Overview

Informatics Competencies for Every Practicing Nurse:

Recommendations from the TIGER Collaborative

www.thetigerinitiative.org
1
 Overview
The TIGER Initiative, an acronym for Technology COLLABORATIVE REPORT
Informatics Guiding Education Reform, was formed in This report provides the detailed findings and
2004 to bring together nursing stakeholders to develop recommendations from the Informatics Competencies
a shared vision, strategies, and specific actions for Collaborative Team. For a summary of the work of all
improving nursing practice, education, and the delivery nine TIGER Collaborative Teams, please review
of patient care through the use of health information “Collaborating to Integrate Evidence and Informatics
technology (IT). In 2006, the TIGER Initiative convened into Nursing Practice and Education” available on the
a summit of nursing stakeholders to develop, publish, website at www.thetigerinitiative.org.
and commit to carrying out the action steps defined
within this plan. The Summary Report titled Evidence The TIGER Informatics Competencies Collaborative
and Informatics Transforming Nursing: 3-Year Action (TICC) Team was formed to develop informatics
Steps toward a 10-Year Vision is available on the recommendations for all practicing nurses and
website at www.thetigerinitiative.org. graduating nursing students. TICC completed an
extensive review of the literature as well as surveying
A COLLABORATIVE APPROACH nursing informatics education, research, and practice
Since 2007, hundreds of volunteers have joined the groups to obtain examples and identify gaps. This report
TIGER Initiative to continue the action steps defined at describes the background, methodology, findings, and
the Summit. The TIGER Initiative is focused on using recommendations for future work in this area.
informatics tools, principles, theories and practices to
enable nurses to make healthcare safer, more effective,
efficient, patient-centered, timely and equitable. This TABLE OF CONTENT
goal can only be achieved if such technologies are
integrated transparently into nursing practice and 1. Overview (p. 2)
education. Recognizing the demands of an increasingly
electronic healthcare environment, nursing education 2. Executive Summary (p. 3)
must be redesigned to keep up with the rapidly
3. Background (p. 4)
changing technology environment.

Collaborative teams were formed to accelerate the 4. Methodology (p. 5)

action plan within nine key topic areas. All teams
5. Basic Computer Competencies (p. 7)
worked on identifying best practices from both
education and practice related to their topic, so that 6. Information Literacy (p. 9)
this knowledge can be shared with others interested in
enhancing the use of information technology 7. Information Management (p. 11)
capabilities for nurses. Each collaborative team
researched their subject with the perspective of “What 8. Implementation Strategies (p. 14)
does every practicing need to know about this topic?”
The teams identified resources, references, gaps, and 9. References (p. 15)
areas that need further development, and provide
recommendations for the industry to accelerate the 10. Appendices (p. 18)
adoption of IT for nursing. The TIGER Initiative builds
11. Acknowledgements (p. 32)
upon and recognizes the work of organizations,
programs, research, and related initiatives in the
academic, practice, and government working together
towards a common goal.

2
 Executive Summary
Nurses are expected to provide safe, competent, and While Nursing Informatics is a highly specialized field,
compassionate care in an increasingly technical and there are foundational informatics competencies that
digital environment. A major theme in this new all practicing nurses and graduating nursing students
healthcare environment is the use of information should possess to meet the standards of providing safe,
systems and technologies to improve the quality and quality, and competent care. The Technology
safety of patient care. Nurses are directly engaged with Informatics Guiding Education Reform (TIGER)
information systems and technologies as the foundation Informatics Competency Collaborative was formed to
for evidence-based practice, clinical-decision support develop the informatics recommendations for all
tools, and the electronic health record (EHR). practicing nurses and graduating nursing students.
Unfortunately, not all nurses are fully prepared to use
these tools to support patient care. The TIGER Following an extensive review of the literature and
Informatics Competencies Collaborative sought to survey of nursing informatics education, research, and
evaluate the current preparedness of the nursing practice groups, the TIGER Nursing Informatics
workforce and propose a set of minimum informatics Competencies Model consists of three parts, detailed in
competencies that all nurses need to practice in today's this document:
digital era. • Basic Computer Competencies
• Information Literacy
A new specialty, called Nursing Informatics, has • Information Management
emerged over the past 20 years to help nurses fully use
information technology to improve the delivery of care. The TIGER Informatics Competencies Collaborative
The most recent 2008 American Nurses Association (TICC) team identified a list of competencies for each of
Nursing Informatics Scope and Standards these categories, as well as the resources available to
defines nursing informatics as the integration of nursing support the educational needs of nurses in achieving
science, computer and information science, and these competencies. TICC recognized that it may take
cognitive science to manage communication and some time to meet these competencies for all nursing
expand the data, information, knowledge, and wisdom staff, and has prioritized the minimum set of
of nursing practice. Nurses certified in Nursing competencies to focus on in the first year, with the goal
Informatics are: of achieving full competency by 2013. These
• skilled in the analysis, design, and implementation recommendations are outlined within this report.
of information systems that support
• nursing in a variety of healthcare settings The work of the TICC was foundational to several other
• function as translators between nurse clinicians and TIGER Collaborative teams. Four other TIGER
information technology personnel Collaborative teams focused on how to implement the
• insure that information systems capture critical TICC competency recommendations: within formal
nursing information academic settings (the TIGER Education and Faculty
Development Collaborative), within health care
These specialized nurses add value to an organization provider settings for nurses currently in practice (TIGER
by: Staff Development Collaborative), for nursing leaders
• increasing the accuracy and completeness of (TIGER Leadership Development Collaborative), and
nursing documentation how to access HIT resources (TIGER Virtual
• improving the nurse’s workflow Demonstration Collaborative). We recommend that
• eliminating redundant documentation you reference the Collaborative reports from these
• automating the collection and reuse of nursing data related TIGER Collaborative teams for
• facilitating the analysis of clinical data, including recommendations on how to implement these
Joint Commission indicators, Core Measures, strategies within your environment. These reports can
federal or state mandated data and facility specific be located on the TIGER website at
data www.thetigerinitiative.org.

