Download TigER INITIATIVE - Shawn Kise BSN, RN

TIGER INITIATIVE
GROUP MEMBERS

Ashlyn Johnson

[email protected]

Amy Vanbuskirk
[email protected]

[email protected]

Amy Wiley
Bethany HanenKrat
[email protected]

Jessica Akemon
[email protected]
Shawn Kise
[email protected]

[email protected]

Kathleen Owens
Shelley Thiebeau
[email protected]

Whitney Dunbar
[email protected]
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 – Technology
I – Informatics
G – Guiding
E – Education
R – 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.) Communication
2.) Education
3.) Informatics Design
4.) Information Technology
5.) Culture
6.) Management and Leadership
7.) 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 & 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
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 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
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
Why Do We Need Reform?




Decrease healthcare costs
Reduce medical errors
National disasters
Threat of terrorism
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
Model


Basic Computer
Competencies
Informatics Literacy
Standard/Source
European
Computer Driving
License/European Computer Driving
License Foundation
Information
Literacy Competency
Standards/American Library
Association
Electronic

Information Management
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


Faculty


Informatics education, a champion in every nursing school,
provide hands on experience to students
NLN


Infrastructure, faculty development, student access to HIT in
clinical experience, inclusion of informatics in curriculum
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



Research suggests that HIT can improve patient
safety


Aim to help staff communicate and manage information
effectively
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 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
STAFF DEVELOPMENT

Workforce ReadinessPrepare 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 training
 Process changes
 Continuity of patient care
 IT administrative support

THE INFORMATICS FOR ADVANCED ARIAL BOLD
PROGRAM AT COLUMBIA
 Informatics
Competency
development
Patient safety
Evidence-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




Clinical application design





Usability
Ergonomics
Human-computer interaction
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 on
 Involved 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, technologyenabled, 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 Itenabled future will be more likely to use EHR in
their practice setting
 Most exposure to IT capabilities are sitespecific, 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 Patient
Right Medication
Right Dose
Right Route
Right 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 Competencies
Review
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 hightechnology 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



State-Wide Collaboration



¼ of leaders and participants came from the academic
community
Academic partnerships proliferating
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 .