ashlyn johnson w036amj@pilot.wright.edu amy vanbuskirk w015amv@pilot.wright.edu amy wiley...

TIGER INITIATIVE

GROUP MEMBERS

Ashlyn Johnson w036amj@pilot.wright.edu

Amy Vanbuskirk

w015amv@pilot.wright.edu Amy Wiley

w064amw@pilot.wright.edu Bethany HanenKrat

w137bmb@pilot.wright.edu Jessica Akemon

w106jkp@pilot.wright.edu

Kathleen Owens

w005kao@pilot.wright.edu Shawn Kise

w025sek@pilot.wright.edu Shelley Thiebeau

w023skt@pilot.wright.edu Whitney Dunbar

w105wld@pilot.wright.edu

OBJECTIVES

1. Understand the background of how the Tiger Initiative got started.

2. Know the 9 collaborative teams of the Tiger Initiative.

3. Be able to state goals of the Tiger Initiative.

4. Know where to access information on the Tiger Initiative.

TIGER INITIATIVE

T – TechnologyI – InformaticsG – GuidingE – EducationR – Reform

EXECUTIVE SUMMARY

Focused awareness with nursing stakeholders in three areas Develop a U.S. nursing workforce capable of

using electronic health records to improve the delivery of healthcare

Engage more nurses in the development of a national healthcare information technology (NHIT) infrastructure

Accelerate adoption of smart, standards-based, interoperable technology that will make healthcare delivery safer, more efficient, timely, accessible, and patient-centered

TIGER: BACKGROUND

2004: President Bush supported adoption of electronic health records

2005: Small group of nursing leaders and advocates met and resolved to strengthen the voice of the nursing profession in the transformation of healthcare for 21st century

Organized TIGER Initiative (2005)

TIGER: BACKGROUND- NURSING ENGAGEMENT

2006: Interactive summit, “Evidence and Informatics Transforming Nursing”

Created a vision for the future of nursing that bridges the quality chasm with information technology, enabling nurses to use informatics in practice and education to provide safer, higher quality patient care

TIGER: BACKGROUND CONT.

Focus on nursing, however recommendations apply to interdisciplinary health professions

Aim to develop a nursing workforce in the US capable of using electronic health records (EHRs) with hope to improve care delivery

2009 Obama signs American Recovery and Reinvestment Act- $19 billion for health information technology (HIT)

Funding by Dept of Labor and Dept of Education to increase HIT workforce

TIGER: BACKGROUND CONT.

Capital, technology, resources, and people needed to create an informatics-aware healthcare workforce

Healthcare provider competency with EHRs (requires basic computer skills, information literacy, and understanding of informatics and information management)

Education reform- ≈3 million currently practicing nurses may not be competent with HIT

TIGER VISION

“Our vision is to enable nurses to use informatics tools, principles, theories, and practices to make health care safer, more effective, efficient, patient-centered, timely, and equitable by interweaving enabling technologies transparently into nursing practice and education, making information technology the stethoscope for the 21st century”.

TIGER EXPECTED OUTCOMES

Publish a Summit report, including Summit findings and exemplars of excellence.

Establish guidelines for organizations to follow as they integrate informatics knowledge, skills, and abilities into academic and practice settings.

Set an agenda whereby the nursing organizations specify what they plan to do to bridge the quality chasm via information technology strategies.

7 KEY PILLARS

1.) Communication2.) Education3.) Informatics Design4.) Information Technology5.) Culture6.) Management and Leadership7.) Policy

TIGER: SUMMARY REPORT

Provides executive summary of activities through 2008

Synopsis of findings and recommendations of the nine teams

Available at www.tigersummit.com

9 COLLABORATIVE TEAMS

1.) Standards & Interoperability2.) National Health Information Technology

Agenda3.) Informatics Competencies4.) Education & Faculty Development5.) Staff Development6.) Usability & Clinical Application Design7.) Virtual Demonstration Center8.) Leadership Development9.) Consumer Empowerment & Personal Health