3
 Background
Nurses have always been at the forefront of computers, the Internet, mobile phones, and
patient care and focused on patient safety. The MP3 (Prensky, 2001). There are a number of
impetus for evaluating how prepared nurses are digital immigrants in the nursing workforce who
to use Electronic Health Records (EHRs) to have not mastered basic computer
improve patient care started in 2004. During competencies, let alone information literacy and
President Bush's State of the Union Address that how to use HIT effectively and efficiently to
year, he mandated that all Americans will be enhance nursing practice.
using electronic health records by the year 2014.
As reported in Building the Workforce for Health The TIGER Summit, “Evidence and Informatics
Information Transformation (AHIMA, 2006), “A Transforming Nursing,” held in November of
work force capable of innovating, implementing, 2006, revealed an aggressive agenda that
and using health communications and consisted of a 10-year vision and 3-year action
information technology (HIT) will be critical to plan for nurses to carry forward into the digital
healthcare’s success.” President Obama age. TIGER 's primary objective is to develop a
continued this momentum when he took office U.S. nursing workforce capable of using
in 2009, proposing to “Let us be the generation electronic health records to improve the
that reshapes healthcare to compete in the delivery of healthcare. For the TIGER Vision to
digital age.” Less than 30 days after taking be realized, the profession must master a
office, President Obama signed the American minimum set of informatics competencies that
Recovery and Reinvestment Act, earmarking $19 allow nurses to use EHRs to deliver safer, more
billion to develop an electronic health efficient, effective, timely and patient-centered
information technology infrastructure that will care. This education will determine how well
improve the efficiency and access of healthcare evidence and informatics is integrated into day-
to all Americans. In addition to the substantial to-day practice. Since the TIGER Summit, five
investment in capital, technology and resources, TIGER collaborative teams were formed to
the success of delivering an electronic healthcare identify how to integrate informatics education
platform will require an investment in people— into nurses competencies and nursing school
to build an informatics-aware healthcare developed recommendations focused on how to
workforce. prepare nurses to practice in this digital era (see
Figure 1). The TIGER Informatics Competencies
This has accelerated the need to ensure that Collaborative (TICC) team helped develop a
healthcare providers obtain competencies minimum set of informatics competencies that
needed to work with electronic records, all nurses need to have to practice today.
including basic computer skills, information
literacy, and an understanding of informatics and
information management capabilities. A
comprehensive approach to education reform is Figure 1 - TIGER Collaborative Teams involved
necessary to reach the current workforce of in Workforce Recommendations:
nearly 3 million practicing nurses. The average
1. Informatics Competencies
age of a practicing nurse in the U.S. is 47 years.
These individuals are “digital immigrants,” as 2. Education and Faculty Development
they grew up without digital technology, had to
adopt it later, and some may not have had the 3. Staff Development
opportunity to be educated on its use or be
comfortable with technology. This is opposed to 4. Leadership Development
“digital natives”: younger individuals that have
grown up with digital technology such as

