Technology Informatics Guiding Education Reform – TIGER[*]An International Recommendation Framework of Core Competencies in Health Informatics for Nurses Funding: This work was supported by the European Commission within Horizon 2020 grant number (Grant Agreement 727552 EUUSEHEALTHWORK), HIMSS North America, the HIMSS Foundation and the Federal Ministry of Education and Research (bmbf) Germany grant number (16OH21026).
29 December 2017
accepted: 15 March 2018
20 June 2018 (online)
Background: While health informatics recommendations on competencies and education serve as highly desirable corridors for designing curricula and courses, they cannot show how the content should be situated in a specific and local context. Therefore, global and local perspectives need to be reconciled in a common framework.
Objectives: The primary aim of this study is therefore to empirically define and validate a framework of globally accepted core competency areas in health informatics and to enrich this framework with exemplar information derived from local educational settings.
Methods: To this end, (i) a survey was deployed and yielded insights from 43 nursing experts from 21 countries worldwide to measure the relevance of the core competency areas, (ii) a workshop at the International Nursing Informatics Conference (NI2016) held in June 2016 to provide information about the validation and clustering of these areas and (iii) exemplar case studies were compiled to match these findings with the practice. The survey was designed based on a comprehensive compilation of competencies from the international literature in medical and health informatics.
Results: The resulting recommendation framework consists of 24 core competency areas in health informatics defined for five major nursing roles. These areas were clustered in the domains “data, information, knowledge”, “information exchange and information sharing”, “ethical and legal issues”, “systems life cycle management”, “management” and “biostatistics and medical technology”, all of which showed high reliability values. The core competency areas were ranked by relevance and validated by a different group of experts. Exemplar case studies from Brazil, Germany, New Zealand, Taiwan/China, United Kingdom (Scotland) and the United States of America expanded on the competencies described in the core competency areas.
Conclusions: This international recommendation framework for competencies in health informatics directed at nurses provides a grid of knowledge for teachers and learner alike that is instantiated with knowledge about informatics competencies, professional roles, priorities and practical, local experience. It also provides a methodology for developing frameworks for other professions/disciplines. Finally, this framework lays the foundation of cross-country learning in health informatics education for nurses and other health professionals.
KeywordsHealth informatics competencies - nursing - inter-professional care - education - curriculum - workforce development - recommendations - methodology
* Supplementary material published on our website https://doi.org/10.3414/ME17-01-0155
- 1 Kokol P, Blazun H, Vosner J, Saranto K. Nursing informatics competencies: bibliometric analysis. Stud Health Technol Inf 2014; 201: 342-348.
- 2 Brenner SK, Kaushal R, Grinspan Z, Joyce C, Kim I, Allard RJ. et al. Effects of health information technology on patient outcomes: a systematic review. J Am Med Inform Assoc 2016; 23 (05) 1016-1036.
- 3 Staggers N, Gassert CA, Curran C. Informatics competencies for nurses at four levels of practice. J Nurs Educ 2001; 40 (07) 303-316.
- 4 Hoffmann S, Ash J. A survey of academic and industry professionals regarding the preferred skillset of graduates of medical informatics programs. Stud Health Technol Inform 2001; 84 (Pt 2): 1028-1032.
- 5 Hersh W. Who are the informaticians? What we know and should know. J Am Med Inform Assoc 2006; 13 (02) 166-170.
- 6 Gadd CS, Williamson JJ, Steen EB, Fridsma DB. (IMIA) on Education in Biomedical and Health Informatics. Methods Inf Med 2010; 49: 105-120.
- 7 Reiss-Brennan B, Brunisholz KD, Dredge C, Briot P, Grazier K, Wilcox A. et al. Association of Integrated Team-Based Care With Health Care Quality, Utilization, and Cost. JAMA 2016; 316 (08) 826-834.
- 8 Hastings SE, Suter E, Bloom J, Sharma K. Introduction of a team-based care model in a general medical unit. BMC Health Serv Res 2016; 16: 245.
- 9 Commission on Accreditation for Health Informatics and Information Management Education – CAHIIM. Curricular Requirements. 2014 Health Informatics Master’s Degree Curriculum Requirements [cited 2018 Mar 13]. Available from: http://www.cahiim.org/hi/curriculumrequire ments.html
- 10 Mantas J, Ammenwerth E, Demiris G, Hasman A, Haux R, Hersh W. et al. Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics. Methods Inf Med 2010; 49: 105-120.
- 11 Global Health Workforce Council (GHWC). Global Academic Curricula Competencies for Health Information Professionals. Chicago, IL: The AHIMA Foundation 2015 [cited 2018 Mar 13]; Available from: http://www.ahima.org/about/global?tabid=council
- 12 Liyanagunawardena TR, Williams SA. Massive open online courses on health and medicine: review. J Med Internet Res 2014; 16 (08) e191.
