There has been exciting progress in meeting the goals identified in the TIGER Summit of October 2006. Nine Collaboratives are working to integrate enabling technologies transparently into nursing practice and education, making information technology the stethoscope for the 21st century. The Collaboratives are focused on activities that will better prepare the nursing work force to make use of informatics tools, principles, theory, and practices in providing healthcare that is not only safer but also more effective, efficient, patient-centered, timely, and equitable.

With more than 260 participants from the profession, the collaborative teams bring together nurses from healthcare provider organizations, nursing schools, nursing specialty associations, government agencies, nursing informatics organizations, and other groups. During the next year, each Collaborative will assess its area of emphasis, prepare needed documents, and share its findings across the nursing profession through targeted outreach activities.

An example of the difference that the TIGER Initiative is making is illustrated by the recent opportunity to present the nursing position on healthcare work force preparedness for the electronic health record (EHR). On September 25, 2007, a panel of experts was asked to present information relative to the adoption of health information technology (IT) to the Electronic Health Records Workgroup of the American Health Information Community. The objective of the meeting was to define key elements, challenges, and solutions related to the healthcare work force and IT adoption. Panel members were Linda L. Kloss, RHIA, CAE, FAHIMA, CEO of AHIMA; Don Detmer, MD, MA, President of AMIA; Don Schoen, CEO and President MediNotes, HIMSS EHR VA; and Carole A. Gassert, RN, PhD, FACMI, FAAN, ANI Co-Chair representing nursing education and the TIGER initiative.

Dr. Gassert's presentation slides have been made available on the TIGER Web site (http://www.tigersummit.com). A follow-up letter emphasizing the needs of nursing relative to work force preparation and adoption of IT and the summary of needs identified at the TIGER summit is also available on this site.

All nine teams have met to identify specific goals, articulate next steps, and assign tasks to members. Support for the Collaboratives is provided by TIGER Program Director Donna DuLong, who is coordinating their monthly meetings, assisting in documenting their progress, and acting as liaison for the team leaders and participants. A more detailed explanation of the goals and activities of each of the nine Collaboratives is presented here. Updates on all these activities are available at the TIGER Web site.

THE COLLABORATIVES

Collaborative 1. Standards and Interoperability. Facilitators: Joyce Sensmeier, MS, RN-BC, HIMSS, and Elizabeth C. Halley, RN, MBA, Mitre Corporation

1. Identify the most relevant healthcare information technology (HIT) standard setting efforts that are important to the TIGER mission and create an inventory and resource list that includes publications, standards organizations, research, case studies and exemplars, ongoing projects, and subject matter experts.

2. Assess whether there is adequate representation/input of the TIGER mission/perspective on said efforts and take action to close any gaps that exist.

3. Communicate the existence and importance of HIT standards and interoperability initiatives to the broad nursing community via awareness campaigns.

4. Create and disseminate tutorials on standardizing data elements, implementing EHRs, using nursing terminology, using evidence-based practice tools, and the importance of interoperability.

Collaborative 2. Health IT National Agenda/HIT Policy. Facilitators: CDR Alicia Bradford, MS, RN-BC, Office of the National Coordinator for Health IT, and Carolyn Padovano, PhD, RN

1. Identify the most relevant HIT national agenda/policy issues that are important to the TIGER mission and create an inventory and resource list that includes reference to publications, policy-making organizations, research, case studies and exemplars, ongoing projects, and subject matter experts.

2. Engage nursing participation to facilitate input and help disseminate information regarding national HIT initiatives in the following four areas:

a) Standards and interoperability efforts (ANSI-HITSP)

b) Clinical and policy initiatives generated by the AHIC/ONC workgroups, including use cases, clinical scenarios

c) Participate in the certification process for the HER (such as reviewing/commenting on CCHIT work products)

d) Develop a communication and outreach strategy for which those materials can be widely disseminated to the TIGER and Nursing Community.

Collaborative 3. Informatics Competencies. Facilitators: Connie White Delaney, PhD, RN, University of Minnesota School of Nursing, and Brian Gugerty, DNS, RN

1. Harmonize and set informatics competencies for all levels of nursing education and nursing practice. This includes defining these competencies and providing a framework to clarify competencies within various nursing practice and education settings.

2. Develop an inventory and resource list that includes a comprehensive literature review, publications, research, case studies and exemplars, ongoing projects to watch related to competencies, and subject matter experts.

3. Advocate for and support including informatics competencies into the scope and standard statements (and like documents) and certification process of nursing specialties.

Collaborative 4. Education and Faculty Development. Facilitators: Diane J. Skiba, PhD, FAAN, FACMI, University of Colorado, and Mary Anne Rizzolo, EdD, RN, FAAN, National League for Nursing

1. Use the informatics competencies, theories, research, and practice examples throughout nursing curriculums.

2. 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.