4
 Methodology
The TIGER Informatics Competencies competencies are standards maintained by
Collaborative was charged with the following existing industry organizations or standards
goals: development organizations. Leveraging existing
competencies that are maintained by standards
Define the minimum set of informatics development organizations allow the TIGER
competencies that all nurses need to succeed in Informatics Competency Collaborative (TICC) to
practice or education in today's digital era. recommend standards that are relevant to
nurses and ones that will be sustainable as these
Fortunately, there was a significant amount of bodies evolve the standards as necessary. Of
nursing research completed on informatics equal or perhaps greater importance, these
competencies, well ahead of most other standard-setting bodies all have put tremendous
healthcare professions. The TIGER Informatics thought, energy and expertise into there
Competency Collaborative (TICC) started by recommended competencies. When those
completing an extensive review of the competencies aligned with the informatics
literature for informatics competencies for competency needs for nurses, we adopted
practicing nurses and nursing students. TICC theirs, thus adding strength, rigor, and validity to
also collected informatics competencies for the TICC recommendations. Figure 2 illustrates
nurses from over 50 healthcare delivery the relationship between the competency
organizations. The results of these efforts are category and the standard development
available on the TICC Wiki at organization.
http://tigercompetencies.pbwiki.com. This
resulted in over 1000 individual competency As like all of the TIGER Collaborative teams, TICC
statements. completed their research with the use of
conference calls and web meetings, electronic
Much of the work involved synthesizing this survey tools, and conducted interviews. Their
extensive list of competencies into a list of conclusions are published in this report and were
competencies that was realistic for the nearly 3 shared with colleagues through webinars that
million practicing nurses. This body of were held in 2008. In addition, numerous
competencies was evaluated and condensed to presentations on this topic were given at local,
create the three parts of the TIGER Nursing national and international conferences.
Informatics Competencies Model:
1. Basic Computer Competencies
2. Information Literacy
3. Information Management

Once the competency categories were

established, each was aligned with an existing
set of competencies maintained by standard
development organizations or defacto standards.
For example, excellent alignment was found with
the existing standards of the European Computer
Driving Licence Foundation for basic computer
competencies; the Health Level 7’s EHR
functional model clinical care components for
information management competencies; and the
American Library Association's information
literacy standards. All of these sets of

5
 Methodology

TIGER Nursing Informatics Competencies Model

Component of the Model Standard Source (Standard-Setting Body)

Basic Computer Competencies European Computer Driving European Computer Driving License
License Foundation

www.ecdl.org

Information Literacy Information Literacy Competency American Library Association

Standards
www.ala.org

Information Management Electronic Health Record Health Level Seven (HL7)

Functional Model – Clinical Care
Components www.hl7.org

International Computer Driving European Computer Driving License

License – Health Foundation

www.ecdl.org

Figure 2

6
 Basic Computer Competencies
A “digital native” has grown up with digital RECOMMENDATIONS
technology such as computers, the Internet, The TIGER Informatics Competency Collaborative
mobile phones, and MP3. A “digital immigrant” (TICC) has adopted the ECDL competencies and
grew up without digital technology and is recommending them for all practicing nurses
adopted it later (Presnky, 2001). There are a and graduating nursing students.
substantial number of digital immigrants in the
nursing workforce who have not mastered basic ECDL certification requires 30+ hours of study
computer competencies. Many digital natives and costs more than some institutions may
have gaps in their basic computer competency be able to afford. Therefore, we have ranked the
skill set. relative importance of ECDL syllabus
items and recommend the following as a first
Europeans realized this shortcoming in the step to basic computer proficiency for all
workforce across many industries and acted on practicing nurses and graduating nursing
it. The European Computer Driving Licence students. These are feasible and affordable and
(ECDL) Foundation set basic computer will provide basic computer competencies for
competencies in the late 1990s and again in this nurses and allow them to go on to obtain
decade. About seven million Europeans other TICC competencies (see Figure 2).
have now taken the ECDL exam and become
certified in basic computer competencies. Module 1: Concepts of Information and
The ECDL syllabus is effectively a global standard Communication Technology (ICT)
in basic computer competencies (see list of Module 2: Using the Computer and Managing
modules below). ECDL has developed extensive Files
training materials, including a certification exam. Module 3, Section 3.1: Word Processing: “Using
the application”
Module 7: Web Browsing and Communication

ECDL Modules
1. Concepts of Information and
Communication Technology (ICT)
2. Using the Computer and Managing
Files
3. Word Processing
4. Spreadsheets
5. Using Databases
6. Presentation
7. Web Browsing and
Communication
A detailed description of these three modules
including the related competency statements
can be found in Appendix A.