- 13 Westra BL, Latimer GE, Matney SA, Park JI, Sensmeier J, Simpson RL. et al. A national action plan for sharable and comparable nursing data to support practice and translational research for transforming health care. J Am Med Inform Assoc 2015; 22 (03) 600-607.
- 14 Weaver CA, Warren JJ, Delaney C. Bedside, classroom and bench: collaborative strategies to generate evidence-based knowledge for nursing practice. Int J Med Inform 2005; 74 (11–12): 989-999.
- 15 Värri A, Blake R, Roberts J, Fenton SH, Cleary M, Zacks SF. et al. Transatlantic collection of health informatics competencies. FinJeHeW 2016; 08 (2–3): 127-136.
- 16 HITCOMP – Health IT Competencies [cited 2018 Mar 13]. Available from: http://hitcomp.org/
- 17 Fischer MR, Bauer D, Mohn K. NKLM-Projektgruppe. Finally finished! National Competence Based Catalogues of Learning Objectives for Undergraduate Medical Education (NKLM) and Dental Education (NKLZ) ready for trial. GMS Z Med Ausbild. 2015 32. (3): Doc35.
- 18 Röhrig R, Stausberg J, Dugas M. GMDS project group “Medical Informatics Education in Medicine”. Development of national competency-based learning objectives “Medical Informatics” for undergraduate medical education. Methods Inf Med 2013; 52 (03) 184-188.
- 19 Malone K, Supri S. A critical time for medical education: the perils of competence-based reform of the curriculum. Adv Health Sci Educ Theory Pract 2012; 17 (02) 241-246.
- 20 Weinert FE. Competencies and key competencies: Educational perspective. In: Smelser NJ, Baltes B. editors. International Encyclopedia of the Social and Behavioral Sciences. 4th ed.. Amsterdam: Elsevier; 2001: 2433-2436.
- 21 Boyatzis RE. Competencies in the 21 Manag Dev. 2008; 27 (01) 5-12.
- 22 Phillips A, Yen PY, Kennedy M, Collins S. Opportunity and Approach for Implementation of a SelfAssessment Tool: Nursing Informatics Competencies for Nurse Leaders (NICA-NL). Stud Health Technol Inform 2017; 232: 207-211.
- 23 Yoon S, Shaffer JA, Bakken S. Refining a self-assessment of informatics competency scale using Mokken scaling analysis. J Interprof Care 2015; 29 (06) 579-586.
- 24 Prahalad CK, Hamel G. The core competence of the corporation. Harvard Business Review. 1990 May-June. 79-90.
- 25 Kulikowski CA, Shortliffe EH, Currie LM, Elkin PL, Hunter LE, Johnson TR. et al. AMIA Board white paper: definition of biomedical informatics and specification of core competencies for graduate education in the discipline. J Am Med Inform Assoc 2012; 19 (06) 931-938.
- 26 Arbeitskreis Deutscher Qualifikationsrahmen (AK DQR). Deutscher Qualifikationsrahmen für ein Lebenslanges Lernen. 22nd March, 2011 [cited 2018 Mar 13]. Available from: http://www.dqr.de/media/content/Der_Deutsche_Qualifikationsrahmen_fue_lebenslanges_Lernen.pdf
- 27 Breeden EA, Clauson KA. Development and implementation of a multitiered health informatics curriculum in a college of pharmacy. J Am Med Inform Assoc 2016; 23 (04) 844-847.
- 28 Tremblay M, Deckard GJ, Klein R. Health informatics and analytics – building a program to integrate business analytics across clinical and administrative disciplines. J Am Med Inform Assoc 2016; 23 (04) 824-828.
- 29 Krathwohl DR. A revision of Bloom’s Taxonomy: An Overview. Theory into Practice 2002; 41 (04) 212-218.
- 30 Ball MJ, Douglas JV, Hinton PWalker, DuLong D, Gugerty B, Hannah KJ. et al. Nursing Informatics: Where Technology and Caring Meet. London: Springer; 2011
- 31 Hübner U, Shaw T, Ball M. The TIGER Initiative. Hospital Healthcare Europe. 2016: 174-177 [cited 2018 Mar 13]. Available from: http://www.hospit alhealthcare.com/it/tiger-initiative
- 32 Egbert N, Thye J, Schulte G, Liebe J, Hackl W, Ammenwerth E. et al. An iterative methodology for developing national recommendations for nursing informatics curricula. Stud Health Technol Inf 2016; 228: 660-664.
