HIT STANDARDS & INTEROPERABILITY Introduction to the...

The T.I.G.E.R. Initiative

Phase II - Facilitating collaboration among participating organizations to achieve the TIGER vision

September 20, 2007

HIT STANDARDS & INTEROPERABILITY Introduction to the Collaborative

HIT Standards and Interoperability Facilitators/Leaders

Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS

VP, Informatics, HIMSS Co-chair, Alliance for Nursing Informatics

• In her role as HIMSS Vice President of Informatics, Joyce is responsible for the areas of clinical informatics, standards, interoperability, privacy and security, and professional certification.

• Joyce is an adjunct faculty member at Northwestern University Chicago and Johns Hopkins University, Baltimore. She previously served at Palos Community Hospital as a nursing coordinator implementing clinical information systems.

• She is currently the Standards Implementation Technical Manager for the Healthcare Information Technology Standards Panel (HITSP) and serves as the co-chair of the Alliance for Nursing Informatics, a collaboration of 25 distinct regional and national nursing informatics organizations.

HIT Standards and Interoperability Facilitators/Leaders

Elizabeth C. Halley RN MBAThe MITRE Corporation Center for Enterprise Modernization Health Mission Area • In her roles as a Principal Healthcare Consultant, Beth leads the

Federal Health Architecture (FHA) Program’s Federal Adoption of Standards for Health IT (FAST) initiative under the Office of the National Coordinator for Health IT (ONC).

• Beth’s has been involved in Health IT for over 20 years and her current responsibilities include coordinating activities related to federal participation in the National Health IT Agenda activities, including the ONC use case review, Healthcare Information Technology Standards Panel (HITSP) standards harmonization efforts and federal terminology services support activities.

• Beth presents often to national audiences on federal adoption on Health IT standards.

Technology Informatics Guiding Education Reform

The focus of the TIGER Initiative is to better prepare our nursing workforce (all practicing nurses and nursing students) to use technology and informatics to improve the delivery of patient care.

We believe that necessary skills for nurses’ portfolio in 2007 includes computer literacy and information literacy.

The TIGER Initiative is a program; not an organization.

TIGER has been a grass-roots effort to engage with all stakeholders that are committed to a common “vision” of ideal EHR-enabled nursing practice. Today, more than 70 diverse organizations have joined this effort.

Nursing Focus• Nearly 3 million practicing nurses in the U.S.• More than 55% of all health care workers• Nurses are knowledge workers

“There is no aspect of our profession that will be untouched by the informatics revolution in progress.”

Angela McBride, Distinguished Professor and University Dean Emeriti, Indiana University School of Nursing

Necessary Skills for Nurses Portfolio in 2007

• Computer Literacy Skills • Information Literacy Skills• Informatics Skills

Building the Work Force for HIT

A work force capable of innovating, implementing and using health communications and information technologies will be critical to healthcare’s success.

For health Information TransformationAHIMA and AMIAhttp://www.ahima.org/emerging_issues/Workforce_web.pdf

http://www.ahima.org/emerging_issues/Workforce_web.pdf

TIGER Summit – Phase I• October 31 -November 1, 2006• Held at the Uniformed Services University for Health

Sciences (USUHS) in Bethesda, MD• 100 participants representing all stakeholders• Created a collective vision for nursing practice and

education within 10 years if nurses were fully enabled with IT resources

• Developed a 3-year action plan required to achieve this vision

• Summary Report published at www.tigersummit.com

http://www.tigersummit.com/

Organizational Commitment• 70 organizations were represented at the Summit• Each committed to creating action plans aligned with the

TIGER vision within their organization/membership• TIGER following organizational progress on these action

plans over the next 3-years• Examples of organizational actions taken to date:

– Distribution of TIGER Summary report to all professional members (AONE)– Presentations of TIGER at National and International Conferences (AMIA,

ANIA, HIMSS, STTI, HIMSS-AsiaPac, SINI, I-MIA/MedInfo)– Regional presentations of TIGER (BANIC, CHIMSS, MINING)– Professional organization presentations of TIGER (ASPAN, AORN)– State-wide initiatives supporting TIGER vision (Minnesota, Massachusetts,

Tennessee)

• Funded by the Alliance for Nursing Informatics (ANI) – a collaboration between AMIA and HIMSS

• Continue to support progress of each participating organization’s 3-year action plan

• Formalize cross-organizational activities/action steps into collaborative TIGER Teams (9 identified)

• Define measurable outcomes of each collaborative team• Provide the infrastructure and support to facilitate the

development and dissemination of the activities of the collaborative

• Develop educational materials that can be distributed to all practicing nurses and nursing students

Matrix Approach – Phase II

Report Format

• Executive Summary• Action Plan/Specific Goals of the

Collab • Background – Overview of the

topic including key projects, publications, and subject experts

• Recommendations for significant gaps

• Case Studies/Exemplars• Recommendations• Resource lists/tools• Participants/Affiliates/Sponsors• Distribution

