Embed Size (px)
Citation preview
TIGER INITIATIVE
GROUP MEMBERS
Ashlyn Johnson [email protected]
Amy Vanbuskirk
[email protected] Amy Wiley
[email protected] Bethany HanenKrat
[email protected] Jessica Akemon
Kathleen Owens
[email protected] Shawn Kise
[email protected] Shelley Thiebeau
[email protected] Whitney Dunbar
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 .