7
 Basic Computer Competencies

Figure 2 - Basic Computer Competencies Timeline

Recommendation Timeline for Adoption

All practicing nurses and graduating nursing students gain or By January 2011
demonstrate proficiency in ECDL modules 1, 2 and 7, as well as
ECDL Category 3.1

All practicing nurses and graduating nursing students become By January 2013
ECDL certified or hold a substantially equivalent certification

RESOURCES
European Computer Driving Licence (ECDL) Foundation
http://ecdl.com
The ECDL syllabus is maintained and periodically updated by the not-for-profit ECDL
Foundation. The ECDL Foundation makes arrangements with entities in various countries
to localize the ECDL syllabus. Outside of Europe, ECDL is known as International Computer Driving Licence.
ICDL is available in the United States through CSPlacement.

CSPlacement
www.csplacement.com
CSPlacement is the official distributor of ECDL within the United States. They offer CSP Basic, an e-
learning course and a certification exam that is substantially equivalent to the TICC recommendation of a
first and significant step towards basic computer competency for 2011. In addition, they also offer CSP, an
e-learning course and a certification exam that is substantially equivalent to the entire ECDL syllabus that
will meet the TICC recommendations for 2013.

Healthcare Information and Management System Society (HIMSS)

www.himss.org
HIMSS has a certificate called Health Informatics Training System (HITS). The HITS
program of e-learning, testing, and certification contains content that is substantially
equivalent to the TICC recommendation of a first and significant step towards basic
computer competency, as well as other content.

8
 Information Literacy Competencies
The Association of Colleges and Research is necessary to determine whether the
Libraries (2000) defines Information literacy as information and its application resulted in
“a set of abilities allowing individuals to improvements. Thus, information literacy
recognize when information is needed and to competencies are fundamental to nursing and
locate, evaluate and use that information evidence-based practice. The components of
appropriately”. Information literacy builds on information literacy are defined in Figure 3.
computer literacy. Information literacy is the
ability to:
• identify information needed for a
specific purpose
• locate pertinent information
• evaluate the information
• apply it correctly INFORMATION LITERACY
Information literacy is critical to incorporating
1. Determine the nature and
evidence-based practice into nursing practice.
extent of the information
The nurse or healthcare provider must be able to
needed
determine what information is needed. This
involves critical thinking and assessment skills. 2. Access needed information
Finding the information is based on the effectively and efficiently
resources available, which can include
3. Evaluate information and its
colleagues, policies, and literature in various sources critically and
formats. Evaluating or appraising the incorporates selected
information also involves critical thinking and the information into his or her
ability to determine the validity of the source. knowledge base and value
The actual implementation of the information system
results in putting the information into practice or
applying the information. The evaluation process 4. Individually or as a member of
a group, use information
effectively to accomplish a
specific purpose
5. Evaluate outcomes of the use
of information

Figure 3 - Information Literacy Components

9
 Information Literacy Competencies
Figure 4 - Information Literacy Competencies Timeline

Recommendation Timeline for Adoption

All practicing nurses and graduating nursing students will have the By January 2011
ability to demonstrate Information Literacy steps 1 through 3

All practicing nurses and graduating nursing students will have the By January 2013
ability to demonstrate all 5 Information Literacy steps

As some institutions may find these competencies difficult to implement in their entirety
immediately, as a first and significant step towards information literacy in nurses, the
TICC recommends focusing on the first three competencies for the first year. Once these
are achieved by nurses in a particular organization, the other two can be added so that by
January 2013, all nurses have all five competencies and incoming nurses demonstrate or
are helped to obtain all five.

RESOURCES
American Library Association
The ALA’s report “Information Literacy Competency Standards for Higher Education”
identifies the competencies recommended above as standards. The report also lists
performance indicators and outcomes for each standard. A faculty member or instructor
can effectively use this report to create a more detailed syllabus and or lesson plan(s) to
implement the TICC information literacy competencies.
http://www.ala.org/ala/mgrps/divs/acrl/standards/informationliteracycompetency.cfm

The Information Literacy in Technology

http://www.ilitassessment.com
The iLIT test assesses a student’s ability to access, evaluate, incorporate, and use
information. It is a commercially available test and may be of use in demonstrating
proficiency in information literacy.

Examples of competency
statements related to each
of the Information Literacy
steps can be found in
Appendix B of this report.