Records

1.STANDARDS & INTEROPERABILITY

Standard-A definition or format that has been approved by a recognized standards organization or is accepted as a

de facto standard by the industry. A standard specifies a well-defined approach that supports a business process and is:

1. Derived by a group of experts2. Examined and evaluated3. Provides rules, guidelines, or characteristics4. Helps to ensure that materials, products, processes, and services are fit for their intended purpose5. Ensures that it is in an accessible format6. Is in a continuous review and revision process

STANDARDS & INTEROPERABILITY

Interoperability-the ability to communicate and exchange data accurately, effectively, securely, and consistently with different information technology systems, software applications, and networks in various settings, and exchange data such that clinical or operational purpose and meaning of the data are preserved and unaltered

STANDARDS & INTEROPERABILITY GOALS: Integrate industry standards for health

IT interoperability with clinical standards for practice and education.

Educate practice and education communities on health IT standards.

Establish use of standards and set hard deadlines for adoption.

2.NATIONAL HEALTH IT AGENDA

Decrease healthcare costs Reduce medical errors National disasters Threat of terrorism

Why Do We Need Reform?National Health IT Organizations that Need Nursing Participation

National eHealth Collaborative

Healthcare Information Technology Standards Panel

Certification Commission for Healthcare Information Technology

HIT Policy Committee and HIT Standards Committee

3.TIGER INFORMATICS COMPETENCIES MODEL

Basic Computer Competencies

Informatics Literacy

Information Management

Model Standard/SourceEuropean Computer Driving

License/European Computer Driving License Foundation

Information Literacy Competency Standards/American Library Association

Electronic Health record Functional Model-Clinical Care Components/Health Level Seven(HL7)International Computer Driving License-Health/European Computer Driving License Foundation

4. EDUCATION AND FACULTY DEVELOPMENT

Recommendations for Associate Degree Programs State Boards of Nursing State Initiatives Human Resource Services Administration Curriculum Development

EDUCATION-FOCUSED ORGANIZATIONS

National League for Nursing (NLN) and American Association of Colleges of Nursing (AACN) support TIGER Initiatives Changes to curriculum to include HIT and

EHRs

EDUCATION-FOCUSED ORGANIZATIONS NLN

23 recommendations for nursing schools Nursing School Administrators

Infrastructure, faculty development, student access to HIT in clinical experience, inclusion of informatics in curriculum

Faculty Informatics education, a champion in every nursing school,

provide hands on experience to students NLN

Funding for think tank, minimal informatics competency for all nurses, create faculty development programs

AACN Include informatics in Baccalaureate and Doctor

of Nursing Practice education

5.STAFF DEVELOPMENT

Official TIGER Staff Development Collaborative Team report not yet available

Staff Development Collaborative Team Aim to help staff communicate and manage

information effectively Research suggests that HIT can improve

patient safety If used improperly HIT may be detrimental to

patient safety Healthcare Organizations

Educate practicing nurses Adopt new technologies to improve patient safety

GOALS FOR STAFF DEVELOPMENT

Staff Development Collaborative – 3 GoalsEducation/programs in practice

settings for ITContinuing education/training in

informaticsCollaborate with industry, service,

and academia to promote HIT education and improve use of HIT in practice

STAFF DEVELOPMENT

Workforce Readiness- Prepare nurses already in the workforce Nurses are the most frequent users of clinical

information systems Organizational Readiness

Knowledge readiness Technical readiness Operation readiness Functional readiness Resource readiness Internal environmental readiness

STAFF DEVELOPMENT CONT.