9 Collaborative Teams1. Health IT Standards and Interoperability2. National Health IT Agenda / Health IT Advocacy3. Informatics Competencies4. Education and Faculty Development5. Staff Development/Continuing Education6. Usability/Clinical Application Design7. Virtual Demonstration Center8. Leadership Development9. Consumer-Centered Care/Personal Health Record

Survey Results• 235 Respondents ~ sent to 350 • Ranked each of the 9 topics in order of priority for their

organization/affiliation• Identified which individuals/organizations would participate

on each of the 9 teams• Blended mix of various stakeholders across each of the 9

teams

Respondent Affiliation

Academic18%

Professional Org11%

Non-Profit 1%

Informatics Organization

4%

Consultant10%

Government Agency4%

Health Care Provider Org43%

Vendor9%

Collab #1 – Health IT Standards and Interoperability

• Ranked 2nd highest (only behind Usability)

• More than 1/3rd

respondents agreed to participate (n = 79)

• Other collaborative groups will be dependent upon work – Usability– Virtual Demo

Healthcare IT Standards and Interoperability

0

10

20

30

40

50

60

1 2 3 4 5 6 7 8 9

Priority (1 = Highest / 9 = Lowest)

Res

pond

ents

• Allow informatics tools, principles, theories and practices to be used by nurses to make healthcare safer, 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

TIGER Vision

Measurable Outcomes of Each Collaborative1. Definition, Scope of Project2. An inventory and analysis of existing resources

• Publications• Research• Subject matter experts• Ongoing Projects

3. Identification and access to subject matter experts and constituent targets

4. Educational web-based audio conferences (target = 2)5. Conference presentations6. A comprehensive white paper-type document (modeled after

TIGER Summary Report)7. Define topic-specific evaluation criteria8. Submit articles for publication and dissemination amongst broader

TIGER audience9. Chapter in the 4th Edition of the Nursing Informatics Series Where

Caring and Technology Meet

• All nurses will understand the importance of Health IT standards and interoperability on the delivery of safe, effective, efficient and patient centered care

• All nurses will understand how to become engaged in Health IT standards adoption efforts to insure the nursing voice is represented and included

Health IT Standards and Interoperability Collaborative Vision and Scope

Health IT Standards Definition:• A standard specifies a well-defined approach that supports a

business process and: (1) has been agreed upon by a group of experts; (2) has been publicly vetted; (3) provides rules, guidelines, or characteristics; (4) helps to ensure that materials, products, processes, and services are fit for their intended purpose; (5) is available in an accessible format; and (6) is subject to an ongoing review and revision process.

• Standards mean the structure and content of health care data, information, or concepts that are usefully exchanged or provided between and among care providers and public health authorities, and the interchange methods used to facilitate these exchanges.Dr. John Halamka, Chair of the Health Information Technology Standards Panel (HITSP),

explained to the American Health Information Community that for HITSP work

• Interoperability means the ability of different information systems, software applications and networks to communicate and exchange information in an accurate, effective, useful, and consistent manner.

• The current landscape of standards does not ensure interoperability due to many factors, such as conflicts and gaps. Further, for true interoperability to be realized, many standards need to be harmonized, including standards that do not traditionally fall into the commonly accepted health care standards arena (e.g., broader technology standards for data interchange).

• Harmonization means the function of developing, reconciling, setting and maintaining standards required to achieve interoperability.

Department of Health and Human Services (HHS) Office of the National Coordinator for Health IT (ONC)

Health IT Interoperability Definition:

• Scope includes relevant nursing and patient care related standards setting efforts– Categories of standards may include:

• Terminology • Information Model• Information Interchange

– Health IT Standards Domains may include:• Nursing• Clinical Specialties (Lab, Radiology, Medications)• Patient Information (Demographics, Allergies, Diagnosis)

– Out of scope• Standards of Practice • Technology and Infrastructure• Security and Privacy

Health IT Standards and Interoperability Collaborative Scope

Health IT Standards and Interoperability Collaborative Action Items:• Identify the most relevant Health IT standard setting

efforts that are important to the TIGER mission.• Assess whether there is adequate representation/input of

the TIGER mission/perspective on said efforts.• Take action to close gaps that exist.• Communicate the existence and importance of Health IT

standards and initiatives to the broad nursing community.• Create tutorials on standardizing data elements,

implementing electronic health records, using nursing terminology, and using evidence-based practice tools.

Health IT Standards and Interoperability Collaborative Next Steps

1. Identify smaller work groups to address: • Catalogue the most relevant Health IT standard setting efforts • Inventory and analysis of:

– Publications– Research– Ongoing Projects

• Identify subject matter experts and constituent targets

2. Create tutorials on: • Standardizing data elements• Implementing electronic health records (adoption, configuration, lessons learned)• Using nursing terminology• Using evidence-based practice tools / decision support

3. Awareness Campaigns• Standards

4. Review work from the nursing and healthcare environments to • Define standards and interoperability• Collect standards and interoperability examples within nursing, healthcare, and

other industries

Team Communication• Website www.tigersummit.com/standards

• Email workgroup preference to [email protected]

• Email facilitators: – [email protected]– [email protected]

http://www.tigersummit.com/standards

mailto:[email protected]



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