10
 Information Management Competencies
Information management is the underlying effective, and efficient manner.
principle upon which TICC Clinical Information
Management Competencies are built. The most rigorous as well as practical work on
Information management is a process consisting enumerating the relevant parts of the EHRs for
of 1) collecting data, 2) processing the data, and clinicians was done by Health Level 7 (HL7) EHR
3) presenting and communicating the processed Technical Committee and was published in
data as information or knowledge. February 2007. This approved American
National Standard (ANSI) publication is titled The
An underlying concept for information HL7 EHR System Functional Model, Release 1,
management is the data-information-knowledge otherwise known as ANSI/HL7 EHR, R1-2007.
continuum. Data are discrete, atomic-level
symbols, for example, the number 120. The direct care component of the HL7 EHR
Information is data that is grouped or organized System Functional Model serves as a basis of
or processed in such a way that the data has information management competencies for
meaning, for example a blood pressure of practicing nurses and graduating nursing
120/80. Knowledge is information transformed students (see Appendix C). Although these
or combined to be truly useful in making clinical information management competencies
judgments and decisions. An example of are numerous, they merely make explicit
knowledge is that a blood pressure of 120/80 is competencies for proficient use of EHRS clinical
dangerously hypertensive in a neonate. nursing responsibilities that practicing nurses
and graduating nursing students are responsible
Information is managed by nurses in a variety of for today in a paper information management
ways, but more and more the preferred or environment or a mixed paper and electronic
required method is through information environment.
systems. We define an information system as
being composed of human and computer However, the direct care component of the HL7
elements that work interdependently to process EHR System Functional Model is not quite
data into information. The most relevant, sufficient by itself to cover the information
important, and fundamental information management responsibilities of nurses in the
management competencies for nurses are those digital era. What is needed is to translate these
that relate to the electronic health record items into a set of competencies that address
system (EHRs). both the purpose and intended use of the HIT
system (EHR in this case) and the “due care “
Using an EHRs will be the way nurses manage that nurses need to take in managing
clinical information for the foreseeable future. information via these systems. For example,
However, nursing responsibilities are not electronic information is accessed and used in
changing in the shift to increased use of EHRs. different ways than on paper, and it is important
For example, nurses are still required to exercise for the user (nurse) to understand these
due care in protecting patient privacy. But the differences as well as the subsequent workflow
manner in which these responsibilities to and policies and procedures.
patients and communities are upheld may be
different. Therefore, all practicing nurses and Fortunately, the European Computer Driving
graduating nursing students are therefore Licence Foundation has come up with a set of
strongly encouraged to learn, demonstrate, and items that address these concerns, called ECDL-
use information management competencies to Health. The following chart (figure 5) illustrates
carry out their fundamental clinical how the ECDL-Health item can be linked to a
responsibilities in an increasingly safe, competency statement.

11
 Information Management Competencies
ECDL-Health
TICC-related Competency Statement
Syllabus Item
The Nurse will:
Concepts
Health
Information Verbalize the importance of Health Information Systems to clinical practice
Systems
Have knowledge of various types of Health Information Systems and their
clinical and administrative uses
HIS Types

Due Care
Assure Confidentiality of protected patient health information when using
Confidentiality
Health Information Systems under his or her control.
Assure Access Control in the use of Health Information Systems under his or
Access Control
her control

Security Assure the Security of Health Information Systems under his or her control

User Skills
Navigation Have the User Skills as outlined in direct care component of the HL7 EHRS
Decision Support model, which includes all of the ECDL-Health User Skills of Navigation,
Output Reports Decision Support, Output Reports and more.

Policy and Procedure

Understand the Principles upon which organizational and professional
Health Information System use by healthcare professionals and consumers
Principles are based.

Figure 5 - ECDL-Health Topics linked to TICC Competency Statements

This list of competencies came from the Direct Care components of the HL7 EHR System Functional
Model. In some cases functional statements were not changed as they can also serve as competencies. For
example, the HL7 EHR System Functional Model statement of “Access Healthcare Guidance” was
unchanged, except for the preamble that applies to all Clinical Information Management Competencies, as
“Using an EHRS, the nurse can: Access Healthcare Guidance.” An example of a change to the HL7 EHR
System Functional Model statements is ‘Communication with Medical Devices’ where “Communication
with Medical Devices” was changed to “Facilitate Communication with Medical Devices” to make it a
Clinical Information Management Competency.

12
 Information Management Competencies
RECOMMENDATIONS
As with the other categories of informatics competencies, the TICC developed a timeline to adopt and
integrate these competencies into nursing practice and education settings. Figure 5 illustrates these
recommendations for adoption.