3. Develop a task force to examine the integration of informatics throughout the curriculum.

4. Improve and expand existing Nursing/Clinical/Health Informatics education programs.

5. Encourage existing Health Services Resources Administration Division of Nursing to continue and expand their support for informatics specialty programs and faculty development.

6. Encourage foundations to start programs that provide funding for curriculum development, research, and practice in nursing informatics and IT adoption.

7. Develop strategies to recruit, retain, and train current and future nurses in the areas of informatics education, practice, and research.

8. Collaborate with industry and service partners to support faculty creativity in the adoption of informatics technology and offer informatics tools within the curriculum.

Collaborative 5. Staff Development/Continuing Education. Facilitators: Elizabeth O. Johnson, MSN, BSN, RN, Tenet Health System, and Joan M. Kiel, PhD, Duquesne University

1. Create educational resources and affordable programs within the practice setting that foster IT innovation and adoption. This team will start by collecting case studies, practice examples, and models of innovative and effective staff development programs within nursing, healthcare and other industries that can be tested and replicated.

2. Use the informatics competencies, theories, research, and practice examples throughout staff development and continuing education programs.

3. Develop recommendations for effective partnerships with industry, academic programs, nursing professional organizations, and technology developers that support competency-based field education programs.

Collaborative 6. Usability/Clinical Application Design. Facilitators: Nancy Staggers, PhD, RN, University of Utah, and Michelle R. Troseth, RN, MSN, Eclipsys

1. Develop design requirements and/or goals that support evidence-based practice, enable collaborative and interdisciplinary care, provide seamless access to published literature and knowledge, support the creation of new knowledge, and speeds the translation of research into practice.

2. Develop usability requirements and/or goals that are informed by and/or positively transform nursing work flows, systems designed using principles of human factors, and work with system developers to maximize clinical system effectiveness and efficiency for nurses.

3. Create an inventory and resource list for both usability and clinical application design that includes case studies and examples, publications, research, ongoing projects to watch, and subject matter experts.

4. Develop a usability/clinical application "toolkit" for healthcare providers and organizations.

Collaborative 7. Virtual Demonstration Center. Facilitators: Teresa McCasky, RN, MBA, McKesson, Marion J. Ball, EdD, IBM and Johns Hopkins, and Jeanine Martin, Microsoft

1. Provide visibility to the 10-year vision of IT-enabled nursing practice and education to the broader healthcare audience.

2. Demonstrate the breadth and depth of IT resources in use by nurses to enhance their practice and educational environments.

3. Demonstrate collaboration among industry, healthcare organizations academic institutions, and professional organizations to create educational modules for nurses that are based upon informatics competencies.

4. Provide universal accessibility to this demonstration for all nursing stakeholder groups.

5. 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.

6. Demonstrate how integrated IT systems impact nurses and the quality and safety of patient care.

Collaborative 8. Leadership Development. Facilitators: Dana Alexander, RN, MSN, MBA, GE Healthcare, and Judy Murphy, RN, Aurora Health Care

1. Develop programs for nurse executives that stress the value of information IT and empower them to use IT knowledgeably, giving the leaders of the profession a strong and identifiable voice.

2. Complete an assessment of nursing leadership development needs and create an inventory and resource list that includes reference to publications, organizations, research, case studies and exemplars, ongoing projects to watch, and subject matter experts.

3. Facilitate nursing leadership to understand, promote, own, and measure the success of IT projects.

4. Develop a strategy for nursing informatics to be integrated within the magnet program.

Collaborative 9. Patient-Focus/Personal Health Record. Facilitators: Charlotte Weaver, RN, PhD, Cerner, and Rita D. Zielstorff, RN, MS, PricewaterhouseCoopers

1. Establish efforts to develop health information literacy with the public and healthcare consumers and create an inventory and resource list that identifies consumer groups in healthcare, trends in consumer behavior and linkage to Internet use, health policy groups advocating for patient-centered care, and trends driving patient engagement.

2. Work with personal health record (PHR) advocates and developers to optimize PHRs as they relate to nursing.

3. Develop an inventory and resource list on PHRs that includes a definition, discussion of content and standards, how PHRs fit into larger EHR systems and the Nationwide Health Information Network (NHIN), usage and users of PHRs, innovations and business models, suppliers of PHR products, and the impact on nursing.

4. Communicate the existence and importance of PHR initiatives to the broad nursing community, including nursing's unique contribution to PHR design and development of consumer use of PHRs.

The Alliance for Nursing Informatiacs (ANI) became the enabling organization for the TIGER initiative in 2007. Through the ANI sponsors, American Medical Informatics Association and Health Information Management Systems Society, ANI supports the TIGER program director position.