This article will discuss a few of the topics that are important in advancing the acceptance of informatics into nursing practice.
TIGER (Transforming Informatics Guiding Education Reform) is a group of nursing leaders and advocates that set forth to increase nursing involvement in the advance of health information technology. It began with a few concerned and motivated individuals who wanted to increase representation of the nursing profession in the transformation of health care. The objectives of the TIGER organization were to first engage stakeholders to create a common vision of the ideal informatics enabled nursing practice. The second step was to facilitate collaboration to achieve the vision. This collaboration has been established with the formation of collaborative committees to address the 9 topics that will achieve the vision.
Each collaborative team has volunteers from different medical organizations that communicate with others to share information. They establish workgroups that have specific goals which produce measurable outcomes. These results can be accessed at the TIGER website, and are very informative.
The discussion of each topic started with the question: What does every practicing nurse need to know about this subject?
One of the topics is the standards and interoperability collaborative. Interoperable systems rely on standard expression of nursing data. TIGER submits that if a standard way of describing nursing practice was developed, communication and accurate description of nursing care would allow comparison of nursing data from different settings, population or geographic regions. It would also enable measurement of the impact of nursing interventions on patient outcomes.
Health care organizations need evidence based, interoperable technology that supports education and practice. Systems should promote use of data for analysis but more importantly clinical decision making, to improve care quality.
The use of technology will facilitate communication and collaboration that is needed across the continuum of care. For an ideal learning environment to be created, generational and learning styles and attitudes towards informatics must be considered, so that informatics will be accepted wholeheartedly, not resisted. Current implementation processes must be evaluated for improvement. In education collaborative learning communities will use technology to share knowledge and therefore best practices
A vital part of TIGER’s groundwork is raising awareness of successful informatics practice so that other medical organizations can benefit and learn from their experiences: Here are some examples.
Innovative work in practice: Electronic Medical Records communicate change across multiple sites. Electronic health records that nurses contribute to enable care plans and reports to be written in a timely manner and with the help of automated practice alerts.
Innovative work in education seeks to link clinical and educational sites. Tools such as hand held devices for student documentation of clinical encounters, or telehealth where technology links patients, clinical sites, students, and faculty in remote areas. Telehealth also enables students to learn in a wider practicum experience. Informatics will also increase the availability of research to inform practice more quickly and efficiently.
The localization of TIGER vision is being established, and will help extend the nation wide use of informatics in nursing. For example Minnesota, California, and Massachusetts have incorporated the TIGER vision. In 2007 ANI and other nursing informatics and government organizations adopted the TIGER mandate.
Often nurses do not have access to new technology, they are only familiar with what is in use that their workplace, or if they are new graduates their only exposure to informatics may have been during their practicum. Therefore TIGER is creating demonstration projects for modeling collaborative relationships across continuum of care. They are called the Virtual Demonstration Centers(VDCs). THE VDCs are located online and hope to eventually have a physical location.
The key is availability, the VDC can be accessed wherever the internet is in use. Nurses can visit demonstration labs of innovative care scenarios where nurse focused technology is in use. They can also network and access contacts anywhere in the nation or world. The VDC are aiming for full interactive capability. They also show how collaboration between medical and professional organizations, academic institutions, and industry can provide synergy.
The third objective is to engage more nurses in the development of a national health information technology infrastructure that is patient centered. Nurse input is vital to ensure that any future national system will in fact be effective, because any system will impact their work the most.
Strategies need to be identified to increase influence and presence of nursing in government and legal bodies. Executives and leadership must articulate the value of informatics. Policy incentives are needed to support and advance coalition building with goal of safer health care. Nurses’ involvement in national health information agendas, congressional testimony, participation in policy decisions would be beneficial in advancing the widespread adoption of health information technology, as well as funding for curriculum, exploration, research, practice in nursing informatics. Identification of incentives that encourage innovation in technology will be explored. TIGER supports a patient health record for all citizens.
The National League for Nursing has stated that education reform is necessary .In their survey of academic institutions they have discovered that faculty has not distinguished between computer literacy, information literacy, and informatics Therefore the first step in that reform is for academic institutions to arrive at a consensus of the definition of informatics and to establish it in the core curriculum. They must also establish minimum competencies for graduates. This means of course that instructors must be well versed in informatics to be able to teach others, or to ensure that nurse informaticists are part of the faculty. In 2006 only 60% of respondents to the survey indicated that clinical experience with information technology was provided.
Academic institutions can also advance informatics by identifying clinical settings that demonstrate integration of informatics that transform clinical practice. They can also partner with other organizations to increase availability of expensive resources. TIGER will seek funding for curriculum innovations and partner with industry leaders, academic, and accrediting institutions
Decreased documentation time will enable nurses to provide more care which results in fewer medical complications, shorter hospital stays, and lower mortality rates. Also decreased documentation time and increased availability of data at the point of care through informatics will facilitate clinical decisions, research and teaching.
Informatics can fulfill its potential and be a powerful tool if it is presented in a way that present and future nurses see its worth. When nurses see informatics as a help and support then it will be applied during the course of nurse work. Informatics needs to support the foundation of nursing values which are knowledge and caring. Only then will it help nurses achieve better quality of care and efficiency.
Sources:
http://www.nln.org/aboutnln/positionstatements/informatics_052808.pdf
http://tigersummit.com/uploads/TIGER_Collaborative_Exec_Summary_040509.pdf
http://tigersummit.com/uploads/TIGERInitiativeReport2007.pdf
http://tigersummit.com/uploads/Action_Plan.html
http://tiger.leadership.pbwiki.com
http://tiger.virtualdemo.pbwiki.com
http://tiger.useability.pbwiki.com
http://tiger.staffdev.pbwiki.com
http://tiger.education.pbwiki.com
http://tiger.competencies.pbwiki.com
http://tiger.standards.pbwiki.com
http://tiger.hitagenda.pbwiki.com
