Technology Informatics Guiding Education Reform Nine TIGER Collaboratives. Donna DuLong, BSN, RN Program Director, The TIGER Initiative Denver, Colorado Marion Ball, EdD Professor, Johns Hopkins University School of Nursing Columbia, MD. Monday, February 25, 2008 Session 53.
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Technology Informatics Guiding Education Reform Nine TIGER Collaboratives
Donna DuLong, BSN, RN
Program Director, The TIGER Initiative
Marion Ball, EdD
Professor, Johns Hopkins University School of Nursing
Monday, February 25, 2008
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 basic computer competencies, information literacy and informatics skills.
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 120 diverse organizations have joined this effort.
Converging forces that are serving as a catalyst for transforming nursing practice
Rising cost and disparity of U.S. Healthcare system demands transformation
IOM studies and reports
Impending nursing shortage
Disaster recovery preparedness
Nearly 3 million practicing nurses in the U.S.
More than 55% of all health care workers
Nurses are knowledge workers
Average age of nurse is 47
Estimated severe shortage of nurses by 2014
Nursing’s workforce must be capable of innovating, implementing, and using health communications and information technologies
“There is no aspect of our profession that will be
untouched by the informatics revolution in progress.”
Distinguished Professor and University Dean Emeriti
Indiana University School of Nursing
While clinicians are trained to use an array of cutting-edge technologies related to care delivery, they often are not provided a basic foundation in informatics (Gorman et al.,2000; Hovenga, 2000).
“All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics.”
IOM - Health Professions Education: A Bridge to Quality, 2003.
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
To Err is Human (2000)
Crossing the Quality Chasm (2001)
Health Literacy: A Prescription to Ending Confusion (2004)
Building a Better Delivery System: A New Engineering/HealthCare Partnership (2005)
Building the Workforce for Health Information Transformation (2006)
Mandates/Executive Orders (President Bush, 4/2004)
Electronic Health Records for all Americans in 10 years
Appointment of a National Coordinator for Healthcare Informatics Technology (ONC/HHS)
The Decade of Health Information Technology: Delivering consumer-centric and information-rich health care
Inform clinical practice
Improve population health
Developing a Strategic Framework
Inform Clinical Practice
Improve Public Health
Defining Elements of Success for HIT
10 Year Vision and 3 Year Action Plan Accomplished
Based on a common “vision” of ideal EHR-enabled nursing practice
Focused on identifying the “gaps” in nursing preparedness to practice in an EHR-enabled environment
Agree to take actions within the next 3 years that can close these gaps
Main focus of deliverables is on the creation of educational tools and resources that can be shared with entire healthcare community
Action Plan with Specific Goals
Background – Overview of the topic including key projects, publications, and subject experts
Recommendations for significant gaps
70 organizations were represented at the Summit
Each committed to creating action plans aligned with the TIGER vision within their organization/membership
TIGER following organizational progress on these action plans over the next 3-years
Examples of organizational actions taken to date:
Distribution of TIGER Summary report to all professional members (AONE)
Presentations of TIGER at National and International Conferences (AMIA, ANIA/CARING, HIMSS, STTI, HIMSS-AsiaPac, SINI, I-MIA/MedInfo, ONS)
Regional presentations of TIGER (BANIC, State-HIMSS e.g., Colorado, Michigan, Wisconsin, N. California)
Professional organization presentations of TIGER (ASPAN, AORN, AWHOHN, MONE)
State-wide initiatives supporting TIGER vision (Minnesota, Massachusetts, Tennessee)
Matrix Approach – Phase II
Created from combining all 3-year action steps into common themes/topics
Standards and InteroperabilityJoyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS,VP, Informatics, HIMSSElizabeth C. Halley, RN MBA, The MITRE Corporation
Identify the most relevant HIT standard setting efforts that are important to the TIGER mission and ensure that there is adequate representation/input of the TIGER mission/perspective on said efforts.
Communicate the existence and importance of HIT standards and initiatives to the broad nursing community.
Create tutorials on standardizing data elements, implementing electronic health records, using nursing terminology, and using evidence-based practice tools.
