Top Challenges for CNIOs: Governance, Priorities, and More


PerfectServe’s Vice President of Clinical Informatics, Miriam Halimi, recently appeared on The Pivotal Podcast. Hosted by Ben Marley, the podcast explores the paths of leaders in the healthcare informatics space.

From her start in nursing to the journey that led her to PerfectServe, we’ve recapped and pulled the highlights from their wide-ranging and informative conversation.

Finding a Path to Nursing

Believe it or not, Miriam didn’t start her nursing career with the desire to be a nurse. After college, she traveled to Israel and wanted to find a career that would allow her to return to the country and work there full time. She heard Israel had a high birth rate, so she decided to try out nurse midwifery as a long-term solution for living in Israel. However, fate had other plans!

Miriam went to school for nursing and eventually decided not to pursue midwifery. After nursing school, she worked in med surg and the ED and was inspired to continue her education beyond those experiences.

“Going to nursing school triggered something in me to [pursue] ongoing education,” Miriam said. 

In 2004, she was in her early twenties and got a job as the Assistant Nurse Manager at a hospital. Part of this role included building out the nurse schedule for the ED. She recalled thinking that it couldn’t be that hard. 

She was handed a stack of papers, and that’s when reality began to set in. How was she going to make a schedule for a busy ED that would satisfy all the nurses and ensure all the department’s requirements would be met?

She spent the weekend scouring the internet for a program that could help. There were a few solutions at the time, but only one seemed to check all the boxes. Her studies had included classes on leadership and business, but this newfound informatics portion of her role was not something she had any experience with.

As time passed, the story of the nurse scheduling technology she implemented, and the process she used to select it, made its way up to the CFO of the hospital. Suddenly, Miriam was asked to build schedules not just for the ED, but for the entire hospital. It was then that the reality of the work she had been doing dawned on her.

“At that time, I had no framework to work with,” Miriam told Ben. “How do I make this problem better?”

Using Technology To Support Healthcare Communication Goals

Taking on a scheduling role at such a young age was just the start of a career filled with technology. When she first began building schedules for the hospital, Miriam wasn’t exactly popular—the IT team “poked all sorts of holes” in her idea to use technology for a previously manual workflow. But the more she learned about how technology could solve problems, the more she pushed. 

“I’ve always had grit and determination—sometimes to a fault,” she told Ben. “But it’s what it took to have such a belief in the impact the technology would have and then to stick with it.”

As her career progressed, Miriam learned from other informaticists and nurse leaders, slowly learning how to determine what was needed most and what priorities superseded others.

Before joining PerfectServe, she deployed clinical communication software at several healthcare facilities. She also worked at Baptist Health Jacksonville as the Chief Nursing Innovation Officer and helped implement PerfectServe within the organization. Her years of experience and time at Baptist Jacksonville cultivated her passion for clinical communication, highlighting the detailed intersections between communication and technology.

“Over the past few years, I’ve had the opportunity to deploy clinical communication software in a way that has been significantly meaningful to clinicians,” she said. She added that she still sees threads of where she started in her role today, and that commonality allows her to identify some unique areas where PerfectServe customers can improve their clinical communication strategies.

 Top Concerns for the CNIO

Having spent a number of years as a CNIO (and in similar roles), Miriam is quite familiar with the top concerns CNIOs face in their day-to-day lives. These concerns still matter deeply to her and help her better understand how improving an organization’s communication workflows can help to meet the needs most relevant to a CNIO.

In Miriam’s experience, the CNIO is responsible for thinking about two central areas, or “constants,” as she calls them. The first is governance, and the second is competing priorities. For governance, a CNIO has to think about the structure of an organization and how decisions will be made within that structure.

The CNIO must think from the perspectives of multiple stakeholders—IT teams, nurse executives, front-line nurses, and more. When it comes to finding new solutions, the CNIO has to think about how each of these stakeholders will be affected. 

“There are key decisions that need to be made during IT implementations, and having solid governance where there’s the right people at the table to make decisions is critical,” Miriam said. 

Decision-making can’t be done without considering a healthcare organization’s many competing priorities. Not every priority can be at the top of the list, so it’s up to the CNIO to think through which priority needs to be addressed first. The CNIO also has to think about how new technology should fit into current and future clinical workflows, how it will be funded, what it will replace, and who will use it. And with the speed at which new technology emerges these days, this can be an almost endless cycle! 

Miriam emphasized that having a committee to help drive these decisions and adjust priorities is crucial. No one person is going to have all the answers.

The PerfectServe Difference

Though she isn’t a CNIO with PerfectServe, Miriam’s experience in a wide range of nurse leadership positions has helped her in both her sales and implementation roles with the company. She believes this experience has shaped how she works with customers to help them achieve—and even exceed—their communication goals. 

PerfectServe takes the time to understand the current processes and communication workflows a health system has in place, as well as where the organization wants to be in the future. Miriam understands where many customers are and is able to picture where they can be once PerfectServe is implemented throughout the organization.

She outlined a few key areas where PerfectServe stands out from other vendors. The company consistently prioritizes: 

  • Listening to customers to understand current workflows and desired future workflows
  • Supporting organizations to optimize their use of PerfectServe’s technology
  • Giving partner organizations best-practice advice so then can not only meet, but exceed their communication goals
  • Ongoing support both pre- and post-implementation—and for the entirety of the customer’s relationship with PerfectServe

The interview dives deep into Miriam’s fascinating career path, from becoming a nurse to how she channeled her informatics experience to pivot to a role with a healthcare IT company. To hear more of Miriam and Ben’s discussion, make sure to listen to the full podcast episode!

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