Diane Trimble, MSN, RN-BC Saint Luke’s Health System

Describe the role of the CNIO Discuss strategies utilized by the CNIO to involve key leaders and endusers in the implementation and optimization of the EMR Identify necessary structures and processes to influence change across the enterprise Describe challenges of the CNIO role in supporting clinical informatics initiatives

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Increasing demands in healthcare, consumer expectations and technology Nursing large consumer of technology Increasing need to ensure clinical integration across all disciplines and departments Nursing needed voice at the table

Conducted to assess trends in nursing informatics 576 individuals responded – 64% percent from a hospital setting and half of those respondents from a hospital with 500 beds or more -61% reported they have an “informatics leader” -48% reported they have CMIO -20% reported they have a CNIO HIMSS, 2015 Impact of the Informatics Nurse Survey

2016 Witt/Kieffer Survey Conducted to assess trends in the marketplace 100 individuals responded - 54% from large integrated/academic medical centers Respondents included CNIOs, CNOs, CIOs, CMIOs and other senior leaders - 51% reported they have a CNIO in place compared to 28% in % of organizations plan to hire a CNIO in next year compared to 17% in % of the CNIOs report to CNOs compared to 28% in 2011 Witt/Kieffer, 2016 Emerging Role of the CNIO Survey

Provides strategic direction and vision Implementation and optimization of the EMR Ensures systems designed to meet requirements, optimize outcomes and ensure patient safety “the heart of the CNIO role involves serving as a liaison between informatics and clinical departments and advocating for system change” The Advisory Board Company, Global ehealth Executive Council (2014). The Emerging Role of the CNIO.

Understanding of nursing informatics and IT technology Ability to collaborate and build effective teams Effective communication Problem solving and process management Ability to facilitate change

Collaboration between nursing and IT Optimization of patient safety Advocate for effective and efficient nursing workflows Adoption and usability Oversight of regulatory compliance and adherence to policy Nursing scope of practice Standardization of nursing practice Clinical Decision Support System optimization

Reporting structures Collaboration of IT leaders Integration into leadership teams, multidisciplinary teams, end-user groups and IT teams - Operational governance - Nursing shared governance - Clinical Readiness Team - Accountability Owners - User Groups

CIO Associate CIO CNIOCMIO Chief Nurse Executive Chief Physician Executive

CNIO embedded within organizational structures -System CNO Council -System Coordinating Council -System Quality Council -System Medication Safety Council -System Clinical Leadership -System Hospital Leadership -Epic Leadership Team -Epic Executive Sponsor -Epic Steering Committee -Clinical Readiness Team -Clinical Analyst Teams -IT Trainers and Clinical Educators Benefits -Communication and planning -Manage expectations -Identification of endusers needs -Assessment of engagement and adoption -Decision-making -Negotiation

to lead the change for a successful go-live Chaired by CNIO Included operational leaders from across the enterprise Began meeting 18 months before go-live Focus on “readiness” and “accountability” Provided forum for communication, information, decision-making and support Moved the team through the change process EMR implementation as a clinical project, not IT project

Kotter’s Steps: One: Create Urgency Two: Form a Powerful Coalition Three: Create a Vision for Change Four: Communicate the Vision Five: Remove Obstacles Six: Create Short-term Wins Seven: Build on the Change Eight: Anchor the Changes in Corporate Culture Based on John Kotter Change Principles – 8 steps for leaders and Vital Smarts Influencer Model

149 Days to Go Live!

Operational owner on Clinical Readiness Team Identified for each discipline Used standardized tool to track specific tasks and due dates Responsible to identify departmental Key Performance Indicators (KPIs) to monitor key processes Participated on daily status calls during go-live period How do I know if my department had a successful launch?

Strategy to ensure organization is prepared for go-live Conducted during Clinical Readiness Team meetings at 90, 60 and 30 days before go-live Report by IT staff as to their readiness status Report by Accountability Owners as to their readiness status Barriers identified Opportunity to request assistance

Clinically owned and led end-user groups Purpose to review and prioritize issues, review and validate changes, on-going optimization Accountability owner tasked with identifying leaders and members IT analyst assigned to each group Organized by practice area Small decision making groups who represent their peers

Implementation of the EMR will often illuminate ineffective processes Heparin PI team Medication Reconciliation Order Management I

Infusion Pump Integration Project implemented in late 2015 Co-led by CNIO and Pharmacy IT Manager Closed loop medication administration system to reduce errors made at the pump Major project requiring significant collaboration between Pharmacy IT and clinical nurses Will be able to perform tasks on hand-held device

-Approximately 50,000 administrations per month qualify for integration

External increasing demands – MU, regulatory, quality patient expectations for access and use of technology increased focus on ambulatory services rapid advancements in technology limited resources Internal balancing the need for rapid cycle optimization with a aggressive amount of planned growth projects many customers requests requests to improve efficiency of workflows constant need for training cost of implementation and optimization Resources – people, money and time

Strategic alignment and vision are key Ensure nursing and other clinicians have a voice at the table Leverage your team to help achieve goals!

Diane Trimble, MSN, RN-BC Chief Nursing Informatics Officer