WG#1 - Catalogue the most relevant Health IT standard setting efforts and related resources
Currently developing a comprehensive framework that consists of data standards, terminologies, standards, standards organizations, transaction standards, and infrastructure standards
Expand the framework to contain references, links, and relevant resources and contacts
WG#2 - Create tutorials related to standardized data elements, EHR implementation, nursing terminology, and the use of decision support and evidence-based practice tools
WG#3 – Create awareness campaigns to disseminate #2 and #3 to broader nursing community
WG#4 – Collect examples and case studies of interoperable systems to demonstrate the value of standards in various practice and education settings
Leveraging Health Information Exchange to Improve Quality and Efficiency – a review of the importance of HCIT standards in providing a foundation for interoperability, the current landscape for health information exchange, and the potential impact of HITSP specifications on consumers and healthcare systems
Introduction to the Standards Lifecycle and HITSP Harmonization Process – a detailed explanation of the lifecycle of standards development within the national HCIT agenda and how nurses can get involved in the interoperability effort
Facilitated Review of Specifications and Use Cases
Medication Management HITSP Interoperability Specification
Consultations and Transfers of Care Use Case
2. Health IT National Agenda/HIT PolicyCDR Alicia Bradford MS, RN-BC, Department of Health and Human Services, Office of the National Coordinator for Health ITDr. Carolyn Padovano PhD, RN, Director, SNOMED-CT
Identify the most relevant HIT agendas and policies that are important to the TIGER mission and ensure that there is adequate representation/input of the TIGER mission/perspective on said policy issues.
Communicate the existence and importance of the National HIT agenda and policies to the broad nursing community.
Create communication strategies that enable nursing participation in strategic HIT policy-setting efforts and disseminate policies back to the nursing community.
Engage Nursing participation to facilitate input and help disseminate information regarding national HIT initiatives in the following four areas:
WG#1 - Standards and interoperability efforts (ANSI-HITSP)
WG#2 - Clinical and policy initiatives generated by the AHIC/ONC workgroups, including use cases, clinical scenarios
WG#3 - Participate in the certification process for the electronic health record (such as reviewing/commenting on CCHIT work products)
WG#4 - Develop a communication and outreach strategy for which those materials can be widely disseminated to the TIGER and Nursing Community.
National Health Information Technology Agenda – a review of the Office of the National Coordinator (ONC), strategic framework, timeline of activities, and opportunities for nursing involvement in these activities.
Invited presentation to the AHIC/Sec. Leavitt re: National Health Workforce Preparedness
Dr. Carole Gassert, RN, PhD
Facilitated Discussion of HITSP Medication Management Interoperability Specification and AHIC Use Case on Consultations & Transfers of Care
Participate in AHIC meeting on Tuesday, February 26, 2008 from 10:15 a.m. – 4:00 p.m. at HIMSS (Rosen Center Rooms 9 &10) - meet at 9:45 a.m. outside the Rosen Center Room 9
3. Informatics CompetenciesConnie White Delaney, PhD, RN, FAAN, FACMI, Professor and Dean, School of Nursing University of MinnesotaBrian Gugerty DNS, RN, Clinical Informatician, Principal Consultant
Harmonize and set informatics competencies for all levels of nursing education: nursing assistants, associate degree, diploma, undergraduate and graduate.
Harmonize and set informatics competencies for nursing practice.
Advocate for and support adding informatics competencies into nursing specialty certifications.
Include informatics competencies in the scope and standard statements (and like documents) of nursing specialties.
