1. Technology Informatics Guiding Education Reform (TIGER) Update for AAN Pre-Conference Phase III Initiative Patricia Hinton Walker, PhD, RN, FAAN Vice President for Nursing Policy Uniformed Services University of the Health Sciences November/December, 2010

2. 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

3. TIGER (Technology Informatics Guiding Education Reform) Initiative Phase III TIGER Phase III Executive Committee Patricia Hinton Walker, Chair Dana AlexanderBarbara Frink Marion BallCarolyn Padovano Rosemary KennedyMary Walker Joyce SensmeierCarol Petersen Michelle TrosethAlicia Morton Roy SimpsonTeresa McCasky

4. Phase II Outcomes Virtual Learning Environment (VLE) Longer Term Implications Linking Phase II Outcomes to Virtual Learning Environment (VLE), Invitational Interdisciplinary Symposium and Longer Term Implications for Comparative Effectiveness and Personalized Medicine TIGER Phase III Vision Nine Collaboratives from Phase II Nine Collaboratives from Phase II: 1.Competencies 2.Education and Faculty Development 3.Staff Development 4.Leadership 5.Usability and Clinical Design 6.Standards and Interoperability 7.Health IT Policy 8.Virtual Demonstration Center (now VLE) 9.Consumers and Personal Health Record (PHR)

5. Dissemination of recommendationsDissemination of recommendations of nine collaboratives in TIGER Phase II; Developing the funding for, pilots and implementation of a Virtual Learning EnvironmentDeveloping the funding for, pilots and implementation of a Virtual Learning 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; relevant to future workforce issues minority, rural populations and consumersAddressing TIGER-related implications relevant to future workforce issues with specific emphasis for bridging the digital divide particularly with minority, rural populations and consumers, and EHRs and PHRs in future Best Practices Decision-SupportLonger term implications of use of EHRs and PHRs in future Best Practices Decision-Support such as: Comparative Effectiveness Research and Personalized Medicine; and Publication of TIGER II Collaborative reports in 4 th 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

6. 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.comhttp://ecdl.com –CSPlacement www.csplacement.comwww.csplacement.com –Healthcare Information and Management Systems Society www.himss.orgwww.himss.org –American Library Association http://ala.org/ala/mgrps/divs/acrl/standards/informationliteracycompetency.cfm http://ala.org/ala/mgrps/divs/acrl/standards/informationliteracycompetency.cfm –The Information Literacy in Technology http://www.ilitassessment.comhttp://www.ilitassessment.com –HL7 EHR System Functional Model http://www.hl7.org/EHR/http://www.hl7.org/EHR/ –ICDL-Health Syllabus http://www.ecdl.com (US-based ICDL-Health Syllabus)http://www.ecdl.com –Digital Patient Record Certification (DPRC) http://dprcertification.comhttp://dprcertification.com Page 6

7. Page 7 Component of the Model StandardSource (Standard- Setting) Body Basic Computer Competencies European Computer Driving License European Computer Driving License Foundation 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

8. 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. Page 8

9. 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 Page 9

10. 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. Page 10

11. Technology Informatics Guiding Education Reform (TIGER) Phase III Initiative Virtual Learning Environment and Strategic Collaborations

12. 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 12 The Challenge

13. 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! 13 Our Solution: TIGER Virtual Learning Environment (VLE)

14. Pilot(s): Virtual Learning Environment For Partnership Entities Education & Faculty Development Staff Development Usability & Clinical Design Standards & Interoperability Virtual Learning Environment Pilot Virtual Learning Environment Pilot Leadership 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 ?? Integration of Nine TIGER Collaboratives Content

15. 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

16. Virtual Communities & TIGER Open Door EHR Vendors Universities Community College Consortiums Regional Extension Centers Consumers Rural & Minorities Interdisciplinary Providers PWGPWG PWGPWG PWGPWG PWGPWG TIGER PWGPWG CC TIGER Open Door Partner WorkgroupClassroom Content Topic A Classroom Content Topic B A.Workforce Development B.Education & Faculty Development C.Future Workforce Development D.Leadership & Management E.Science & Technology F.Consumer EHRs &PHRs Virtual Communities TIGER Public Portal to free content in Resource Center Partners Portals access shared content & resources

17. TIGER Architecture Fundamental 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 TIGER Initiative Portal 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

18. Resource Center & Classroom Content EHR Vendors Universities Community College Consortiums Regional Extension Centers Consumers Rural Providers PWGPWG PWGPWG PWGPWG PWGPWG TIGER PWGPWG CC TIGER Open Door Partner WorkgroupClassroom 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.

19. TIGER Open DoorResource Center and TIGER 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 TIGER Open Door –The 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 TIGER VLE PartnersClassrooms Content Donated and/or Leveraged by 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

20. Complete Module/Course &/or Experiential Learning s Entry Survey, Registration, Select Learning Options Career and/or Informatics Competencies Assessment Healthcare or Health Informatics Occupation Tour Learning Community Advisor Exit Survey Certification(s) (recommendation) Register & Start Classes and/or Experiential Experiential Learning Learning Learning Community Advisor Learning Community Advisor Study Groupsclasses Part time job Home Workspace with books and reading materials Workforce Profile Name_________ Pre Workforce__ Entry Level ____ Current___ Post___

21. VLE Data Flow EHR Vendors Universities Community College Consortiums Regional Extension Centers Consumers Rural Providers PWGPWG PWGPWG PWGPWG PWGPWG TIGER PWGPWG C C C C C CC TIGER Open Door Partner WorkgroupClassroom Content Topic A Classroom Content Topic B Entry Survey & Demographics Exit Survey & Evaluation TIGER Database Repository VLE Partner Survey Copy

22. Proposed VLE Governing Structure Content Management Sub-Structure Content from Individual Volunteers Content from VLE Partners Competency Competency GroupGroup

23. VLE Governing Structure (explanation) Governing Council A 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) TIGER PartnersTIGER individual volunteersA Content Management Subgroup will contact and work with both TIGER Partners and 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. a competency-review –For VLE Pilot II, 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 GroupsInterdisciplinary and International Advisory Groups will review to determine if content needs to be ‘tweaked’ to meet international and interdisciplinary needs.

24. 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

25. Category Of Develop- ment EHRs Training PHRs Consumer Meaningful Use Usability & Clinical Design Clinical Decision Support Health Info Exchange HIE Standards & Inter- operability Comparative Effectiveness Research Web- Resource Case Studies Decision- Tree Develop Modules Competency Matching Simulation -Based Second Life Grid for Volunteer Development of TIGER Virtual Learning Environment

26. Technology Informatics Guiding Education Reform (TIGER) Phase III Goal Educate Nurses and Interdisciplinary Providers About: Evidence-Based Practice Benefit of Health IT Adoption

27. 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

28. 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

29. TIGER: Successful Nursing and Other Interdisciplinary Groups Successful when implementing Health IT!

30. 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/https://www.tigersummit.com/ –For information on Phase 3 and Phase II Executive Summary Report see http://www.allianceni.org/tiger.asphttp://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 Committeephintonwalker@usuhs.mil phintonwalker@comcast.net TIGER –NEW TIGER WEB-SITE READY SOON!!! www.thetigerinitiative.com

31. Technology Informatics Guiding Education Reform (TIGER) Update for AAN Pre-Conference Phase III Initiative Patricia Hinton Walker, PhD, RN, FAAN Vice President for Nursing Policy Uniformed Services University of the Health Sciences November/December, 2010