Marion Ball, Ed.D., is a fellow at the IBM Research Center for Healthcare Management and professor at the Johns Hopkins University School of Nursing (both are based in Baltimore). She is also co-chair of the executive committee for the Technology Informatics Guiding Education Reform (TIGER) Initiative, which was formed in 2004 to bring together nursing stakeholders to develop a shared vision, strategies, and specific actions for improving nursing practice, education, and the delivery of patient care through the use of health IT. A highly respected expert in the field of healthcare IT, Ball has authored several pieces, including an article in Methods of Information in Medicine that examined why clinical information systems are failing. Recently, Associate Editor Kate H. Gamble spoke with Ball, who is also a member of the Healthcare Informatics Editorial Board, about the report’s findings, the mission of the TIGER Initiative, why IT adoption is still low, and the importance of involving clinicians in the planning, development and implementation of IT systems.
KG: And this is where initiatives like TIGER come into play.
MB: Right, I’m a big advocate of the TIGER Initiative for technology. We need to have trained healthcare professionals who can effectively communicate with the well-meaning IT people and vendors. They themselves are going to be using the technology, and we need to train them to know what’s available.
Take for example someone who was living in Europe in the 1940s, and all they knew about cereal was that they had oatmeal for breakfast. Well, if you take them to the cereal aisle at A&P or another a big store in the U.S., they’ll see 200 or 300 different kinds of cereals. Now you see that there are other options, and other ways they can look at this. The bottom line is, if you don’t even know something exists, you can’t try it. You can’t see whether this option is going to be better, and it’s the same thing with nursing. We don’t even give them that kind of exposure.
So that’s why I feel that new training methods are needed in nursing schools, pharmacy schools and dental schools, where the young people already know about enabling technologies and can learn how to apply them. Even more important, the average age of a nurse is 48. And if you’re 48, you just had maybe the beginnings of computing when you were going to professional school. How are we going to retrain what I call the foot soldiers of the healthcare delivery system? There are 3 million registered nurses, and if you add the aids and the LPNs (licensed practical nurses), you’ve got another 3 million, and that’s 6 million of your foot soldiers who don’t have the weapons to fight the war.
That’s when I get on my high horse and preach like a zealot. But that’s why we wrote that paper on failure — to provide clinicians with the useful systems that they need. We’ve got to jump over what we’re doing now. A leapfrog example would be what we talked about: the smart room and voice documentation with clinicians.
KG: Ultimately, what does TIGER hope to accomplish, and what message would you like to send out to hospital leaders about the initiative?
MB: You can’t do anything unless you recognize the problem. So the first thing is to realize that the medium is not the message. It’s not about technology; it’s about how do we change behavior and processes and thought flow to be able to transform the way we practice, and then use the enabling technologies to transform healthcare. That’s what it’s all about.
TIGER stands for Technology Informatics Guiding Educational Reform. We’ve got to retrain the entire workforce and make them basically computer-literate. Teach them basic competencies and provide opportunities for virtual demonstration centers so that people can have the chance to go to the store and see all of the cereals, or see what nurses are doing in other locations that is transforming the way they practice.
We need to be able to get involved with changing legislation. There is very little research, money and support for nursing, and yet nurses are the ones who are taking care of all the sick people and we’re all going to need them when we get older. And we’ve got enormous workflow problems. In Maryland, for every five nurses that retire, we’re bringing one more in the system. That’s scary.