WG#1 – Define the scope of this collaborative and adopt a framework for competencies within nursing and healthcare
Collect select non-informatics competency exemplars used within nursing (both practice and education) healthcare, and other industries
WG#2 – Develop a comprehensive inventory of competencies and resources gathered from the literature and ongoing programs
WG#3 – Develop a comprehensive inventory of competencies and resources gathered from practice and educational settings
Integration Team (HSG) – Harmonize the competencies collected from WGs 1-3 and synthesize into framework with proposed recommendations for the other TIGER teams to implement (Education, Staff Development, and Leadership)
Draft Recommendations – 4 Categories of Competencies:
Information Literacy Competencies
Information Management/Informatics Competencies
Attitudes & Awareness
Source: http://www.nsula.edu/watson_library/shreve/curri_enhanct.ppt#270,32,Slide 32
DC.1 (Care Management)
DC.1.1 (Record Management)
DC.1.2 (Manage Patient History)
DC.1.3 (Preferences, Directives, Consents and Authorizations)
DC.1.4 (Summary Lists) i.e. Manage Allergy, Intolerance and Adverse Reaction List
DC.1.5 (Manage Assessments)
DC.1.6 (Care Plans, Treatment Plans, Guidelines, and Protocols)
DC.1.7 (Orders and Referrals Management)
DC.1.8 (Documentation of Care, Measurements and Results)
DC.1.9 (Generate and Record Patient-Specific Instructions)
DC.2 (Clinical Decision Support)
DC.2.1 (Manage Health Information to Provide Decision Support)
DC.2.2 (Care and Treatment Plans, Guidelines and Protocols)
DC.2.3 (Medication and Immunization Management)
DC.2.4 (Orders, Referrals, Results and Care Management)
DC.2.5 (Support for Health Maintenance: Preventive Care and Wellness)
DC.2.6 (Support for Population Health)
DC.2.7 (Support for Knowledge Access)
DC.3 (Operations Management and Communication)
DC.3.1 (Clinical Workflow Tasking)
DC.3.2 (Support Clinical Communication) i.e. Support for Inter-Provider Communication
4. Education and Faculty DevelopmentDiane J. Skiba. PhD, FAAN, FACMI, Professor, UCDHSC & Chair, Task Force Faculty Development related to informatics, National League for Nursing Mary Anne Rizzolo, EdD, RN, FAAN, Senior Director, Professional Development, National League for Nursing
Use the informatics competencies, theories, research and practice examples throughout nursing curriculums.
Create programs and resources to develop faculty with informatics knowledge, skill and ability and measure the baseline and changes in informatics knowledge among nurse educators and nursing students.
Develop a task force to examine the integration of informatics throughout the curriculum.
Improve and expand existing Nursing/Clinical/Health Informatics education programs.
Encourage existing Health Services Resources Administration Division of Nursing to continue and expand their support for informatics specialty programs and faculty development.
Encourage foundations to start programs that provide funding for curriculum development, research, and practice in nursing informatics and IT adoption.
Develop strategies to recruit, retain, and train current and future nurses in the areas of informatics education, practice, and research.
Collaborate with industry and service partners to support faculty creativity in the adoption of informatics technology and offer informatics tools within the curriculum.
5. Staff Development/Continuing EducationElizabeth O. Johnson, MSN, BSN, RN, FHIMSS, Vice President of Clinical Informatics, Tenet Health SystemJoan M. Kiel, Ph.D., C.H.P.S., Chairman, University HIPAA ComplianceAssociate Professor, Duquesne University, Pittsburgh, PA
Create educational resources and affordable programs within the practice setting that foster IT innovation and adoption.
Create competency-based, cost-effective staff development and continuing education programs and training strategies specifically for informatics knowledge, skill and ability.
Improve and expand existing Nursing/Clinical/Health Informatics education programs by collaborating with industry, service and academic partners to support and enhance the use of technology and informatics in practice.
WG#1 - Collect case studies, practice examples, models of staff development programs from nursing, healthcare, other industries and develop a framework to categorize the models (e.g., web-based, face-to-face, etc.)
WG#2 - Review, inform and integrate work from the TIGER Competencies Collaborative into Staff Development Collaborative
WG#3 – Complete comprehensive literature review of staff development and field-based training models
WG#4 - Develop recommendations for Industry/Academic Partnerships – e.g., with technology partners, academic institutions, professional organizations, and others
WG#5 – Collaborate with the TIGER Leadership Development team to evaluate the impact of leadership development on staff development programs
Completed a survey to gather general information on the “state of staff development/continuing education” — e.g., who delivers the education, how computer literate are nursing staff as well as to help identify organizations that have innovative models of staff development and continuing education for case studies.
Currently collecting case studies from various practice environments
Comprehensive literature search – evaluation in progress
Currently evaluating recommendations from the informatics competencies for implementation into staff development/continuing education programs
6. Usability/Clinical Application DesignNancy Staggers, PhD, RN, FAAN, Associate Professor, Informatics and Interim Director, Informatics Program, College of Nursing, University of UtahMichelle R. Troseth, RN, MSN, Executive Vice President and Chief Professional Practice Officer, Clinical Practice Model Resource Center (CPMRC)
Design requirements and/or goals
Support evidence-based practice
Enables collaborative and interdisciplinary care
Provide seamless access to published literature, knowledge
Support the creation of new knowledge (knowledge discovery requirements)
Speed the translation of research into practice
Usability requirements and/or goals
Informed by and/or positively transforms nursing workflows
Systems designed using principles of human factors
Work with system developers to maximize clinical system effectiveness and efficiency for nurses
WG#1 – Develop a comprehensive literature review on topics related to usability and clinical application design. Obtain resources from nursing and other disciplines (e.g., Human Factors, Engineering, etc.)
