Quality. In a series of groundbreaking reports, including The Computer-Based Patient Record [1,2], To Err Is Human [3] and Crossing the Quality Chasm [4], the Institute of Medicine (IOM) concluded that information technology (IT) holds the promise of transforming healthcare practice to achieve foundational aims—safety, effectiveness, patient/family centeredness, timeliness, efficiency, and equity.

Information Technology. In April 2004, President Bush issued an Executive Order that called for action to put electronic health records in place for most Americans in ten years. One first step was the naming of Dr. David Brailer to head up the newly created Office of the National Coordinator for Health Care Information Technology (ONCHIT). In July 2004, a national conference, Cornerstones for the Electronic Health Record, brought together leaders from across health care, including nurse educators and informaticians, to discuss the national health information infrastructure. Medicine, government, IT, hospitals, and insurance all had prominent places in the program. Though one nurse served on one panel, the profession of nursing was invisible in outlining the work environment transformation under way, despite IOM’s 2004 report focusing on this very topic.

Nursing. In the fall of 2004, a small group of individuals who had been at the conference began work to ensure that the nursing profession achieves equal footing, and contribute their expertise to achieving the national agenda. In January 2005, they brought nurses and nurse advocates from industry, education, and government participated in a one-day working meeting at the Johns Hopkins University School of Nursing. The group, dubbed the TIGER Team, for Technology Informatics Guiding Educational Reform, agreed that “utilizing informatics” is a core competency for healthcare professionals in the 21 st century, as the IOM acknowledged in Health Professions Education: A Bridge to Quality [5]. They also agreed that the majority of nurses lack IT skills and the ability to make use of online evidence to support their work. Although specific informatics competencies in nursing [6] have been identified, there has been little diffusion of these competencies in nursing education. The challenge is to incorporate them into accreditation standards and performance appraisals and to disseminate them to nursing organizations and others outside informatics. To meet this challenge and to give nursing the prominence it requires, the TIGER Team set forth and explicated a vision for the nursing profession in the 21 st century. McBride [7] described the opportunities and challenges of the informatics revolution to nursing based upon her work as an IOM Scholar-in-Residence. Her poignant analysis of the nursing profession’s readiness for this revolution served as a catalyst for this summit. She raised the question, “But do the proactive activities by some meant that the profession as a whole understands the promise of information technology?” [7]. Perhaps her closing statement sums up the mission of this summit, “that is why every nurse cannot afford to be unconnected to this transformation, but must take an active rile in ensuring that IT is used in service to our profession’s values.” [7]. It should be noted that Dr. Don Detmer, CEO of the American Medical Informatics Association (AMIA), affirmed the importance of nursing to the informatics revolution when he commented on McBride’s article [7].

• Expand collaborations by maximizing the Alliance for Nursing Informatics and entering into national and international efforts as key partners.
• Interweave enabling technologies transparently into nursing practice and education, making information technology the stethoscope for the 21st century.
• Bring evidence-based knowledge to the practice setting, taking translational research from bench to bed then onto the home.
• Bridge the gap between practice and education, establishing new models for collaboration between academic and practice settings.
• Transform standards for the use of enabling technologies, defining educational and licensure requirements for students, practitioners, and faculty.
• Seek empowerment as knowledge broker and coach, using enabling technologies to support patients in self-directed management.
• Reform the classroom to incorporate virtual continuous learning and clinical experiences for students, faculty, and practitioners.

• Nursing Organizations: Alliance for Nursing Informatics, representing 20 organizations including the American Medical Informatics Association (AMIA) and the Healthcare Information Management and Systems Society (HIMSS); and over 60 nursing professional organizations; representing nursing in educational, practice, specialty and administration areas.
• Government Agencies: Division of Nursing, National Institute of Nursing Research (NINR); National Library of Medicine (NLM); Agency for Healthcare Research and Quality (AHRQ); Veterans Administration (VA); Department of Defense (DoD).
• Other Key Stakeholders: IOM, academic institutions, practice settings (AHA), and the vendor community (Cerner, CPM Resource Center, Ecilpsys, GE Healthcare Systems, IBM, McKesson, Mitre, Seimens, and Thomson Healthcare).

A final published TIGER report will be the result of capturing the dialogue and ideas from the Summit, building on the foundation of the challenge papers. The TIGER report will synthesize and summarize the vision, insights, and key learning experienced from the Summit event. The report will also outline an action plan that prioritizes the strategies nursing organizations plan to do to bridge the quality chasm by integrating technology into practice and education. Invited members of each of the participating professional organization and ANI constituents and other stakeholder groups will prepare for the Summit by bringing their organizations current agenda and strategic goals.

Outcomes. To ensure that the impact of the Summit is not limited to the meeting, the TIGER Team proposes to disseminate and activate its findings. Following models provided by the IOM’s quality chasm Summit and, earlier, by the health professional workstation conference hosted by the International Medical Informatics Association (IMIA), the Summit will produce a report to be published for the greater healthcare community, including policy makers, educators, and practitioners. The report will make the consensus findings and exemplars of excellence from the Summit in a format that is readily accessible and eminently readable. Plans also call for publishing guidelines for organizations to follow as they integrate informatics competencies into nursing education curricula and into the practice environment of all nurses.

To activate its findings, the Summit will develop an agenda whereby the generic nursing organizations specify what they plan to do to bridge the quality chasm via IT strategies. This effort will target activities to occur long after the Summit is over and its findings are published. The focus is on actions that will develop and sustain the vision into the future.

Summit outcomes will be to:
1. Publish a report, including Summit findings and exemplars of excellence;
2. Establish guidelines for organizations to follow as they integrate informatics into academic and practice settings; and
3. Set an agenda whereby the nursing specialty organizations specify what they plan to do to bridge the quality chasm via IT strategies.

Each professional organization and ANI constituent organization will at the end of the Summit:
1. Use the IOM recommendations for addressing the quality chasm and bridge to quality via education as a framework to develop individual nursing organization or collaborative action plans to increase the knowledge and skills of nurses to practice in an informatics rich and consumer centric health care environment
2. Identify organizations or partnerships that can help them accomplish their action plans
3. Agree to commit a point person who will respond to evaluation surveys and reporting mechanisms
4. Agree to accomplish at least 85% of their established short-term (first year) goals, and
5. Agree to accomplish 100% of long term goals within the three year time span.

The Alliance of Nursing Informatics (ANI) and the various nursing professional organizations will at the end of the Summit:
6. Commit to a joint presentation/activity/collaborative presence at their individual professional organization annual conferences
7. Commit to a joint presentation/activity/collaborative presence at annual NI Symposia at the annual HIMSS conference and the Fall AMIA conference
8. Develop collaborative relationships among nursing organizations, government funding agencies, provider organizations, vendors and policy organizations.

References
[1]. CPRI . The Computer-Based Patient Record: An Essential Technology for Health Care. Richard S. Dick, Elaine B. Steen, editors Washington, DC: National Academy Press; 1991.
[2] CPRI. The Computer-Based Patient Record: An Essential Technology for Health Care, Revised Edition. Richard S. Dick, Elaine B. Steen, and Don E. Detmer, Editors; Committee on Improving the Patient Record, Washington, DC: Institute of Medicine, 1997.
[3] Institute of Medicine. To Err is Human. Washington, DC: National Academy Press, 2000. [4]Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press, 2001.
[5] Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington, DC: National Academy Press, 2003.
[6]. American Nurses Association. Scope and Standards of Nursing Informatics Practice. Washington, D.C: American Nurses Publishing, 2001. [7] McBride, A. Nursing and the informatics revolution. Nursing Outlook [in press].