Technology can improve patient safety

Healthcare Settings (implementing HIT)Staff preparation and trainingProcess changesContinuity of patient careIT administrative support

THE INFORMATICS FOR ADVANCED ARIAL BOLD PROGRAM AT COLUMBIA

Informatics Competency developmentPatient safetyEvidence-based care

THE INFORMATICS FOR ADVANCED ARIAL BOLD PROGRAM AT COLUMBIA

Applications to support nurses in various roles Student use of handheld devices for

clinical documentation Clinical practice guidelines for depression,

obesity, and tobacco cessation A patient safety website for reporting

hazards Access to National Cancer Institute

information for tobacco cessation

6.USABILITY AND CLINICAL APPLICATION DESIGN

Current information systems may not meet workflow demands

Current technology was not designed with nursing workflow or thought process in mind

Systems with designs appropriate for daily nursing practice are needed

USABILITY AND CLINICAL APPLICATION DESIGN

Recommendations provided for HIT vendors as well as practitioners Improve HIT products

Efficiency Effectiveness Satisfaction

Better HIT designs Greater productivity Reduction of errors Fitting to workflow Improvement of accuracy Easy to learn Increased satisfaction of healthcare providers

USABILITY

Usability Principles Focus on the product users Match designs to users, tasks, and

environments Evaluate products (users and metrics)

Usability Goals Evidence-based Patient-centered Allow interdisciplinary collaboration at

point-of-care

USABILITY & CLINICAL APPLICATION DESIGN Human Factors

Usability Ergonomics Human-computer interaction

Clinical application design Usability EBP interdisciplinary collaboration knowledge discovery

Systems thinking Individual competency EBP Scope of practice Knowledge discovery Integrated competency

COLLABORATIVE GOALS

Usability Goals Nursing informed and helpful for nursing workflow Known principles and processes drive systems design Improve system effectiveness by working with

developers Clinical Application Design Goals

Support EBP Collaborative and interdisciplinary care Provide access to literature and knowledge Support knowledge-discovery Enable research to practice translation

CLINICAL REQUIREMENTS

Define user needs Understand nursing role and

appropriate system actions Provides recommendations to both

health care practitioners and vendors

CLINICAL REQUIREMENTS

Recommendations for Vendors Clinician representation Clear requirements for developers (non-

clinicians) who hard-code designs Requirements of different skill levels (nurses

choose level of system support) Work with organizations analysts and users to

validate requirements during development/customization of the product

Partner with customers to meet the needs of end-users

CLINICAL REQUIREMENTS

Recommendations for Health Care Practitioners Select the team (interdisciplinary team to define

clinical requirements) Analyze the systems impact on workflow of each dept Use standardized terminology for organization (allow

free text, support EBP, end-users to review) Customization of system Legal considerations (electronic signature, audit trail) Tools (system setup and maintenance)

USABILITY AND CLINICAL APPLICATION AND DESIGN RECOMMENDATIONS

Safety and usability recommendations for vendors For healthcare practitioners

Usability Evaluations Design prototype then evaluate

Product design User Environment

Human Factors recommendations Understand human capability and limitation

Human errors Technical errors Judgmental errors Monitoring and vigilance failures

COLLABORATIVE 6: CASE STUDIES

Case studies have identified key factors for success User and key stakeholder involvement

Involved early onInvolved with requirements development

and selection Clinicians + developers

Create design which fits workflow Vendors understand workflow of end users

7: VIRTUAL DEMONSTRATION CENTER (VDC)

Created to develop a dynamic Internet Create a physical destination to

demonstrate high effective and efficient, technology-enabled, solutions of exemplary health care delivery systems

VDC

Goal: Encourage innovative and disruptive approaches to improving health care delivery with the use of technology

Allow access to the Center from anywhere

Expand current thinking about healthcare

VDC

Held two virtual conferences in 2008 Provided “Gallery Walk” to nurses Provided exemplars of best practice for

technology utilization, contact resources, and virtual networking

Interactive experience

VDC GOALS

Provided visibility to the vision of IT Demonstrated future IT resources Demonstrated collaboration between

industry, healthcare organizations, academic institutions, and professional organization

Provided universal accessibility to this demonstration for all nursing stakeholders

VDC GOALS

Used practice exemplars from different practice environments

Demonstrated how integrated IT systems impact nurses and the quality and safety of patient care