Figure 5 - Information Management Competencies Timeline

Recommendation Timeline for Adoption

Schools of nursing and healthcare delivery organizations will By January 2012

implement the information competencies listed in Appendix.

Schools of nursing and healthcare delivery organizations will By January 2012

implement the transformed ECDL-Health syllabus items listed
above.

RESOURCES

HL7 EHR System Functional Model

http://www.hl7.org/EHR/
This ANSI standard can be used by nursing instructors in schools of nursing and healthcare delivery
organizations to develop curriculum to impart the recommended information management competencies
to all practicing nurses and graduating nursing students.

ICDL-Health Syllabus
http://www.ecdl.com
A significant portion of the HL7 EHR System Functional Model is covered by the ECDL-Health Syllabus. The
ECDL-Health Syllabus was developed by the ECDL Foundation to extend the foundation of basic computer
competency skills that are not industry specific into the healthcare industry.

Digital Patient Record Certification (DPRC)

http://dprcertification.com
The DPRC Program was developed with a panel of U.S. informatics subject matter experts and is endorsed
by the American Medical Informatics Association. The DPRC web site states that it assesses a healthcare
professional’s ability to accurately, dependably, and legally manage patient records in a digital
environment.

Healthcare Information and Management Systems Society

www.himss.org
The HITS program, sponsored in the United States by the Healthcare Information and Management
Systems Society, uses a more international version of the ICDL-Health syllabus. Both the DPRC and HITS
certifications are a substantial first step towards achieving clinical information management competencies
for U.S. nurses and graduating nursing students.

13
 Implementation Strategies
In summary, Federal initiatives mandate the use http://www.nursing-
of EHRs on all patients in the U.S. necessitates informatics.com/niassess/tutorials.html
the need for all practicing and graduate nurses
to master a minimum set of informatics http://www.nursing-
competencies. This report describes the informatics.com/niassess/tests.html
recommended competencies, and provides
recommendations for resources that have As mentioned previously, four other
already developed related educational material, TIGER Collaborative teams developed
and recommends a timeline for completion. recommendations on how to implement
the TICC competencies. Please refer to
There are several other resources that might be their reports for additional suggestions.
helpful in developing competency-based training These four teams include:
programs for informatics. The Quality Safety 1. TIGER Education and Faculty
Education For Nurses (QSEN) project is one such Development
resource. QSEN, a program funded by the
Robert Wood Johnson Foundation since 2006, is 2. TIGER Staff Development
primarily focused on developing the knowledge, 3. TIGER Leadership Development
skills and attitudes (KSAs) necessary to improve
the quality and safety of the healthcare systems 4. TIGER Virtual Demonstration Center
within which they work. One of the KSAs within
These TIGER Collaborative reports are
QSEN is informatics. The QSEN project believes accessible on the TIGER website at
that nurses need to "Use information and www.thetigerinitiative.org.
technology to communicate, manage
knowledge, mitigate error, and support decision
making" (www.qsen.org). Faculty development
as well as curricular resources have been
developed through QSEN and are available for
dissemination on their website at
http://www.qsen.org .

Another beneficial resource that has developed

tools for nurses to assess their competencies
related to informatics can be found online at
http://www.nursing-
informatics.com/niassess/index.html. This
website also offers tools to help develop a
"Personal development plan" to improve
informatics competencies (see
http://www.nursing-
informatics.com/niassess/Personal_Plan_2
007.pdf). Other tools available include
quick informatics tutorials as well as self-
tests:

14
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Curran CR (2003) Informatics competencies for Grobe SJ (1989) Nursing informatics

nurse practitioners. AACN Clinical competencies. Methods Inf Med 28(4):267-269

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McNeil BJ, Elfrink VL et al (2006). Computer Simpson RL (2005) Practice to evidence to

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information technology knowledge, skills, and Nursing Education Perspectives 25(6):312
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TIGER Informatics Competencies Collaborative

(2007) Wiki. Accessed on November 20, 2009 at
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Travis L, Brennan PF (1998) Information science

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Vanderbeek J, Beery TA (1998) A blueprint for an

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17
 Appendix A - Basic Computer Competencies

TIGER Informatics Competencies Recommendations - Basic Computer Competencies

1. Basic Computer Competency

1.1
Hardware
1.1.1. Concepts
1.1.1.1 Understand the term hardware.
Understand what a personal computer is. Distinguish between desktop, laptop (notebook), tablet P C in
1.1.1.2 terms of typical users.
Identify common handheld portabledigital devices like: personal digital assistant (PDA), mobile phone,
1.1.1.3 smartphone, multimedia player and know their main features.
Know the main parts of a computer like: central processing unit (CPU), types of memory, hard disk, common
1.1.1.4 input and output devices.
1.1.1.5 Identify common input/output ports like: USB, serial, parallel, network port, FireWire.

