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CIO Unplugged 10/19/11

October 19, 2011 Ed Marx 5 Comments

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

This is the fourth in a short series of posts on “The CIO’s Best Friends,” those BFFs who are critical in ensuring CIO effectiveness. This time we cover the CNO – CIO relationship.

Got Clinicians?

The CNO and I started our jobs about the same time. We knew we needed one another to be successful. With an electronic health record implementation looming, our partnership would be imperative.

As organizational rookies, we became kindred spirits. We commiserated, encouraged, and partnered. Through my CNO’s coaching, I learned we needed more clinicians inside of IT. “Got clinicians?” he prodded often. “If you don’t, you should.”

I wondered how many credentialed clinicians a healthy IT department should have. I now think 25% is a good target. Whatever your starting point, push to raise the percentage. Include a mix of MDs; RNs; radiology, medical, and pharmacy techs; pharmacists; therapists; and a smattering of other less common specialties. While many organizations have a CMIO, equally critical is a CNIO.

My CNO taught me that once you have clinicians on your team, you’ve got to ensure their successful transition into IT. Here are some things to think about in order to succeed.

Challenges for Clinicians Moving Into IT

Adapting to the office environment

  • Cubes vs. nursing station reduces the sense of teamwork
  • Use of meeting rooms is equated with loss of casual social interaction
  • Taking work home
  • Going out to lunch vs. grazing between patient care tasks

Difficulty recognizing accomplishments/results

  • Need to understand the bigger picture (see beyond the patient)
  • IT systems are configurable with gray areas; reduced workflow focus
  • No more rapid results (average patient LOS is three days)
  • Used to implementing changes quickly
  • Giving up precision and timing on tasks

Loss of familiarity generates stress. The clinician must:

  • Learn new tasks, find new resources, and create a new employee network
  • Learn basic IT software (no more IVs)
  • Fight pressure to already understand IT on the first day of work
  • Assimilate IT language/acronyms

Facilitation skills are not in the typical nursing repertoire

  • Scheduling appointments
  • Creating agendas
  • Taking minutes
  • Using a meeting room to solve problems instead of on-the-spot interactions

Common Conflict Areas and Issues of Concern for Clinicians

  • IT staff is generally unaware of clinician’s former environment and the required adjustments
  • Lack of training for clinicians in IT subjects
  • Clinicians are expected to already know what to do
  • Downtime scheduling affects issues regarding patient care
  • Clinicians have an inherent desire for more testing on software applications (like testing a drug before giving it to a patient)

Bridging the Gap and Investing in Clinicians

Preceptor program

  • Increase depth of typical IT orientation
  • Pair new clinical staff with experienced IT person; identify future clinician leaders
  • Document and publish referable guidelines
  • Create Web-based training on IT tools
  • Ensure clinicians don’t get sucked into traditional IT mentality

Project management training

  • Create project management processes that nurses can relate to
  • Help clinician visualize the big picture and break it down into tasks

Professional development

  • Develop a facilitation/leadership class
  • Provide continuing education credits (CEU)
  • Create internal training opportunities specific to clinical IT
  • Develop clear development pathways, like a clinical ladder
  • Clarify the position’s responsibilities

Spend time with your CNO. Actively partner. If you can’t afford a CNIO to bridge the nursing and IT gap, assign another clinician as a part-time liaison.

Over the years, we moved from 5% clinical staff to nearly 25%. I believe one reason we successfully implemented and adopted clinical applications was due to our staff mix.

Embrace the significance of melding clinicians with IT. Be intentional with it, maximize the value, and encourage further adoption. A healthy mix leads to a high-performing healthcare IT organization. I’m so glad I listened to my CNO.

Got Clinicians?

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

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Currently there are "5 comments" on this Article:

  1. As a clinician I find Ed Marx’s words to ring true. I transitioned from clinical nursing to IT as patient care liaison in 1993, when clinical IT was in its infancy. They didn’t have enough hospital patient information systems for me to work on, so I did some payroll, pharmacy, and laboratory systems work. I wish I had the roadmap in this article to help me realize what I didn’t know. I often tell people, my first day in IT my supervisor pointed to a keyboard & monitor and said, “Here is where you can sit to build your tables.” In my head I said, “What’s a table?” Now, thousands of tables later, I can honestly say I had aptitude and that was about it. Thank you Ed for helping more clinicians and IT to prepare for the transitions.

  2. This is a very thoughtful and insightful article. It’s nice to see that consideration is given to the challenges of moving employees from one role to another. The one piece that I would add, having managed an IT staff of clinicians and non-clinicians, is to watch for the natural battle lines that are sometimes drawn. Clinicians tend to think they are always right and tromp on the ideas of non-clinicians. Clinicians do have the patient care knowledge but often forget that IT systems have to apply to more than one person and more than one domain. They start to develop an attitude of superiority. While conflict is healthy and good, an IT manager needs to be aware of it and manage it to obtain the best outcomes.

  3. Ed, I too wish that I had your roadmap as I transitioned into the IT world 15 years ago. Your insight is amazing. Keep the great articles coming. I recently read an article in the Dallas Morning News about the compensation of executives of not-for-profits in the DFW area. I was quite disappointed that your name was not on the top 100 list, although there were a lot of healthcare executives listed.

  4. A few years ago I worked in IT at the corporate office of a multi-state rural healthcare organization. One of our analysts, Sam, had been nursing administrator of a 20-bed hospital where, years later, we were piloting an internally-developed clinical system. While the old-timers remembered when Sam was in charge of nursing, the newer staff knew him only as “the guy from corporate who fixes printers.” Sam happened to be on-site when a two-car accident on the freeway overwhelmed the tiny ER (with 3 or 4 patients) and the call went out for all hands to report. Apparently it caused quite a reaction when Sam (at the the request of the charge nurse) proved quite adept at starting an IV. So there is another reason to have clinicians on the IT staff!

  5. Nicely put and great examples. As an RN who moved into IT in the early 1980’s – it took a bit of education on both IT staffs part and mine until we learned the most effective way to work together. Even after all these years, the value of the items mentioned are still core to how I perceive my job. Even as I moved into the vendor area, there are times when my thought processes are quite different from non-clinicians. Thanks for bringing publishing this.

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