse Call 2012 Projects HIE Mobile device penetration Connected Health Initiative- ACO Patient Portal Device Integration- Smart Pumps, NIBP, Ventilators, Cardiac Monitors, etc. Bar-Code Blood Administration RTLS- (Real-Time Locator Systems) Scheduling and OR systems implementation 26

27 Nursing Challenges affected by Technology Greater reporting requirements Patients expectations on use of technology Patients with more sophisticated medical devices Technology evolving- becoming more mobile and more connected Constant need for training and adoption may be slow Significant resources needed to implement, maintain and optimize Increase in coordination of care Changing roles to accommodate changing landscape 27

28 Nursing Informatics Council Reviews technology strategies within the organization Makes recommendations for technology use affecting nursing Recommends optimization, support, and training opportunities Reports to CNO Council Representatives from every hospital, various disciplines- Physicians, Quality, Training, IT Includes Professional Development activities related to Nursing Informatics 28

29 Role of the CNIO in Promoting Professional Development of Nursing Informatics Nursing Informaticists Nurses working in Informatics roles across the organization- IT, Hospital- Based, Training, Support. Large group of nurses interested in pursuing NI as a career choice Many nurses involved in formal NI graduate programs. Created the Nursing Informatics Network (NIN) 29

30 Professional Development Opportunities Work with front-line staff to increase awareness of professional practice Identify and commit front line staff with NI skills Advance new roles for Nursing Informatics Support of education and training for staff to learn and maintain skills and knowledge with technology. Mentor Nurse Leaders in their responsibilities for advancing technology Represent Nursing voice both within the organization and globally, through involvement in local, state and national committees. 30

31 Statewide Nursing Approach to HIT HIT Task Force- co-sponsored with TNA and TONE Creation of educational content and dissemination Campaign to Raise Awareness HIT CNE for practicing nurses Nursing HIT curriculum development Constituent involvement [incl. TIGER] Benchmarking Reports Towards Progress Formation of Advisory Structure State TIGER Initiative Work within framework of TIGER for education and development of Nurses and their use of Technology Defined competencies 31

32 I would love to hear from you! Mary Beth Mitchell, MSN, RN, BC Chief Nursing Informatics Officer Innovative Technology Solutions 32

33 References Boone, E., (2010, March). EMR usability: Bridging the Gap Between Nurse and Computer. Nursing Management Hagland, Mark (2008, November) Nursing First - Smart CIOs are partnering with nurse executives for IT implementation success. Healthcare Informatics November;25(11):48-53 HIMSS Adoption Model- HIMSS Jha, A. K., et al. (2009, April 16). Use of Electronic Health Records in U.S. Hospitals. New England Journal of Medicine. 360(16) Moody, L., et al., (2004). Electronic Health Records Documentation in Nursing: Nurses Perceptions, Attitudes, and Preferences. Computers, Informatics, Nursing. 22(6), Ribitzky, R., Sterling, M.A., Bradley, V. (2010, March). EHR Usability Pain Points Survey Q HIMSS EHR Usability Taskforce User Pain Points Workgroup. HIMSS Annual Conference Swindle, C., and Bradley, V. (2010, June 20). The Newest O in the C-Suite- CNIO. Nurse Leader,

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