1. Weaver, Charlotte A. PhD, RN
  2. Skiba, Diane PhD

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This update on the TIGER Initiative for the ANI Connection will cover the background, members, strategy, and summit plans for 2006. TIGER stands for "Technology Informatics Guiding Educational Reform" and originated from the July 2004 conference convened by Dr David Brailer, Director of the Office of the National Coordinator for Health Care Information Technology. This conference entitled, "Cornerstones for the Electronic Health Record," brought together leaders from across healthcare, including nurse educators and informaticians, to discuss the dependencies and requirements of a national electronic health record. Medicine, government, information technology (IT), hospitals, and insurance all had prominent places in the program. Nursing was not represented in the program despite the Institute of Medicine's 2004 report, Keeping Patients Safe1, on the importance of nurses in patient safety and quality outcomes. In fact, Charles Safran, past president of the American Medical Informatics Association, spoke on behalf of the nurses, citing the need to have 6000 additional nurse informaticians in the marketplace by 2010. In response to this omission, a small group of individuals who had been at the Brailer conference started working to address resource gaps and to ensure that nursing would be positioned to represent itself in future strategic planning and health policy initiatives aimed at achieving the national electronic health record agenda.


In January 2005, this working group convened a broader audience of nurses and nurse leaders from industry, education, and government in a 1-day meeting hosted by Johns Hopkins University School of Nursing. In this "Think Tank" session, the group adopted the name "TIGER Team" and the following platform:


* Using informatics is a core competency for healthcare professionals in the 21st century.


* The majority of the 2.8 million licensed nurses in today's workforce lack IT skills and the ability to use online evidence to support evidence-based practice in their work.


* Nurse executive leaders in healthcare organizations lack IT competency and knowledge needed to lead electronic health record programs in their own institutions.


* Nursing education has not changed its curriculum to include the informatics competencies identified as needed in a number of published reports.2-4


* Nursing faculty shortage is compounded by the nurses' lack of IT competency skills needed to teach required informatics competencies.


* PhD-prepared nurse informaticians for informatics program faculty are inadequate to resource the numbers needed in US universities to produce the 6000 additional nurse informaticians projected for 2010.




To meet this challenge, the TIGER team voted to adopt the following vision:


Allow informatics tools, principles, theories and practices to be used by nurses to make healthcare netsafer, effective, efficient, patient-centered, timely and equitable. Interweave enabling technologies transparently into nursing practice and education, making information technology the "stethoscope" for the 21st century.


The TIGER team decided in the January 2005 meeting that the most effective way to operationalize this vision and to get a profession-wide focus on these competency deficits and gaps would be to hold an invitational summit that would bring together the key stakeholders. We are proud to announce that this summit is scheduled for October 30 to November 1, 2006, and will be hosted by Dean Patricia Hinton Walker at the Uniformed Services University of the Health Sciences, Bethesda, MD. The participating nursing organizations include American Nurses Association (AACN)-practice; National League for Nursing and American Association of Colleges of Nursing-education; and the American Organization of Nurse Executives-administration. The Summit meeting will be held so as to overlap with the American Nurses Association Dean's meeting on October 1. These organizations have all agreed to serve as lead coordinators of the Summit. These four organizations represent over 2 million nurses. In addition, more than 45 nursing specialty organizations have been invited to participate. Government agencies included are the Division of Nursing, National Institute of Nursing Research, National Library of Medicine, Agency for Healthcare Research and Quality, Veterans Administration, and Department of Defense. Other key stakeholders are the nursing leaders from 12 vendor companies, academic institutions, American Hospital Association, American Academy of Nursing, and the Institute of Medicine.


The 2-day Summit agenda consists of speeches from keynote speakers, panel discussions, case study exemplars, and small and large group dialogue. A number of methods and tools will be used to engage the participants in processing content through decisions and action recommendations. These methods include audience response technology, experiential learning, and open-space facilitation with graphic recording to capture output in support of generating post-Summit action plans and recommendations report.



The success of the TIGER team's efforts will be judged on what outcomes will result from the Summit's recommendations. To ensure this dissemination, the TIGER team plans to follow conference models from the Institute of Medicine and the International Medical Informatics Association. The Summit deliverable will be a published report that is disseminated to all participants and the greater healthcare community, extending to policy makers, educators, and practitioners. The Summit report will make the consensus findings and exemplars of excellence available in hardcopy and electronic text. To help make the findings immediately actionable, the Summit will develop an agenda whereby the generic nursing organizations specify what they plan to do to bridge the quality chasm via IT strategies. These efforts will target ongoing activities that occur as go-forward action plans for the different industry members and nursing segments. It will be these initiatives and efforts that will actually make transformation happen.



The following are the Tiger team members (listed here in alphabetical order):


Executive team: Marion Ball, Connie Delaney, Donna Dulong, Brian Gugerty, Angela McBride, Joyce Sensmeier, Diane Skiba, Michelle Troseth, and Charlotte Weaver.


General members: Patti Abbott, Emily Barey, Helen Connors, Jim Cato, Linda Dietrich, Judy Douglas, Ellen Ehnfores, Ronnie Freeg, Carole Gassert, Karen Greenwood, Martha Hill, Kate Hudson, Holly Farish-Hunt, Melinda Jenkins, Lynda Joseph, Gail Latimer, Teresa McCasky, Judy Ozbolt, Cathy Padovano, Virgina Saba, Patrick Shannon, Sheryl Taylor, Mary Walker, P. Hinton Walker, Bonnie Wesorick, and Rita Zielstorff.




1. Institute of Medicine. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: National Academies Press; 2004. [Context Link]


2. American Nurses Association. Scope and Standards of Nursing Informatics Practice. Washington, DC: American Nurses Publishing; 2001. [Context Link]


3. Staggers N, Gassert CA, Curran C. A Delphi study to determine informatics competencies for nurses at four levels of practice. Nurs Res. 2002;51(6):383-390. [Context Link]


4. Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington, DC: National Academy Press; 2003. [Context Link]