- 33 Australian Health Informatics Education Council (AHIEC). Health Informatics Scope, Careers and Competencies Version 1.9. 2011 [cited 2018 Mar 13]. Available from: http://www.ahiec.org.au/docs/AHIEC_HI_Scope_Careers_and_Competencies_V1–9.pdf
- 34 bCanada’s Health Informatics Association, National Office. Canada’s Health Informatics Association (COACH), Health Informatics Professional Core Competencies v3.0. Toronto, 2012 [cited 2018 Mar 13]. Available from: https://www.coachorg.com/en/resourcecentre/resources/Health-InformaticsCore-Competencies.pdf
- 35 Gugerty B, Delaney CW. TIGER Informatics Competencies Collaborative (TICC). Final Report. 2009 [cited 2018 Mar 13]. Available from: http://tigercompetencies.pbworks.com/f/TICC_Final.pdf
- 36 Li S, Bamidis PD, Konstantinidis S. et al. Prioritization of actions needed to develop the IT skills competence among healthcare workforce. PeerJ PrePrints. 03. e1137v3 2015 [cited 2018 Mar 13]. Available from: https://dx.doi.org/10.7287/peerj.preprints.1137v3
- 37 Hübner U, Ball M, de Fátima HMarin, Chang P, Wilson M, Anderson C. Towards Implementing a Global Competency-Based Nursing and Clinical Informatics Curriculum: Applying the TIGER Initiative. Stud Health Technol Inf 2016; 225: 762-764.
- 38 Bland JM, Altman DG. Cronbach’s alpha. BMJ 1997; 314: 572.
- 39 bAmerican Association of Colleges of Nursing. Essentials of Doctoral Education for Advanced Nursing Practice. Washington DC: American Association of Colleges of Nursing 2006 [cited 2018 Mar 13]; Available from: http://www.aacn.nche.edu/dnp/Essentials.pdf
- 40 Parry D, Hunter I, Honey M, Holt A, Day K, Kirk R. et al. Building an educated health informatics workforce – the New Zealand experience. Stud Health Technol Inf 2013; 188: 86-90.
- 41 Chang P, Kuo MC. Chapter 25. Taiwan Model: Nursing Informatics Training. In: Ball MJ, Hannah KJ, Newbold SK. et al. editors. Nursing Informatics: Where Caring and Technologies Meet. London: Springer; 2011: 411-428.
- 42 Strudwick G, Hardiker NR. Understanding the use of standardized nursing terminology and classification systems in published research: A case study using the International Classification for Nursing Practice(®). Int J Med Inform 2016; 94: 215-221.
- 43 Brennan PF, Bakken S. Nursing Needs Big Data and Big Data Needs Nursing. J Nurs Scholarsh 2015; 47 (05) 477-484.
- 44 Hackl WO, Rauchegger F, Ammenwerth E. A Nursing Intelligence System to Support Secondary Use of Nursing Routine Data. Appl Clin Inform 2015; 06 (02) 418-428.
- 45 Van Houdt S, Sermeus W, Vanhaecht K, De Lepeleire J. Focus groups to explore healthcare professionals’ experiences of care coordination: towards a theoretical framework for the study of care coordination. BMC Fam Pract 2014; 15: 177.
- 46 Remus S. Advancing the Digital Health Discourse for Nurse Leaders. Stud Health Technol Inform 2016; 225: 412-416.
- 47 bAmerican Nurses Association. Nursing informatics: scope and standards of practice. 2nd ed.. Silver Spring, MD: American Nurses Association; 2015
- 48 Kannry J, Sengstack P, Thyvalikakath TP, Poikonen J, Middleton B, Payne T. et al. The Chief Clinical Informatics Officer (CCIO): AMIA Task Force Report on CCIO Knowledge, Education, and Skillset Requirements. Appl Clin Inform 2016; 07 (01) 143-176.
- 49 Cummins MR, Gundlapalli AVI, Gundlapalli AV, Murray P, Park HA, Lehmann CU. Nursing Informatics Certification Worldwide: History, Pathway, Roles, and Motivation. Yearb Med Inform 2016; (01) 264-271.
- 50 Gardner RM, Overhage JM, Steen EB, Munger BS, Holmes JH, Williamson JJ. et al. Core content for the subspecialty of clinical informatics. J Am Med Inform Assoc 2009; 16: 153-157.
- 51 Ricciardi L, Mostashari F, Murphy J, Daniel JG, Siminerio EP. A national action plan to support consumer engagement via e-health. Health Aff (Millwood) 2013; 32 (02) 376-384.
- 52 Moen A, Mæland LMKnudsen. Nursing informatics: decades of contribution to health informatics. Healthc Inform Res 2013; 19 (02) 86-92.