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Be A TIGER! with Harold, Marion and friends. No golf required!

September 12, 2008
by Joe Bormel
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Last week, I attended my first Informatics Grand Rounds at Johns Hopkins. The speaker was Marion Ball and the topic was International Informatics . My goals with this post are to share two things:

  • awareness of this great resource (The Grand Round Seminar Series); and
  • observations from and about Marion’s major points

The Johns Hopkins Medicine Division of Health Sciences Informatics Grand Rounds series and its faculty are terrific; this is especially worth mentioning since you can attend current and future sessions virtually, and their video archives are on-line and very impressive. Here's the link to the entire schedule.

Joe, how do you find the time?

I watch educational materials while doing my daily exercise.

Marion, in yet another tour d'horizon, summarized an impressive time span and global perspective, making it clear that certain informatics themes are highly useful. The full video archive is available here.
One initiatives that Marion’s is involved in is called TIGER. The Technology Informatics Guiding Educational Reform (TIGER) Initiative aims to enable practicing nurses and nursing students to fully engage in the unfolding digital electronic era in healthcare. Marion and others have identified that a central bottleneck in healthcare transformation is operational informatics, and nurses have the key role. She’s right, of course.

The TIGER riff in the topic and leading graphic? See original.

She shared a number of quotes. One was: “What we learn from history is that we don’t learn from history.” (George Bernard Shaw)

I’d like to share a variation: History doesn’t repeat itself, but it does rhyme ” (Mark Twain) To me, that means that certain driving forces (which are learnable) that are recurrently ignored. Number one of these, according to Marion:

People Matter:

it wont take you a second to think of your own example.

This grand rounds session was beautifully facilitated by Harold Lehmann, M.D., Ph.D., including a Q and A session that created a lot of independent value.

One question was “what is the real goal of 100% E H R adoption (that we’re so dismally short of)?” My take is that there isn’t an answer, either within any organization, or nationally. We’re too pluralistic. That said, my answer: An E H R should be an enabler in the coordination of care. Implicit in that is ‘appropriate care,’ and ‘from the standpoint of the person/patient/consumer of the needed services.’ Most of us would add in ‘always informed by evidence-based medicine and management, where it exists.’

The last observation I’d like to share here about International Informatics is that we’re all too darn parochial. Marion called out these recurring issues:




Very interesting (and well-researched) blog, Joe.

I had the privelage of hearing Marion Ball speak during a workshop at HIMSS this past February. Marion is a great advocate for IT adoption in the nursing community, and has suggested that more widespread use of IT can work to combat the nursing shortage. But with the average age of a nurse somewhere around 45-50 (depending on who you ask), the challenge lies in getting people who were not raised on IT to adapt to a completely different way of doing his or her job a way that, in the beginning, may not at all seem like a timesaver. (I have some experience in this, as I'm trying to convince my parents to throw away their outdated maps and use a GPS system - it's not going well so far).

Getting nurses to move from away from charts and paper will require a significant cultural change, but with the nursing population both declining in numbers and increasing in average age, it's one that needs to be made. The TIGER initiative is working to make this happen, and blogs like yours that call attention to its efforts are critical.

Thanks for the kind words and perspective.

I watched a wonderful nurse take care of my daughter last year at AI duPont.  She was using an application that rhyme's with Power-Heart from a company whose hometown name rhymes with Cansas Sity.  The PC was outside of the room and the I watched this nurse document a 'plan of care' online.  This nurse found it very usable and fast.

To Daphne Lawrence's blog post, Kid's We're Getting a New EMR, this organization is also replacing one functional EMR with another.  The vendor's home city rhymes with Radison.

The nurse at duPont did back to back shifts, so we had fabulous continuity of care.  Tough job for the nurse though.

I think you make a great point about adoption of technology with the parent's GPS experience.  The great news is that technology is rapidly getting much more adoptable!

In the above post, I made reference to dialogue mapping, and provided a link. Dialogue mapping is a technique to deal with the social aspect of 'wicked problems.' It's a skill, along with techniques like nominal group process, that are essential to help make some challenging conversations effective.

After I posted this topic, I tested the links and struggled to make to make it work. I added a link to the author, Dr Jeff Conklin's name above and that seems to work. This link is guaranteed (by YouTube):

Limits of Conversational Structure

Ruminations on the above ... (Did I mentioned that I'm trained as a rheumatologist?)

Chris presented a question during the Q & A to Marion's talk. If I misrepresent it, the video link above will give me away.

Chris asked, "why have only a few academic organizations shown effectiveness and success with clinical informatics, and not the commercial sector?"

What do you think?