Growing up, I loved Winnie-the-Pooh. I had my own Pooh (still have him) who slept with me and comforted me. Milne’s stories were a marvel, both because Pooh was relatable and snuggling in my mother’s arms while being read to was like being hugged by the whole world. Not until I read Pooh to my children, did the magic of childhood wonder really resonate with me. The magic of Milne’s 100 Acre wood brought to life with words. Words which make kids cackle with joy and choose which character they are. Words are magic. They inspire. They charm. They sow discord. They heal. They harm. They deceive.
Words can empower us. Words can be manipulative and false. Words can scaffold theatrical scenery to hide a monster.
Though slightly dated, the TIGER initiative set forth to create standards for EHRs with the idea that electronic health records would be safer for the patient, could improve communication between different medical facilities and possibly provide better overall care for patients(O’Connor et al., 2017). The pillars of TIGER vision are admirable. Educating nurses to apply technology in their jobs is fundamental for career success today. Seeing how technology has anchored itself in healthcare application at nearly every level, nurses who are not comfortable with technology will find the profession very limited for options.
How is technology shaping healthcare as highlighted by the TIGER initiative? Given active global population shifts, individuals can have healthcare providers all over the world. Consequently, interoperability of EHR software improves effective, efficient communication between multiple healthcare platforms. Increased administrative efficiency in healthcare management contributes to lower overhead costs for systems. Systems have to make money to stay in business. Larger systems can render smaller, localized systems obsolete, which in turn increases the needs of the larger system. Larger systems require more specialties. If they are affiliated with Universities, systems require efficient communication between specialties, faculty and students(O’Connor et al., 2017). Uncomplicated access to patient’s medical records can inform providers in ways the patient might not be able to and improves patient outcomes. Interoperability ideally increases collaboration between specialists who can all look at the same record simultaneously. We can communicate. We can share information through words.
Back to words. Looking at the pillars of TIGER vision, these are words (and catchy phrases) I see:
Revolutionary, empowers, transformation, collaborative, knowledge development, best practice, standardized, person-centered, facilitate, teamwork, relationships, care, evidence-based, interoperable, support, foster, quality care and safety, affordable, universal, standards-based, advocacy, coalition-building, culture of safety, respectful, open, trust, high quality.
I think: WOW! Let’s do this. But. What’s between these words?
Leadership, drives, executes, maximize, driving, rapid, deployment, implementation, processes, intelligence systems, technologies, incentive-based initiatives, achieving, resourcing, system, leverages, technology, informatics, stakeholders, goal.
I think: Well. Healthcare is system-based, so …
Wait.
What word is missing? What is not being said?
There is a gulf between the idealism of pillars and application of technology in healthcare. Having worked with technology from critical care to ambulatory nursing, I have seen how electronic health records have improved safety for nurses if only for not having to interpret MD chicken-scratch. However, all members of the system involved with advancing EHRs must have complete buy-in to adapt their practice. Policy has to be created to maintain equanimity of staffing roles. Efficiency has to be balanced with compassion. Technology alone can’t save healthcare.
There’s a word: healthcare. Health. Care.
As nurses we care. As nurses actively working toward the peak of our careers, we care a lot. How has technology helped us care for health? Technology has helped in the ED to make triage protocols for nursing orders effective and efficient. I can read the notes of what the RN did in the shift before me (if she remembers to document in the 11th hour), rather than trying to work through scribbles from a pink flow sheet. In the future (like now) patients will be able to see their physicians notes if they have digital access to their medical records.
However, in the world of clinics, technology has shifted a fundamental dynamic. The world of most APRNs is the clinic. The clinic is ruled by relative value units (RVUs) or how many people you see (and their complexity). Technology shows the system you work for that you have (or should have) enough time based on your patient population, to see X number of patients. Technology shows the system when you are not keeping up your RVUs and you better have a good reason not to. Technology seamlessly commodifies how much you care, but in quantity alone.
Have you figured out the missing word?
The wonder of words ultimately, is that words have no power over choice. We always have a choice. We can choose to abide the rapid deployment of achieving systems that maximize incentive-based technology initiatives for stakeholders. Or we can choose to use our knowledge development to transform relationships, support coalition-building; foster affordable, universal support while advocating for respectful, person-centered care.
We can care. For.
Patients.
Hebda, T., & Calderone, T. L. (2010). What Nurse Educators Need to Know About the TIGER Initiative. Nurse Educator, 35(2), 56–60. https://doi.org/10.1097/nne.0b013e3181ced83d
O’Connor, S., Hubner, U., Shaw, T., Blake, R., & Ball, M. (2017). Time for TIGER to ROAR! Technology Informatics Guiding Education Reform. Nurse Education Today, 58, 78–81. https://doi.org/10.1016/j.nedt.2017.07.014
Sensmeier, J. (2007). 2006 TIGER SUMMIT Evidence and Informatics Transforming Nursing. CIN: Computers, Informatics, Nursing, 25(1), 55–56. https://doi.org/10.1097/00024665-200701000-00014