Technology Informatics Guiding Education Reform (TIGER) Update for AAN Pre-Conference

Phase III Initiative

Patricia Hinton Walker, PhD, RN, FAANVice President for Nursing Policy

Uniformed Services University of the Health Sciences

November/December, 2010

• TIGER Phase I

– Engaged stakeholders to create a common vision of electronic health record-enabled practice

• TIGER Phase II

– Facilitated collaboration among participating organizations to achieve the vision for practice and education through development of nine collaborative reports.

• TIGER Phase III - – Integrate interdisciplinary & allied health professionals into efforts, disseminate results, and

develop a Virtual Learning Environment to enhance widespread adoption of Health IT

• Allow informatics tools, principles, theories and practices to be used by nurses, other interdisciplinary providers and consumers

• Interweave enabling technologies transparently into practice, education and research to improve outcomes, patient safety and reduce costs of healthcare

• Better preparing workforce to use technology and informatics for improvement of patient care

TIGER Vision & Phases

TIGER (Technology Informatics Guiding Education Reform) Initiative Phase III

TIGER Phase III Executive Committee Patricia Hinton Walker, ChairDana Alexander Barbara FrinkMarion Ball Carolyn PadovanoRosemary Kennedy Mary WalkerJoyce Sensmeier Carol PetersenMichelle Troseth Alicia MortonRoy Simpson Teresa McCasky

Linking Phase II Outcomes Phase II Outcomes to Virtual Learning Virtual Learning Environment (VLE)Environment (VLE), Invitational Interdisciplinary Symposium and Longer Term Implications Longer Term Implications for Comparative Effectiveness and Personalized Medicine

TIGER Phase III Vision

Nine Collaboratives from Phase IINine Collaboratives from Phase II:1.Competencies2.Education and Faculty Development3.Staff Development4.Leadership5.Usability and Clinical Design6.Standards and Interoperability7.Health IT Policy8.Virtual Demonstration Center (now VLE)9.Consumers and Personal Health Record (PHR)

• Dissemination of recommendations Dissemination of recommendations of nine collaboratives in TIGER Phase II; 

• Developing the funding for, pilots and implementation of a Virtual Learning Developing the funding for, pilots and implementation of a Virtual Learning Environment Environment that enhances the adoption of informatics and technology. 

• Exploring application and integration of TIGERExploring application and integration of TIGER Phases I and II with nursing, interdisciplinary and allied health stakeholders through an interdisciplinary invitational symposium;

• Addressing TIGER-related implications relevant to future workforce issues relevant to future workforce issues with specific emphasis for bridging the digital divide particularly with minority, rural populations and consumersminority, rural populations and consumers, and

• Longer term implications of use of EHRs and PHRs in future Best Practices EHRs and PHRs in future Best Practices Decision-Support Decision-Support such as: Comparative Effectiveness Research and Personalized Medicine; and

• Publication of TIGER II Collaborative reports in 4th Edition of Nursing Informatics:  Where Technology and Caring Meet;

• Planting Seeds for TIGER International roll-out in Montreal, Canada - 2012

TIGER Next Steps!!!

2009 -2012 Phase III

Informatics Competencies Collaborative

• TIGER Competencies Collaborative (TICC) formed to establish a minimum set of competencies for ALL practicing nurses and graduating nursing students:

– Foundational to all TIGER work related to preparing nursing workforce for EHRs – TICC Collected over 1,000 informatics competencies from published literature

and practice examples – Established a Model for the organization of Competencies

• Informatics Competencies Educational Resources:– European Computer Driving Licence (ECDL) Foundation http://ecdl.com – CSPlacement www.csplacement.com – Healthcare Information and Management Systems Society www.himss.org – American Library Association

http://ala.org/ala/mgrps/divs/acrl/standards/informationliteracycompetency.cfm – The Information Literacy in Technology http://www.ilitassessment.com – HL7 EHR System Functional Model http://www.hl7.org/EHR/ – ICDL-Health Syllabus http://www.ecdl.com (US-based ICDL-Health Syllabus)– Digital Patient Record Certification (DPRC) http://dprcertification.com

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Component of the Model

Standard Source (Standard-Setting) Body

Basic Computer Competencies

European Computer Driving License

European Computer Driving License Foundation

Information Literacy Information Literacy

Competency Standards

American Library Association

Information Management

Electronic Health Records

Functional Model – Clinical Care Components

International computer Driving License - Health

Health Level Seven (HL7)