1.1.2 Computer Performance

Know some of the factors that impact on a computer’s performance like: CPU speed, RAM size, graphics
1.1.2.1 card processor and memory, the number of applications running.

1.1.2.2 Know that the speed (operating frequency) of the CPU is measured in megahertz (MHz) or gigahertz (GHz).

1.1.3 Memory and Storage

Know what computer memory is: RAM (random-access memory), ROM (readonly memory) and distinguish
1.1.3.1 between them.
1.1.3.2 Know storage capacity measurements: bit, byte, KB, MB, GB, TB.
Know the main types of storage media like: internal hard disk, external hard disk, network drive, CD, DVD,
1.1.3.3 USB flash drive, memory card, online file storage.

1.1.4 Input, Output Devices

Identify some of the main input devices like: mouse, keyboard, trackball, scanner, touchpad, stylus, joystick,
1.1.4.1 web camera (webcam), digital camera, microphone.

1.1.4.2 Know some of the main output devices like: screens/monitors, printers, speakers, headphones.
1.1.4.3 Understand some devices are both input and output devices like: touch screens.
1.2
Software
1.2.1 Concepts
1.2.1.1 Understand the term software.
1.2.1.2 Understand what an operating system is and name some common operating systems.

Identify and know the uses of some common software applications: word processing, spreadsheet, database,
1.2.1.3 presentation, e-mail, web browsing, photo editing, computer games.
1.2.1.4 Distinguish between operating systems software and applications software.
Know some options available for enhancing accessibility like: voice recognition software, screen reader,
1.2.1.5 screen magnifier, on-screen keyboard.

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 Appendix A - Basic Computer Competencies
TIGER Informatics Competencies Recommendations - Basic Computer Competencies
1.3 Networks
1.3.1 Network Types
Understand the terms local area network (LAN), wireless local area network (WLAN), wide
1.3.1.1
area network (WAN).
1.3.1.2 Understand the term client/server.
1.3.1.3 Understand what the Internet is and know some of its main uses.
1.3.1.4 Understand what an intranet, extranet is.
1.3.2 Data Transfer
1.3.2.1 Understand the concepts of downloading from, uploading to a network.
Understand what transfer rate means. Understand how it is measured: bits per second (bps),
1.3.2.2
kilobits per second (kbps), megabits per second (mbps).
1.3.2.3 Know about different Internet connection services: dial-up, broadband.
Know about different options for connecting to the Internet like: phone line, mobile phone,
1.3.2.4
cable, wireless, satellite.
Understand some of the characteristics of broadband: always on, typically a flat fee, high
1.3.2.5
speed, higher risk of intruder attack.
1.4 ICT in Everyday Life
1.4.1 Electronic World
1.4.1.1 Understand the term Information and Communication Technology (ICT).
Know about different Internet services for consumers like: e-commerce, ebanking, e-
1.4.1.2
government.
Understand the term e-learning. Know some of its features like: flexible learning time, flexible
1.4.1.3
learning location, multimedia learning experience, cost effectiveness.
Understand the term teleworking. Know some of the advantages of teleworking like: reduced
1.4.1.4 or no commuting time, greater ability to focus on one task, flexible schedules, reduced
company space requirements. Know some disadvantages of teleworking like: lack of human
contact, less emphasis on teamwork.
1.4.2 Communication
1.4.2.1 Understand the term electronic mail (email).
1.4.2.2 Understand the term instant messaging (IM).
1.4.2.3 Understand the term Voice over Internet Protocol (VoIP).
1.4.2.4 Understand the term Really Simple Syndication (RSS) feed.
1.4.2.5 Understand the term web log (blog).
1.4.2.6 Understand the term podcast.
1.4.3 Virtual Communities
Understand the concept of an online (virtual) community. Recognize examples like: social
1.4.3.1
networking websites, Internet forums, chat rooms, online computer games.
Know ways that users can publish and share content online: web log (blog), podcast, photos,
1.4.3.2
video and audio clips.
Know the importance of taking precautions when using online communities: make your
1.4.3.3 profile private, limit the amount of personal information you post, be aware that posted
information is publicly available, be wary of strangers.

