1. Sensmeier, Joyce MS, RN-BC, CPHIMS, FHIMSS
  2. Anderson, Christel

Article Content

Technology Informatics Guiding Education Reform (TIGER) is working to help the United States realize its 10-year goal of electronic health records for all of its citizens. Starting as a grassroots initiative, TIGER now involves more than 70 professional nursing organizations, associations, vendors, and governmental entities.


The TIGER initiative aims to enable practicing nurses and nursing students to fully engage in the unfolding digital electronic era in healthcare. The purpose of this initiative is to identify information/knowledge management best practices and effective technology capabilities for nurses. The goal of TIGER is to create and disseminate local and global action plans that can be duplicated within nursing and other multidisciplinary healthcare training and workplace settings.


* Phase I of the TIGER initiative engaged stakeholders to create a common vision of electronic health record-enabled nursing practice.


* Phase II of the TIGER initiative facilitated collaboration among participating organizations to achieve the vision.


* Phase III of the TIGER initiative is a call to action to our leaders, organizations, and individuals whereby all stakeholders are charged with ACTION in the following crucial areas:


* Standards and Interoperability


* National Health Information Technology (IT) Agenda


* Informatics Competencies


* Education and Faculty Development


* Staff Development


* Usability and Clinical Application Design


* Virtual Demonstration Center


* Leadership Development


* Consumer Empowerment and Personal Health Record



Since 2007, TIGER has successfully brought together hundreds of volunteers in nine collaborative teams to address the areas listed above. The Alliance for Nursing Informatics (ANI), as the enabling organization for TIGER Phase II, has developed a communication plan to distribute the TIGER Call to Action Reports. Many of the organizations that have been involved in the TIGER initiative are also developing their own communication plans.


Now, TIGER is entering the implementation phase. In 2009, TIGER will move forward to integrate a full set of recommendations from the reports of the collaborative teams into the nursing community along with colleagues from disciplines across the continuum of care. This will include the following:


* developing a US nursing workforce capable of using electronic health records to improve the delivery of healthcare;


* engaging more nurses in the development of a Nationwide Health Information Technology infrastructure; and


* accelerating the adoption of smart, standards-based, interoperable, patient-centered technology that will make healthcare delivery safer, more efficient, timely, accessible, and efficient.



The work of the collaborative teams culminated in the publication of recommendations for achieving this TIGER vision. The TIGER Phase II Executive Summary can be accessed at


In the area of Education and Faculty Development, several key outcomes have already been accomplished. The American Association of Colleges of Nursing has included informatics and computer competencies in the Essentials Documents for Baccalaureate Education and Doctor of Nursing Practice. And the National League for Nursing Board of Governors approved a position statement that recommends that all nursing schools integrate informatics, computer literacy, and information literacy into their curriculum. This report is available on their Web site at


A key recommendation from the Leadership Development Collaborative included the need to develop programs for nurse executives and faculty that stress the value of information technology and empower them to use health IT successfully. Efforts are underway in a joint project with the American Organization of Nurse Executives (AONE) to promote sharing of best practices. This will be a mechanism for demonstrating nursing excellence in using technology to improve nursing practice and the delivery of safer, more effective patient care. The Technology Task Force of the AONE has developed a toolkit to equip nurse leaders with the necessary resources to promote health IT adoption.


The Standards and Interoperability Collaborative convened workgroups to create tools and resources to promote health IT standards and interoperability capabilities within the nursing profession. Recommendations from this team state that the successful adoption of standards requires consensus and adoption on a national scale, and to that end, more nursing input is needed in two areas:


* For the betterment of clinical practice and the profession, nurses must embrace collaboration and build a consensus agreement regarding standardization of nursing language.


* Nurses have a professional responsibility to be engaged in standards development, harmonization, and implementation activities, including encouraging adoption of and patient engagement in personal health records and electronic health records.



All participating stakeholders are encouraged by TIGER, ANI, and each organization involved in this initiative to establish long-term goals and plans for their own members and other constituents to deliver the TIGER Call to Action Reports to the 2 900 000 nurses practicing in the United States today.