WG#2 - Collect case studies and examples that illustrate usability/clinical application design from your experience/environment
Exemplars (good, replicable examples)
Lessons to be learned (bad examples that can help to inform others what to avoid)
WG#3 - Summarize recommendations for:
Highly usable applications
Good clinical application design
WG#4 - Develop recommendations for vendors for usability and good clinical application design
WG#5 - Develop a usability/clinical application “toolkit” for healthcare providers and organizations
Completed extensive literature search—in process of synthesizing the results
Currently collecting case studies and examples that illustrate usability/clinical application design from various practice experience/environment
Will start to synthesize and summarize recommendations in March for:
Highly usable applications
Good clinical application design
Virtual Demonstration CenterTeresa McCasky, RN, MBA, Chief Nursing Strategist, McKessonMarion J. Ball, Ed.D., FHIMSS, CHIME, IBM Research, Fellow, Center for Healthcare Management, Professor Emerita, Johns Hopkins University School of NursingJeanine Martin, Microsoft Corporation, US Provider Healthcare Industry
Provide visibility to the 10 year vision of IT-enabled nursing practice and education to broader healthcare audience by demonstrating how integrated IT systems impact nurses and the quality and safety of patient care.
Demonstrate the breadth and depth of IT resources in use by nurses to enhance their practice and educational environments.
Demonstrate collaboration between industry, healthcare organizations academic institutions, and professional organizations to create educational modules for nurses that are based upon informatics competencies.
Provide universal accessibility to this demonstration for all nursing stakeholders.
Use practice examples from different practice environments that can demonstrate best practices, results of research, case studies and lessons learned by partnering with nursing professional organizations.
Work Group 1 – Johns Hopkins/IBM – physical simulation lab
Work Group 2 – Future state scenarios based on the context of global trends (e.g., staff shortages, globalization, increases in chronic diseases, consumer empowerment, etc.). These will focus more on the abstract—or “art of the possible”.
Work Group 3 – Technology currently available today – A scenario-approach allows us to utilize current technologies (that are available today) and expand their use into the future.
8. Leadership DevelopmentDana Alexander, RN, MSN, MBA, Chief Nurse Officer, GE Healthcare Integrated IT SolutionsJudy Murphy, RN, FACMI, FHIMSS, Vice President, Information Services, Aurora Health Care, Milwaukee, WI
A relatively small investment of TIGER effort with nursing leaders will be multiplied many times due to the leaders’ power and influence in their organizations and the profession.
Develop programs for nurse executives that stress the value of information technology and empower them to use IT knowledgeably, giving the leaders of the profession a strong and identifiable voice.
Facilitate nursing leadership to understand, promote, own, and measure the success of IT projects.
WG#1 - Complete a comprehensive review of the literature, ongoing research, publications, subject experts, programs and other materials related to nursing leadership, leadership qualities, transformation and technology, leadership development programs, etc.
WG#2 – Incorporate informatics competencies into leadership development programs
WG#3 - Determine strategy for working with the magnet program
WG#4 - Complete an assessment of nursing leadership development needs
WG#5 – Synthesize the results from WG1-4 and develop the recommendations and summary report
9. Patient-Focus/Personal Health RecordCharlotte Weaver, RN, PhD, Vice President and Executive Director for Nursing Research, Cerner Corporation Rita D. Zielstorff, RN MS, PricewaterhouseCoopers LLP
Consumers are becoming more empowered healthcare participants. Informatics can mediate consumers drive for improved health and healthcare as well as broker the relationship between nurse and client.
Establish efforts to develop health information literacy with the public and healthcare consumers.
Work with Personal Health Record (PHR) advocates and developers to optimize PHRs as they relate to nursing.
12-15 Webinars (free to all nurses and nursing students – will provide CEU credit)
Summary Report for each Collaborative Team will include overview of issue, why important to nursing, case studies and examples, and recommendations for the industry
Virtual (on-line) Demonstration Center
Virtual Conference (demos, summary reports, interaction with industry experts, educational sessions, social networking)
Nursing Informatics 4th Edition: Where Caring and Technology Meet (available in print late 2009)
If you would like to get more involved or stay informed, please register at the TIGER website: www.tigersummit.com