# Presentation: 007669

## Carole A. Gassert, RN, PhD, FACMI, FAAN
Co-Chair ANI (AMIA Representative)
TIGER Representative

**Co-Chair ANI (AMIA Representative)**
**TIGER Representative**

**September 25, 2007**

**TIGER Initiative and the Alliance for Nursing Informatics**

## Nursing Perspective on HIT Workforce Issues

- TIGER Initiative – a program to engage all nursing stakeholders to better prepare our nursing workforce (all practicing nurses and nursing students) to use technology and informatics to improve the delivery of patient care.
- Alliance for Nursing Informatics – collaboration of organizations that represent a united voice for nursing informatics.
- Technology Targets Study by American Academy of Nursing (supported by Robert Wood Johnson Foundation) – creating a process to improve efficiency in care delivery on medical/surgical units by prompting industry to develop technology and HIT that help with workforce issues.
- HIMSS 2007 Nursing Informatics Survey
- AACN’s Essentials of Education – proposed recommendations for Baccalaureate and Doctorate of Nursing Practice

## Technology Informatics Guiding Education Reform

- The focus of the TIGER Initiative is to better prepare our nursing workforce (all practicing nurses and nursing students) to use technology and informatics to improve the delivery of patient care.
- We believe that _*necessary skills*_ for nurses’ portfolio in 2007 includes computer literacy and information literacy.
- The TIGER Initiative is a program; not an organization.
- TIGER has been a grass-roots effort to engage with all stakeholders that are committed to a common “vision” of ideal EHR-enabled nursing practice.  Today, more than 70 diverse organizations have joined this effort.

## Allow informatics tools, principles, theories and practices to be used by nurses to make healthcare safer, effective, efficient, patient-centered, timely and equitable

Interweave enabling technologies transparently into nursing practice and education, making information technology the stethoscope for the 21st century

- Interweave enabling technologies transparently into nursing practice and education, making information technology the stethoscope for the 21st century

**TIGER**** ****Vision**

## Nursing Focus

- Nearly 3 million practicing nurses in the U.S.
- More than 55% of all health care workers
- Nurses are knowledge workers
- Necessary Skills Nursing Portfolio in 2007
- Computer Literacy Skills
- Information Literacy Skills
- Informatics Skills

## Building the Work Force for HIT

- A work force capable of innovating, implementing and using health communications and information technologies will be critical to healthcare’s success.
- For health Information Transformation
- AHIMA and AMIA
- _[http://www.ahima.org/emerging_issues/Workforce_web.pdf](http://www.ahima.org/emerging_issues/Workforce_web.pdf)_

## TIGER Summit – Phase I

- October 31 -November 1, 2006
- Held at the Uniformed Services University for Health Sciences (USUHS) in Bethesda, MD
- 100 participants representing all stakeholders, 70 organizations
- Created a collective vision for nursing practice and education within 10 years if nurses were fully enabled with IT resources
- Developed a 3-year action plan required to achieve this vision
- Summary Report published at _[www.tigersummit.com](http://www.tigersummit.com/)_

## Enabled by the Alliance for Nursing Informatics (ANI) – a collaboration between AMIA and HIMSS
Continue to support progress of each participating organization’s 3-year action plan
Formalize cross-organizational activities/action steps into collaborative TIGER Teams (9 identified)
Define measurable outcomes of each collaborative team
Provide the infrastructure and support to facilitate the development and dissemination of the activities  of the collaborative
Develop educational materials that can be distributed to all practicing nurses and nursing students

- Continue to support progress of each participating organization’s 3-year action plan
- Formalize cross-organizational activities/action steps into collaborative TIGER Teams (9 identified)
- Define measurable outcomes of each collaborative team
- Provide the infrastructure and support to facilitate the development and dissemination of the activities  of the collaborative
- Develop educational materials that can be distributed to all practicing nurses and nursing students

**Collaborative Work Groups – Phase II**

## 9 Collaborative Teams

- Standards and Interoperability
- Healthcare IT National Agenda/HIT Policy
- Informatics Competencies
- Education and Faculty Development
- Staff Development/Continuing Education
- Usability/Clinical Application Design
- Virtual Demonstration Center
- Leadership Development
- Patient-Focus/Personal Health Record

*Created from combining all 3-year action steps into common themes/topics*

## Measurable Outcomes for Each Collaborative Team

- Definition, scope, success criteria, and timeline for deliverables (1 year)
- Inventory and analysis of existing resources (e.g., literature review, subject matter experts, publications, programs, etc.)
- Identification and access to resources and constituent targets
- Educational web-based audio conferences (target = 2)
- Conference presentations  (e.g., AONE, AWHONN, AACN, NONPF, ARN, NADONA, etc.)
- Comprehensive white paper-type document (modeled after TIGER Summary Report – see next slide)
- Articles for publication and dissemination amongst broader TIGER audience
- Chapter in the 4th Edition of the Nursing Informatics Series _*Where Caring and Technology Meet*_

## ANI 
Alliance for Nursing Informatics is a collaboration of organizations that represent a united voice for nursing informatics.
Alliance represents more than 3000 nurses and brings together 26 distinct nursing informatics groups in the U.S.

