Bridging the technical divide

New clinical informatics roles for nurses have the potential to transform IT in healthcare, writes Linda Belardi.

As Victoria's first formally appointed Chief Clinical Information Officer, Jenny O'Brien says she's part of an emerging hybrid of clinical leaders straddling the IT and clinical communities.

Coming out of an Intensive Care nursing background, O'Brien has crossed the divide into clinical informatics but created a bridge in doing so.

"What I feel that we are is the emerging bridge. We are closing the gap between clinicians and IT," O'Brien told a recent nursing informatics symposium.

Addressing the HIMMS conference in Melbourne, O'Brien outlined the burgeoning role of nurses and medical health professionals in clinical informatics, both here and overseas.

The Chief Clinical Information Officer (CCIO) and the Chief Medical Information Officer (CMIO), while they are well articulated in the US, they are under-recognised in Australia and exist in a lot of different guises and titles.

"In Australia, the movement is happening but it is definitely bubbling quietly away under the surface," she says. Minimal networking and collaboration between individuals in similar roles has limited their ability to organize professionally.

"We are out there but we don't have the prominence, the profile or the cohesiveness that people do in other countries. Our next step in Australia needs to be for all these people to rise up from their individual organisations discuss their role and to be recognized," she said.

O'Brien took up her CCIO appointment at Epworth HealthCare a year ago, following her role as Chief Information Officer at St Vincent's public hospital in Melbourne.

She said the new roles are well received by the IT community who have long been looking for strategic direction and advice from clinicians about what they actually want from technology.
"Rather than trying to drag IT into a clinical environment and expecting IT providers to understand something that is foreign to them. We are now starting to bring clinicians in to work with the IT."

The CMIO and the CCIO roles are relatively new positions to healthcare and have a more advanced history abroad. In the US, the roles are pervasive in approximately 10 to 15 per cent of health providers - mainly large organisations.

In hospitals and acute care settings they are often recruited from within the organisation's own workforce - commonly a practicising doctor, nurse or allied health professional.

While the CMIO roles don't necessarily have a strong informatics background, they have the clinical credibility to carry a health team through the process of technological change.

"They are clinical champions and they bring an understanding of the needs of clinicians," she said.
"They are there not only to convince and cajole and to bring their compatriots on the journey, but to represent the views of clinicians and to speak authoritatively for those they represent."

What's more important than technical expertise is the ability to interpret the needs of the clinical community and to be able to translate that into the IT environment, she said.

O'Brien's CCIO role requires her to be both facilitator and collaborator and to be able to consult with a wide range of stakeholders.

"The CMIO is a highly strategic role in the US and it has been crucial to achieving organisational objectives. To a large extent it is the lynchpin of the clinical informatics team".

As a clinician, the CMIO and CCIO understand the barriers and challenges to the implementation of IT in a clinical environment.

"You can mentally understand how this is going to work and what the challenges are going to be. You can then focus and address those hurdles before you introduce the clinical system."

CMIO and CCIO roles are responsible for clinical implementation, driving the health informatics agenda and leveraging the best out of IT systems. They can also be an important tool for empowering and engaging clinicians by heading up clinical advisory groups.

"Clinical advisory groups led by someone with a clinical informatics role can be much more relevant than traditional IT steering committees," she said.

Strategically, clinical informatics roles are more highly developed in the US and the UK where they have a stronger professional voice. This includes the circulation of professional CMIO magazines and dedicated electronic journals, as well formal accreditation.

In the UK, health professionals are currently lobbying the health ministry through petitions to embed the CCIO role in the public sector. The political campaign has received widespread support from doctors, radiologists and nurses.

Here, O'Brien's call to action now is to entrench these roles as formal positions in Australian healthcare organisations and to allow them to drive the development of clinical information strategies.

O'Brien has also called for the inclusion of these roles to be added to healthcare's accreditation parameters.

"What I would like to see is that some of the key quality indicators and accreditation processes actually focus on the use of the CCIO role and the effectiveness and validation of the clinical systems introduced to support clinical care."

Significantly, the CMIO and the CCIO roles also form a new breed of clinical leaders at a time when clinical leadership is eroding.

"There is a little bit of a vacuum in clinical leadership which is affecting how we are getting on with clinical informatics."

High staff turnover and burnout has reduced the capacity of the nursing and medical workforce to invest in clinical transformation. "In nursing we've had nursing hours cut back and handovers are much shorter. We're struggling just to get the job done - let alone to spend the time evaluating processes and contributing intellectually to how we develop the clinical informatics arena."

While she sees the real potential in the e-health movement, she said it's important not to think of it as a miracle cure. Investment in clinical leadership is needed to match.

"A lot of the statements made about e-health are somewhat a nirvana in terms of improving quality and safety, managing risk and reducing costs. The reality can be more disappointing, which is why these clinical informatics roles are so important."

"Introducing IT into healthcare can be done well or it can be done poorly. Often the difference in doing it well is that the clinical informatics position is filled by people who do straddle both sides of the fence."

The Healthcare Information and Management Systems Society (HIMSS) AsiaPac conference was held in Melbourne in September.

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