Tiger INITIATIVE

1. Tiger INITIATIVE

2. 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

3. 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. Objectives

4. T – Technology I – Informatics G – Guiding E – Education R – Reform TIGER INITIATIVE

5. 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 Executive Summary

6. 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

7. 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- Nursing Engagement

8. 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.

9. 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: Background Cont.

10. “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 VISION

11. 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. TIGER Expected Outcomes

12. 1.) Communication 2.) Education 3.) Informatics Design 4.) Information Technology 5.) Culture 6.) Management and Leadership 7.) Policy 7 KEY PILLARS

13. Provides executive summary of activities through 2008 • Synopsis of findings and recommendations of the nine teams • Available at www.tigersummit.com TIGER: Summary Report

14. 1.) Standards & Interoperability 2.) National Health Information Technology Agenda 3.) Informatics Competencies 4.) Education & Faculty Development 5.) Staff Development 6.) Usability & Clinical Application Design 7.) Virtual Demonstration Center 8.) Leadership Development 9.) Consumer Empowerment & Personal Health Records 9 collaborative teams

15. 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 experts 2. Examined and evaluated 3. Provides rules, guidelines, or characteristics 4. Helps to ensure that materials, products, processes, and services are fit for their intended purpose 5. Ensures that it is in an accessible format 6. Is in a continuous review and revision process 1.Standards & Interoperability

16. 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

17. 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. Standards & Interoperability Goals:

18. Why Do We Need Reform? National Health IT Organizations that Need Nursing Participation • Decrease healthcare costs • Reduce medical errors • National disasters • Threat of terrorism • National eHealth Collaborative • Healthcare Information Technology Standards Panel • Certification Commission for Healthcare Information Technology • HIT Policy Committee and HIT Standards Committee 2.National Health IT Agenda

19. Model Standard/Source • Basic Computer Competencies • Informatics Literacy • Information Management • European 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 3.TIGER Informatics Competencies Model

20. Recommendations for • Associate Degree Programs • State Boards of Nursing • State Initiatives • Human Resource Services Administration • Curriculum Development 4. Education and Faculty Development

21. 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

22. 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 Education-Focused Organizations

23. 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 5.Staff Development

24. Staff Development Collaborative – 3 Goals • Education/programs in practice settings for IT • Continuing education/training in informatics • Collaborate with industry, service, and academia to promote HIT education and improve use of HIT in practice Goals for Staff Development

25. 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

26. Technology can improve patient safety • Healthcare Settings (implementing HIT) • Staff preparation and training • Process changes • Continuity of patient care • IT administrative support Staff Development Cont.

27. Informatics • Competency development • Patient safety • Evidence-based care The Informatics for Advanced Arial Bold Program at Columbia

28. 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 The Informatics for Advanced Arial Bold program at Columbia

29. 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 6.Usability and Clinical Application Design

30. 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 and Clinical Application Design

31. 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

32. 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 Usability & Clinical Application Design

33. 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 Collaborative Goals

34. Define user needs • Understand nursing role and appropriate system actions • Provides recommendations to both health care practitioners and vendors Clinical Requirements

35. 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

36. 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) Clinical Requirements

37. 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 Usability and Clinical Application and Design Recommendations

38. Case studies have identified key factors for success • User and key stakeholder involvement • Involved early on • Involved with requirements development and selection • Clinicians + developers • Create design which fits workflow • Vendors understand workflow of end users Collaborative 6: Case Studies

39. 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 7: Virtual Demonstration Center (VDC)

40. 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

41. 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

42. 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

43. Used practice exemplars from different practice environments • Demonstrated how integrated IT systems impact nurses and the quality and safety of patient care VDC Goals

44. 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 for 2008

45. Provided an example of how education can be made more widely available • Universal adoption of informatics competencies for all nurses Benefits and VDC Outcomes 2008

46. 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 Future Opportunities

47. 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 8: Leadership Development

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

49. 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

50. 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- Executive