ANI and the TIGER Initiative
In 2007, ANI became the enabling organization for the TIGER initiative

- Alliance for Nursing Informatics is a collaboration of organizations that represent a united voice for nursing informatics.
- Alliance represents more than 3000 nurses and brings together 26 distinct nursing informatics groups in the U.S.
- ANI and the TIGER Initiative
- In 2007, ANI became the enabling organization for the TIGER initiative

##  Addressing the Demand on Nurses

- Technology Targets Study by American Academy of Nursing - funded by Robert Wood Johnson Foundation
- Aims of the study
- Create an improved process for identifying technology and HIT solutions to improve efficiency in care delivery on medical/surgical units, incorporating nurses’ viewpoints
- Capture the attention of and prompt industry to develop technology and HIT that help with workforce issues.

## Technology Drill Down (TD2)

- Two day process of brainstorming and visioning
- 20 – 30 multidisciplinary representatives
- Primary Purpose
- Map gaps between current workflow & idealized workflow
- Identify potential technological applications that could close the gaps

## Preliminary Findings from SitesDocumentation

- Computerized Order Entry included in  electronic record
- Touch screen/Voice activated
- Global Documentation System
- Multidisciplinary
- Real time
- Universal – physician, hospital, home care
- Flash Drive/Smart Card

## Preliminary Findings from SitesPatient Care

- Smart Monitoring Devices – interfaced with EHR
- Portable devices to quickly add information and updates to patient charts
- ID Bracelet or Tracking Chip System -** **Use with a handheld scanner. Linked to chart. Interfaces with screen at bedside.
- Smart Bed

## Preliminary Findings from SitesCommunications

- Computerized, centralized patient scheduling system for all departments
- Wireless voice communication device/Hands free communication device.
- RFID for caregivers.
- Universal Translator/Automatic language interpretation device.

## Preliminary Findings from SitesMedications

- Robotic delivery
- Medication Barcode/Chip System (same system for labs, blood products)
- Smart IV/Blood Pump
- Simplify systems and eliminate redundancies

## Preliminary Findings from SitesSupplies & Equipment

- RFID tag - item scanned when used Inventory to central computer  Include linens, supplies & equipment
- Robot to restock and deliver supplies & equipment
- Ensure availability at the point of care

## Workforce Development:
Nursing Informaticists (n=776)
	41% no formal training in informatics
	25% job training in informatics
	12% informatics certificate
	17% masters in informatics, 2% PhD
	12% enrolled in degree or certificate program
(~12 degree granting programs in Nursing Informatics in US)

- Nursing Informaticists (n=776)
- 	41% no formal training in informatics
- 	25% job training in informatics
- 	12% informatics certificate
- 	17% masters in informatics, 2% PhD
- 	12% enrolled in degree or certificate program
- (~12 degree granting programs in Nursing Informatics in US)

- HIMSS 2007 Nursing Informatics Survey, sponsored by McKesson

## Essential IV – Nursing Informatics and Patient Care Technology within the Practice of the Baccalaureate Generalist
Use IT and patient data for clinical decision making
Use technologies that facilitate clinical care
Evaluate technologies used in patient care
Protect privacy of patients relative to IT
Use safeguards in IT and IS to create safe environment
Demonstrate knowledge of regulations for using IT
Use technologies to assist in effective communication
Develop awareness that new technology requires new workflow and changes in practice

- Use IT and patient data for clinical decision making
- Use technologies that facilitate clinical care
- Evaluate technologies used in patient care
- Protect privacy of patients relative to IT
- Use safeguards in IT and IS to create safe environment
- Demonstrate knowledge of regulations for using IT
- Use technologies to assist in effective communication
- Develop awareness that new technology requires new workflow and changes in practice

**Essentials of Baccalaureate Education – AACN (under review)**

## Essential #4: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care
Design, select, use and evaluate programs the evaluate and monitor outcomes including consumer use
Analyze and communicate critical elements in selection, use and evaluate HIT
Demonstrate conceptual ability and technical skills to develop and execute an evaluation plan including data extraction
Provide leadership in resolution of ethical issues related to use of HIT
Evaluate health information sources for accuracy, timeliness, and appropriateness.

- Design, select, use and evaluate programs the evaluate and monitor outcomes including consumer use
- Analyze and communicate critical elements in selection, use and evaluate HIT
- Demonstrate conceptual ability and technical skills to develop and execute an evaluation plan including data extraction
- Provide leadership in resolution of ethical issues related to use of HIT
- Evaluate health information sources for accuracy, timeliness, and appropriateness.

**Doctorate of Nursing Practice**

## TIGER communication
www.tigersummit.com
Donna DuLong, TIGER Program Director
donna@tigersummit.com

ANI communication
www.allianceni.org
Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS
HIMSS Representative 
JSensmeier@himss.org
Carole Gassert, RN, PhD, FACMI, FAAN
AMIA Representative 
Carole.gassert@nurs.utah.org

- _[www.tigersummit.com](http://www.tigersummit.com/)_
- Donna DuLong, TIGER Program Director
- _[donna@tigersummit.com](mailto:donna@tigersummit.com)_
**ANI communication**
- _[www.allianceni.org](http://www.allianceni.org/)_
- Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS
- HIMSS Representative
- _[JSensmeier@himss.org](mailto:JSensmeier@himss.org)_
- Carole Gassert, RN, PhD, FACMI, FAAN
- AMIA Representative
- _[Carole.gassert@nurs.utah.org](mailto:Carole.gassert@nurs.utah.org)_