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The TIGER Initiative

Monday March 14, 2011
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In 2004, former President George W. Bush set a goal that most Americans would have electronic health records by 2014. For nurses passionate about the benefits of high technology in the healthcare setting, this announcement was cause for celebration.

But their excitement was dampened several months later when nurses were not represented at a much-anticipated health information technology summit held by the Office of the National Coordinator for Health Information Technology, the federal entity created to administrate the EHR program. During the summit, leading medical groups from across the country met to discuss strategies to help the country achieve the EHR adoption goals.

Aware that nurses — who represent the largest healthcare occupation — would play a critical role in helping the country prepare for the arrival of EHR, a group of about a dozen nurses informally met to discuss how they could rally around this objective. This meeting laid the foundation for a grassroots organization called the TIGER Initiative (Technology Informatics Guiding Educational Reform), a group leading the charge to help the healthcare industry embrace the high-tech revolution transforming patient care.

“We realized that we had to do something,” says Patricia Hinton Walker, RN, PhD, PCC, FAAN, chairwoman of the third phase of the TIGER Initiative. “We knew that nursing needed to have a voice in the changes that were coming. We also understood that nursing was not ready for the healthcare IT changes on the way and we needed to do something to prepare the nursing profession.”

Since that meeting, the TIGER Initiative has grown to include more than 1,500 nurses and people from other disciplines who are working toward a common goal: to prepare nurse educators, researchers and practicing nurses to thrive in the emerging technological era in healthcare.

Meeting of the Minds

After the initial informal meeting, the group formed an executive steering committee of 14 members representing a variety of universities, informatics associations and healthcare organizations. Most were nurses; all were volunteers.

“We realized that nursing needed to be part of a team of healthcare professionals all working together like an orchestra to facilitate the large IT task ahead of us,” says Marion Ball, EdD, senior adviser for IBM Research and an original TIGER steering committee member. “If you do not have a conductor to help the instruments play together, you can’t make excellent music. We wanted TIGER to be the conductor.”

The steering committee immediately began planning an interactive summit to gather leaders from a variety of nursing constituencies.

“We knew that the majority of people in nursing leadership were what are called ‘digital immigrants,’” says Walker, vice president for nursing policy at Uniformed Services University of the Health Sciences in Maryland. “These were people who were generally older, so digital, technology-driven communication was a second language because they didn’t grow up with it. Our intent with the summit was to get the profession together to raise awareness that IT-enabled healthcare was coming and discuss how we could prepare nurses across the profession.”

More than 100 nursing leaders attended the TIGER Summit in 2006. The two-day program included a gallery walk in which participants rotated through different stations where experts educated participants about health IT, such as different forms of EHRs, how care plans could be done electronically and clinical decision support. Participants then worked together in groups to form a 10-year vision and three-year action plan that would pave the way for a smooth introduction of informatics into nursing.

“People were really enthusiastic because our profession doesn’t always speak with the same voice,” Walker says. “We brought specialty groups together that don’t usually work side- by-side to accomplish a common goal that could change the profession.”

Following the summit, the TIGER Initiative launched the second phase by forming nine collaborative teams who would work to implement the action plan. For the next two years, the teams met via phone to decide what needed to be accomplished and delegated tasks to different volunteers on the call. More than 1,500 nurses worked together on these teams, which included numerous subcommittees.

During the second phase, one of the most daunting — and most necessary — tasks was to identify what competencies were needed in order to be successful in both practice and education environments that used health IT. After reviewing more than 1,000 competencies, members of the TIGER team came up with a comprehensive list of knowledge and skills nurses would need. This information was released in January 2011 in the book "Nursing Informatics: Where Technology and Caring Meet." The book also covers critical information from TIGER teams that explored topics such as strategies for culture change in healthcare and staff development for IT.

One sign that nursing informatics is gaining momentum came to light two years ago. One of the nine TIGER collaborative teams had made recommendations for all levels of nursing to include informatics content in nursing education. Subsequently, the National League for Nursing and the American Association of Colleges of Nursing have incorporated informatics content and competencies into the requirements for accreditation.

Then in 2009, informatics advocates were pleased when President Obama not only endorsed Bush’s 2014 goal, but also included significant funding to go toward meeting that goal. In the American Recovery and Reinvestment Act of 2009, about $20 billion in funding was allocated to healthcare IT. Now the strategies the TIGER Initiative had been working on were an even higher priority throughout the nation.

“We had started this work with the summit in 2006, so when Obama was elected, the nursing profession was already three years ahead of where everyone else was starting,” Walker says. “Suddenly people were asking what competencies were needed, and we already had that prepared to share.”

Now in its third phase, the TIGER Initiative’s main goal is to use high-tech tools to facilitate the sharing of information between different healthcare stakeholders. TIGER is developing a virtual learning environment where users can include videos, PowerPoint presentations and other content related to health IT.

In February, TIGER cleared two major hurdles in the effort to establish a VLE. First, IBM contributed a server to support the project. Two weeks later, the Healthcare Information and Management Systems Society agreed to sponsor TIGER to become a tax-exempt 501(c)(3) group. This status as an official charitable organization will allow TIGER to seek funding and other support, and to create strategic partnerships for content contribution to the VLE.

“We are talking about ideas like putting avatars on the VLE, and modules that are computer- based training on how to use a specific technology within the context of clinical workflow,” says Dana Alexander, RN, MSN, MBA, a member of the TIGER executive committee. “We hope to create a place where organizations can share learning resources with others that have been helpful to them as they embrace modern technology.”

The information in the VLE will be available for healthcare providers of all disciplines. In fact, TIGER leaders like Walker are already receiving requests to share information with physicians, physical therapists, dieticians and diabetes educators.

“I love nursing, and I believe we have a whole lot to offer,” Walker says. “Frequently, we as a profession have been late to the table when it comes to making changes. Part of what I enjoy about TIGER is that we are all about action and the future. We see the difference we could make in healthcare in this country through informatics, and that is exciting.”

Heather Stringer is a freelance writer.


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