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It’s time for Canada to embrace the CNIO role


Authors: Gillian Strudwick, Helen Edwards, Peggy White, Lynn Nagle, Brian Lo And Sonia Pagliaroli


Canadian healthcare environments have experienced significant technological shifts over the last several years. The COVID-19 pandemic has accelerated these changes, ushering in a new era of virtual care, which has become more common than in-person care in some cases.

Additionally, electronic health record systems with an increasing number of functions and features are either being implemented, replaced or optimized in every Canadian jurisdiction.

With all of these transformations in clinical care, the role of the Chief Medical Informatics Officer (or a similar title) has grown significantly across the country, and for good reason. The work that physicians do is impacted a great deal by these technological systems, and physicians therefore need to be at key decision-making tables to ensure that the right path is forged to support the delivery of excellent clinical care.

The need to be present at these decision-making tables is also true for other health disciplines, particularly nursing, yet in Canada there are barely more than a handful of organizations with a complementary Chief Nursing Informatics Officer or CNIO role in place.

Given the significant role that nurses play in the health of Canadians, and the 400,000+ regulated nurses currently practicing in these technologically evolving environments, it’s time for Canada to embrace the CNIO role.

What is the CNIO role?

According to a 2015 article on how nursing informatics leaders can help make a digital National Health Service (NHS) a reality: “The Chief Nursing Information Officer (CNIO) provides a crucial role in bridging the gap between IT professionals, clinicians and hospital management, ensuring that new technologies meet the needs of nurses in practice on the ward. The CNIO is the voice of calm and reason, with the experience and appetite to lead care transformation by restructuring an organization’s culture and workflows and having a deep understanding and appreciation of the barriers and pressures involved”.

The CNIO role is about engaging with nurses and other health disciplines to understand their clinical support needs, workflows and pain points, and creating both a vision and structure for how to work through these issues. Solutions may include the creation of a governance structure to support key technology decision-making, including the identification of needs for new systems and changes to existing systems.

It may also include linking and situating clinical practice within all key decisions related to technological systems in healthcare environments. For example, CNIOs provide leadership to building systems in ways that nursing data is collected and reported on – supporting the work of nursing leaders to improve practice and clinical operations.

Moreover, the CNIO can be strategically positioned to drive the gathering of clinical and administrative data that informs ongoing quality improvements, ultimately supporting the quadruple aim of healthcare. (Improving the patient experience; improving outcomes and the health of populations; reducing the cost of healthcare; improving the work life of providers.)

While the CNIO role isn’t new, its existence in Canada seems to be. While roles such as Director or Manager of Clinical/Nursing Informatics have been common across Canada, there is currently only a handful of CNIOs with executive decision-making authority.

To the authors’ knowledge, the first individuals with this title in a healthcare delivery type role were from Vancouver Coastal Health, and the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa and began in their roles in 2015 and 2017 respectively.

Many organizations had nurses in leadership roles like director or manager of informatics, but these leaders did not necessarily sit at the higher-level tables in the organization. In addition, responsibilities for informatics might be incorporated into other roles – e.g., VP Clinical, Chief Nursing Executive – but these leaders often had little experience with informatics and they did not have the ability to focus on it given their expansive role.

In the United States, findings of the HIMSS Nursing Informatics Workforce Survey indicated that 41% of respondents reported this role existing in their organization, with an overall upward trend from previous surveys. In 2016, an American Medical Informatics Association task force published a report on the knowledge, education and skills to be considered for this type of role, drawing on the expertise of those in similar roles for several years.

Similarly, in 2015 the United Kingdom NHS vocalized the need for strong nursing informatics leadership to support and lead the digitization of healthcare in the country, and subsequently hired CNIOs for most of the Trusts in the ensuing years. With only a few CNIOs in Canada, we seem to be far behind other health systems undergoing similar technological transformations.


Authors (shown from left to right): Gillian Strudwick, Helen Edwards, Peggy White, Lynn Nagle, Brian Lo, Sonia Pagliaroli

Gillian StrudwickHelen EdwardsPeggy WhiteLynn NagleBrian LoSonia Pagliaroli