BENEFITS AND VDC OUTCOMES FOR 2008

Nurses who can visualize the benefits of an It-enabled future will be more likely to use EHR in their practice setting

Most exposure to IT capabilities are site-specific, except nursing informatics resources

Provided a vision of how to partner with colleagues to widen the availability of resources due to limited accessibility

BENEFITS AND VDC OUTCOMES 2008 Provided an example of how education

can be made more widely available Universal adoption of informatics

competencies for all nurses

FUTURE OPPORTUNITIES

Develop a virtual environment- Second Life

3D interactive “avatars” that allows interaction with the program

Social networks and virtual technology Goal: secure funding to help build out a

virtual island that will support the TIGER mission

Improve patient care and outcomes

8: LEADERSHIP DEVELOPMENT

Transform organization’s values, beliefs, and behaviors

Technology changing but adoption of technology will not happen without leadership

Requires vision, influence, risk taking, clinical knowledge, and a strong expertise related to professional nursing practice

LEADERSHIP

Leaders: Model the Way Inspire a Shared Vision Challenge the Process Enable Others to Act Encourage the Heart

LEADERSHIP

Develop revolutionary leadership that drives, empowers, and executes the transformation of health care

Requires nursing leadership to understand, promote, own, and measure the success of health IT

Ensure development of informatics competencies at the beginning management role or the charge nurse

LEADERSHIP- EXECUTIVE

Informatics competencies should focus on: budgetary, regulatory, safety, security, and privacy policies

Expected to fully understand and articulate goals and benefits of technology implementation

Remain engaged throughout the lifecycle of system selection, implementation, and optimization

LEADERSHIP

Responsible for developing a culture that is innovative and ready to embrace change

The Magnet Program TIGER – collected examples of how

organizations used HIT to demonstrate aspects of their Magnet journey

LEADERSHIP: RECOMMENDATIONS

Develop programs for nurse executive and faculty that emphasizes the value of IT and empowers those to use HIT

Expand and integrate informatics competencies into Nursing Leadership Development Programs

LEADERSHIP: RECOMMENDATIONS

Promote sharing of best practices using HIT effectively to improve the delivery of nursing care

Promote alignment with the Magnet Recognition Program as a mechanism to demonstrate nursing excellence in using

CRITERIA FOR LEADERSHIP DEVELOPMENT

Maintain knowledge of cutting edge practice and for management of clinical teams

Areas of focus: Evidence Content Technology Standards

9: CONSUMER EMPOWERMENT & PERSONAL HEALTH RECORDS

33% of adults are confident in their physicians an other HC providers having a complete and accurate picture of their medical history

Need for consumers to take a more active role in their health care

Personal Health Record (PHR)- internet based

CONSUMER EMPOWERMENT & PERSONAL HEALTH RECORDS

PHR: promotes patient empowerment and supports the patient’s engagement in their own health care

Nurses obligated to become families with the technology

Objective of TIGER: make information available to nurses about PHRs and to encourage inclusion of this content to nursing curricula

CONSUMER EMPOWERMENT & PERSONAL HEALTH RECORDS

Ways nurses can impact the adoption and use of consumer empowerment strategies

PHRs: easy to use and accessible to consumers Developed an inventory of usability principles for

patient-focused applications Barrier of PHRs: lack of interoperability with

other systems National Health IT activities have focused on

identifying and supporting the adoption of standards for PHRs

CONSUMER EMPOWERMENT & PERSONAL HEALTH RECORDS

President Obama supports greater use of technology in healthcare Included significant funds in the economic

stimulus package to increase adoption of PHRs

High prospect of achieving PHRs that are complete, accessible, interoperable, and secure

Reducing Medication Errors with Electronic Medical Records and Bar Coding Technology

Bar Coding Video 

While caring for a premature neonate the nurse administers many intravenous medications throughout her shift, including heparin 10 units/mL. The adult dose of heparin 10,000 units/mL is in similar packaging and labeling. The two very different doses of medication are easily confused due to similar labeling and packaging. To prevent medication errors we observes the 5 Rights of Medication administration: checking: 

Right PatientRight MedicationRight Dose Right RouteRight Time

But, to err is human. We increase patient safety and lessen the risk of medication error with preventative strategies, such as electronic medical records, medication bar coding, unit dose labeling and smart (programmed pumps).