European Computer Driving License Foundation

Informatics Competencies Collaborative

Adapted from TIGER Competencies Report

Staff Development Collaborative

• Six Factors that lead to Success in Adoption of Health IT:– Addressing Staff Attitudes– Improving access to technology– Focusing on Patient Safety– Using a variety of Teaching Methods– Using Nursing Informatics Specialists as resources– Keeping the programming competency-based

• Recommendations:– Adoption of Health IT can be facilitated or impeded by attitudes toward

technology – First Step should be an assessment of attitudes and skills– Development of HIT-Focused Education should consider multigenerational

learning needs and styles (attention to digital immigrants and natives).– Develop competency-based education that utilizes pre- and post-tests to

demonstrate effectiveness in meeting competencies– Staff Development resources must have adequate access and opportunities to

develop their knowledge related to use of technology and adoption of Health IT.

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Usability and Clinical Design

• Recommendations to Administration, Vendors and Individual Health Care Providers:– Nurses must be involved from the outset with consideration to:

• Clinical Requirements• Safety and Usability• Human Factors• Evidence-Based Practice

– Nurses must be involved in ongoing training– Nurses (as end-users) involved in evaluation of the systems

and in the revision process.

• See Best Practice Exemplar (page 21) Usability and Clinical Design TIGER Collaborative Report for a Model

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Leadership Development Collaborative

• TIGER VISION FOR LEADERSHIP : Revolutionary Leadership that drives, empowers, and executes the transformation of healthcare through the use of Health IT. – RECOMMENDATIONS

• Develop programs for nurses and other healthcare executives and faculty that stress the value of information technology

• Empower them to use Health IT knowledgably

• Expand and integrate informatics competencies into Nursing and Healthcare Leadership and Management Development Programs.

• Promote sharing of best practices using Health IT effectively to improve the delivery of nursing care.

• Promote alignment with the Magnet Recognition Program as a mechanism to demonstrate nursing excellence in using technology to improve nursing practice and the delivery of safer, more effective patient care.

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Technology Informatics Guiding Education Reform (TIGER)

Phase III Initiative

Virtual Learning Environment and Strategic Collaborations

• Without access to health IT tools such as: EHRs, PHRs, CPOE, and other health IT related technologies to enhance learning, there are distinct challenges for:– Educators in universities and community colleges cannot prepare

the workforce of the future unless they learn new health IT technologies

– Staff development educators in hospitals and other care delivery settings cannot prepare the current interdisciplinary workforce

– Minority populations do not have equal internet access for learning– Small rural hospitals cannot afford training materials and educators

to teach staff new health IT technologies– Individual providers in small practices and/or rural settings do not

have access enough to know which systems to purchase to meet goals of ‘meaningful use’ or how to use the systems when purchased

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The Challenge

• Developed from TIGER Phase II Collaborative Reports

– Initially TIGER Competencies

– Amended to include national QSEN Competencies (RWJ Funded)

– Integrate Competency Examinations (from ONC grants)

– Integrate content from nine TIGER collaborative reports

• Designed through interdisciplinary collaboration serving nurses, other interdisciplinary groups, rural health and minority populations

• Designed to address traditional and futuristic instructional design through technology-enhanced learning including:

– Tutorials

– Scenario-based learning including pre-post tests

– Traditional online learning

– Second Life and Educational gaming/modules/scenarios

• Plan for Open-sourced system housed in Government or Non-Government setting to ensure it belongs to the people!

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Our Solution: TIGER Virtual Learning Environment (VLE)

Pilot(s): Virtual Learning EnvironmentFor Partnership Entities

Education & Faculty

Development

Education & Faculty

Development

Staff Development

Staff Development

Usability & Clinical Design

Usability & Clinical Design

Standards & Interoperabilit

y

Standards & Interoperabilit

y

Virtual Learning

EnvironmentPilot

Virtual Learning

EnvironmentPilot

LeadershipLeadership

Health IT Policy

Health IT Policy

Proposed Early Pilot Groups Can Include Partners such as: - American Nurses Assoc.? - National League for Nursing? - American Federation of Teachers? - Univ. Pitt Nursing & Medicine? - Selected Universities Baylor? Kansas? - Specialty Organizations (AORN and ??

