540 ■ III: ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
- Demonstrate the conceptual ability and technical skills to develop and execute
an evaluation plan involving data extraction from practice information sys-
tems and databases. - Provide leadership in the evaluation and resolution of ethical and legal
issues within health care systems relating to the use of information,
information technology, communication networks, and patient care
technology. - Evaluate consumer health information sources for accuracy, timeliness, and
appropriateness (AACN. 2006, p. 13).
Advancing the technology and informatics skills of all nursing students, not
just DNP students, has been aggressively promoted since 2004 by the TIGER initia-
tive— Technology Informatics Guiding Education Reform, and supported by many
nursing and corporate organizations, including the AACN (Cheeseman, 2012;
Hebda & Calderone, 2010). The 3- year and 10- year goals for the TIGER initiative
are outlined in a white paper published by the Executive Steering Committee, led at
the time by Marion Ball, EdD, of Johns Hopkins University School of Nursing and
Diane J. Skiba, PhD, FAAN, FACMI, University of Colorado at Denver and Health
Sciences Center, School of Nursing (co- chairs) (Tigersummit.com, 2007). Almost 10
years later, we can revisit whether the TIGER goals have been accomplished, and
examine what role the DNP graduate is having in this area of knowledge manage-
ment, data/ evidence- driven health care, and the contribution health and nursing
informatics is making to the efficient, safe, and effective delivery of health care (see
Table 24.5 )
In 2009, the Healthcare Information and Management Systems Society (HIMSS)
published the latest report available on the TIGER initiative (it covered data through
2008) (thetigerinitiative.org, 2009). Part of the report focused on progress made by col-
laborative teams, which was charged with asking: Why does the nurse today need to
know? (see Table 24.6 ).
Progress toward full TIGER implementation has been observed in the earmarking
of some $19 billion to develop an interoperable medical record as part of the American
Recovery and Reinvestment Act in 2008/ 2009. But this remains a continuing goal, per-
haps even a “wicked problem” as movement to a full electronic record has increased
time burden to health professionals according to some studies, has not increased
efficiency simply by being automated, may take more time away from patients, nor
improve health outcomes (Accenture, 2015; Freudenheim, 2012; Periyakoil, 2007). These
findings only indicate that movement to a full electronic medical record can have some
negative consequences.
TABLE 24.5 Seven Pillars of the TIGER Vision
- Management and leadership
- Education
- Communication and collaboration
- Informatics design
- Information technology
- Policy
- Culture