Discussion Points

Informatics CompetenciesReview

The Informatics Competencies as outlined in the TIGER initiatives is a plan for “all practicing nurse and students to have the necessary skills to practice nursing in the high-technology environment emerging in all avenues of healthcare.” (Hebda and Calderone, 2010)

For All Nurses

Entry and retrieval of data in electronic medical records

Analyze and interpret information as part of care plan

Use informatics applications designed for nursing practice

Implement policies relevant to best practice

For Students and Beginning Nurses Basic computer literacy and desktop applications such as e-mail

Access data and document using computerized patient records

Access and apply evidenced based practice

Support patient safety using information technology

For Experienced Nurses Build upon informatics knowledge gained

Become content expert in system designs

Appreciate relationships among data patterns

Exercise clinical judgment based on observed data trends

Safeguard access to patient data

Work toward improving information management and communication 

As a student seeking degree and certification as an Advanced Practice Nurse

What are some of the ways we support patient safety initiatives while integrating informatics technology? In what ways do nurses or physicians resist change in patient care?

How can we work toward safeguarding patient data and health information in electronic medical records? What challenges does this present in your nursing practice?

References

Hebda, T. Calderone, T. (2010) What Nurse Educators Need to Know About the TIGER Intiative. Nurse Educator, (35) 2, 56-0

Saba, K. & McCormick, K. (2006) Essentials of Nursing Informatics, McGraw Hill

TIGER: IMPACT

Structured as program Relied on the participating

organizations to distribute information Collaborative approach

Organizations and nine collaborative teams Nursing Informatics Community

Presentations and meetings at several national, regional, and international conferences

TIGER: IMPACT

Practice Specialty Community: ANA & STTI Presented on TIGER at regional and national

conferences, & conferences within organization Published articles in member newsletters or

journals Nursing Leadership Community

Enhanced visibility and access to nursing executives

Executives contributed articles and presentations r/t technology and the TIGER effort

TIGER: IMPACT

Educational Community ¼ of leaders and participants came from the academic

community Academic partnerships proliferating

State-Wide Collaboration Minnesota developed a state approach: bringing together

stakeholders in an annual Minnesota TIGER conference Other states have brought together the key organizations to

discuss issues r/t technology adoption Vendor Community: GE Healthcare, Mckennson, Cerner, CPM Resource

Center & others Developed an interactive “Gallery Walk” Presented TIGER at their user group conferences or via webinars

REFERENCES

Kouzes, J.M., & Posner, B.Z. (2007). The leadership challenge (4th ed.). San Francisco: Jossey-Bass.

McCormick, K. A, & Saba, V.K. (2006). Essentials of nursing informatics (4th ed.). New York, New York: McGraw-Hill

The T.I.G.E.R. Initiative. (2011). Retrieved July 6, 2011, from Tiger Summit: http://www.tigersummit.com/Home_Page.php

The TIGER Initiative. (2007-2011). Designing usable clinical systems: Recommendations from the TIGER usability and clinical application design collaborative team. Retrieved from

http://www.tigersummit.com/uploads/Tiger_usability_Report.pdf The TIGER Initiative. (2007-2011). Staff development and

continuing education programs that support technology adoption. Retrieved from http://tigerstaffdev.pbworks.com/w/page/22250544/FrontPage

REFERENCES

The TIGER Initiative. (2007-2011). Transforming education for an informatics agenda: TIGER education and faculty development collaborative. Retrieved from http://www.tigersummit.com/uploads/Educ.Tiger.Report_final4.pdf

You Tube. Computerized Health Records Reduce Medical Errors (2008). Retrieved from http://www.youtube.com/watch?v=fjnyDNZE3RY&feature=relmfu .