Evaluation data:•What modules taken•Demographics•Type of profession•Outcomes

•Regional•National

Learning modules

Virtual communities

EHR Vendors

Universities

Community College Consortiums

Regional Extension Centers

Consumers

Rural & Minorities

Faculty /Students& Interdisciplinary

Colleagues

Conceptual Design of TIGER Virtual Learning Environment

Virtual Communities & TIGER Open Door

EHR Vendors

Universities

Community College Consortiums

Regional Extension Centers

Consumers

Rural &Minorities

InterdisciplinaryProviders

PWG

PWG

PWG

PWG

TIGER

PWG

TIGER

TIGER Open Door

Partner Workgroup Classroom Content Topic A

Classroom Content Topic B

A. Workforce DevelopmentB. Education & Faculty

DevelopmentC. Future Workforce DevelopmentD. Leadership & ManagementE. Science & TechnologyF. Consumer EHRs &PHRs

Virtual CommunitiesVirtual Communities

TIGER Public Portal to TIGER Public Portal to free content in free content in

Resource CenterResource Center

Partners Portals access shared

Partners Portals access shared

content & resources

content & resources

Fundamental TIGER Architecture TIGER Architecture

Core TIGER Web Site/Server • Developed and maintained by TIGER Host with guidance from TIGER Executive Leadership.• Envisioned to include one or more databases.• Data used for Research and Evaluation.

Exchange• Learning Content could reside on all or any of the Host, the Partner, or Industry Members’ servers and, optionally, could be shared among any/all.•Copies of updated TIGER Web Site provided periodically to partner hosting organizations.• Some or all Organization TIGER Database records entered by Web Clients would be automatically periodically replicated to Core TIGER Master Database.

Replication• The process of sharing information between databases or site code to ensure that the content is consistent among systems. Replication is normally used to increase the number of clients to be served, thereby reducing the load on each.

Partner PITT & Others

Partner Nursing

Spectrum

Partner ANA & NLN Partner

JALC/NoVA

Partner AFT

Core TIGERInitiative

Portal

Partner’s Web

Clients

Partner’s Web

Clients

Partner’s Web

Clients

Partner’s Web

Clients

Partner’s Web

Clients

Partner ?

Partner NLM

Industry :Industry Participate by sharing tools, demonstration and scenario based

EHRs and PHRs and Decision Support and/or training in kind and/or funding

Resource Center & Classroom Content

EHR Vendors

Universities

Community College Consortiums

Regional Extension Centers

Consumers

Rural

Providers

PWG

PW

G

PW

G

PW

G

TIGER

PWG

TIGER

TIGER Open Door

Partner Workgroup Classroom Content Topic A

Classroom Content Topic B

Resource Center Contains Web-based Library Links to Free

Learning Content & Documents

Classroom Content Topics will be Organized According to Leveled TIGER Competencies & QUSEN Competencies when

applicable.

• Resource Center and TIGER Open DoorTIGER Open Door– The Portion of the VLE that contains materials readily available on the web such

as:• Free Web-Based Resources and Health IT-related documents• Free Webinars and/or Demonstration Modules

– The TIGER Open Door TIGER Open Door provides:• Access to all resources by providers, faculty, students and consumers• Access without being a member of one of the TIGER VLE Partners

• Classrooms Content Donated and/or Leveraged by TIGER VLE Partners TIGER VLE Partners such as:– Case-Based Scenarios linked to EHRs and Clinical Decision Support– Scientific Content such as: Comparative Effectiveness Research– Content related to challenges of Adoption of Health IT including:

• Web Links

• Information related to relationship of content to potential certification

• Reading Lists

Resource Center and Classroom Content

Complete Module/Course

&/or Experiential Learning

s

Entry Survey,Registration ,

Select LearningOptions

Career and/or Informatics

CompetenciesAssessment

Healthcare or Health

Informatics Occupation

Tour

Learning Community

Advisor

Exit Survey Certification(s)

(recommendation)

Register & Start Register & Start Classes and/orClasses and/or ExperientialExperiential LearningLearning

Learning Community

Advisor

Learning Community

Advisor

Study Groupsclasses

Part time job

Home Workspace with books and reading materialsWorkforce Profile

Name_________Pre Workforce__Entry Level ____Current___Post___

VLE Data Flow

EHR Vendors

Universities

Community College Consortiums

Regional Extension Centers

Consumers

Rural

Providers

PWG

PWG

PWG

PWG

TIGER

PWG

TIGER

TIGER Open Door

Partner Workgroup Classroom Content Topic A

Classroom Content Topic B

Entry Survey & Demographics

Exit Survey & Evaluation

TIGER Database Repository

VLE Partner Survey Copy

Proposed VLE Governing StructureProposed VLE Governing Structure

Content Management Sub-Structure

Content from Content from Individual VolunteersIndividual Volunteers

Content fromContent fromVLE PartnersVLE Partners

Competency

Gr

ou

p

VLE Governing Structure (explanation)

• A Governing Council Governing Council will be established to be the final approval of content and learning experiences in the Virtual Learning Environment to ensure educational integrity including:

–Members from Academic Communities such as University of Kansas and University of Minnesota and University of Colorado

–Members from the Staff Development Community (for providers)

–Members from the Nursing Student organization to ensure relevance to youth and other representative groups (such as minority populations)

•A Content Management Subgroup will contact and work with both TIGER PartnersTIGER Partners and TIGER individual volunteers TIGER individual volunteers to obtain content and learning experiences:

–These will be evaluated for relevance and meeting pre-established criteria – then to the Governing Council for review and posting to TIGER VLE Server.

–For VLE Pilot II, a competency-review a competency-review will take place to determine which competency the learning experience addresses – then will be sent on to VLE Governing Council for final decision.

•Interdisciplinary and International Advisory Groups Interdisciplinary and International Advisory Groups will review to determine if content needs to be ‘tweaked’ to meet international and interdisciplinary needs.

VLE Community Developing the Content

Examples of Content and Resources: 1. Potential Content available in Organization and Emerging Partners such as:

ANIA-CARING, NLN, STTI, NNSDO, HiMSS, NLM, Nursing Spectrum, ANA, AFT, Banner Health SIM Center, industry members, AORN, other specialty organizations and others

2. Conference Presentations/Webinars from above partners and others

3. Selected Vendor Training educational materials and product videos possibly used as is or in second life (consistent with TIGER vision)

4. University Based and Community College Modules (as partners with outputs from some current grants)

5. Educational tools to assist in clinical decision support and use of future Comparative Effectiveness Research outputs

6. Web-based audio/video training modules re: Adoption of Health IT

7. White paper-type documents, report, articles and publications

8. WEB-Based Free Resources in the Resource Section of the VLE

Category Of Develop-

ment

EHRs Training

PHRs Consumer

Meaningful Use

Usability &

Clinical Design

Clinical Decision Support

Health Info Exchange

HIE

Standards&

Inter-operability

ComparativeEffectiveness

Research

Web-Resource

Case Studies

Decision-Tree

Develop Modules

Competency Matching

Simulation-Based

Second Life

Grid for Volunteer Development of TIGER Virtual Learning Environment

Technology Informatics Guiding Education Reform (TIGER)

Phase III Goal

Educate Nurses and Interdisciplinary Providers About: Evidence-Based

Practice Benefit of Health IT Adoption

Health IT Adoption: EHRs + Best Practice (and Evidence-Based Practice)

• EHRs will facilitate the creation of evidence that is directly relevant to everyday clinical decisions.

• EHRs greatly increase real-time access to knowledge in the practice setting.

• EHRs offer a novel approach to the creation of clinical knowledge, in which observing, intervening, and creation of clinical evidence are part of the normal clinical encounter.

• Registries and Clinical Data Repositories for Health Information Exchange (HIE):– Registries represent a unique and powerful model for

the collection of observational, epidemiologic, health management, economic and other outcomes data.

Background

TIGER III Goal: Educate Providers about Evidence-Based Practice Benefits of Health IT Adoption

• Nurses, physicians and other interdisciplinary providers need to:– Understand more about Comparative Effectiveness Research (CER)– How EHR data can be used for research purposes– How EHR data in the future can inform practice through CER

• Nurses and Other Health Care Scientists need to become aware of and where relevant, develop expertise in:– Research Methodologies used in CER– Privacy Requirements related to use of clinical data– Possibilities of the changes in Evidence-Based Practice with increase

of CER

• More clearly identify clinical and other relevant data that should be captured to inform future CER research

Comparative Effectiveness Research

TIGER: TIGER:

Nursing and Other Interdisciplinary Groups SuccessfulSuccessful when implementing Health IT!

TIGER Is ALIVE and WELL! • For more information and to participate:

– The first TIGER Summary Report and Executive Summary Phase II Report is available at https://www.tigersummit.com/

– For information on Phase 3 and Phase II Executive Summary Report see http://www.allianceni.org/tiger.asp

– For TIGER Phase III, contact Patricia Hinton Walker, PhD, RN, FAAN @ phintonwalker@usuhs.mil or phintonwalker@comcast.net and/or Any Member of the TIGER Executive Committee

– NEW TIGERTIGER WEB-SITE READY SOON!!!

www.thetigerinitiative.com

Technology Informatics Guiding Education Reform (TIGER) Update for AAN Pre-Conference

Phase III Initiative

Patricia Hinton Walker, PhD, RN, FAANVice President for Nursing Policy

Uniformed Services University of the Health Sciences

November/December, 2010