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 Appendix A - Basic Computer Competencies
TIGER Informatics Competencies Recommendations - Basic Computer Competencies
1.4.4 Health
1.4.4.1 Understand the term ergonomics.
Recognize that lighting is a health factor in computer use. Be aware that use of artificial light,
1.4.4.2
amount of light, direction of light are all important considerations.
Understand that correct positioning of the computer, desk and seat can help maintain a good
1.4.4.3
posture.
Recognize ways to help ensure a user’s wellbeing while using a computer like: take regular
1.4.4.4
stretches, have breaks, use eye relaxation techniques.
1.4.5 Environment
1.4.5.1 Know about the option of recycling computer components, printer cartridges and paper

1.4.5.2 Know about computer energy saving options: applying settings to automatically turn off the
screen/monitor, to automatically put the computer to sleep, switching off the computer.
1.5
Security
1.5.1 Identity/Authentication
Understand that for security reasons a user name (ID) and password are needed for users to
1.5.1.1
identify themselves when logging on to a computer.
Know about good password policies like: not sharing passwords, changing them regularly,
1.5.1.2
adequate password length, adequate letter and number mix.
1.5.2 Data Security
1.5.2.1 Understand the importance of having an off-site backup copy of files.
1.5.2.2 Understand what a firewall is.
Know ways to prevent data theft like: using a user name and password, locking computer
1.5.2.3
and hardware using a security cable.
1.5.3 Viruses
1.5.3.1 Understand the term computer virus.
1.5.3.2 Be aware how viruses can enter a computer system.
Know how to protect against viruses and the importance of updating antivirus software
1.5.3.3
regularly.
1.6 Law
1.6.1 Copyright
1.6.1.1 Understand the term copyright.
Know how to recognize licensed software: by checking product ID, product registration, by
1.6.1.2
viewing the software licence.
1.6.1.3 Understand the term end-user license agreement.
1.6.1.4 Understand the terms shareware, freeware, open source.
1.6.2 Data Protection
Identify the main purposes of data protection legislation or conventions: to protect the rights
1.6.2.1
of the data subject, to set out the responsibilities of the data controller.
1.6.2.2 Identify the main data protection rights for a data subject in your country.
1.6.2.3 Identify the main data protection responsibilities for a data controller in your country.

20
 Appendix A - Basic Computer Competencies
TIGER Informatics Competencies Recommendations - Basic Computer Competencies
2.1 Operating System
2.1.1 First Steps
2.1.1.1 Start the computer and log on securely using a user name and password.
2.1.1.2 Restart the computer using an appropriate routine.
2.1.1.3 Shut down a non-responding application.
2.1.1.4 Shut down the computer using an appropriate routine.
2.1.1.5 Use available Help functions.
2.1.2 Setup
View the computer’s basic system information: operating system name and version number,
2.1.2.1
installed RAM (random- access memory).

2.1.2.2 Change the computer’s desktop configuration: date & time, volume settings, desktop display
options (color settings, desktop background, screen pixel resolution, screen saver options).
2.1.2.3 Set, add keyboard language.
2.1.2.4 Install, uninstall a software application.
2.1.2.5 Use keyboard print screen facility to capture a full screen, active window.
2.1.3 Working with Icons
Identify common icons like those representing: files, folders, applications, printers, drives,
2.1.3.1
recycle bin/wastebasket/trash.
2.1.3.2 Select and move icons.
2.1.3.3 Create, remove a desktop shortcut icon, make an alias.
2.1.3.4 Use an icon to open a file, folder, application.
2.1.4 Using Windows
Identify the different parts of a window: title bar, menu bar, toolbar or ribbon, status bar,
2.1.4.1
scroll bar.
2.1.4.2 Collapse, expand, restore, resize, move, close a window.
2.1.4.3 Switch between open windows.
2.2 File Management
2.2.1 Main Concepts
Understand how an operating system organizes drives, folders, files in a hierarchical
2.2.1.1
structure.
Know devices used by an operating system to store files and folders like: hard disk, network
2.2.1.2
drives, USB flash drive, CD-RW, DVD-RW.
2.2.1.3 Know how files, folders are measured: KB, MB, GB.
Understand the purpose of regularly backing up data to a removable storage device for off-
2.2.1.4
site storage.
2.2.1.5 Understand the benefits of online file storage: convenient access, ability to share files.
2.2.2 Files and Folders
2.2.2.1 Open a window to display folder name, size, location on a drive.
2.2.2.2 Expand, collapse views of drives, folders.
2.2.2.3 Navigate to a folder, file on a drive.
2.2.2.4 Create a folder and a further subfolder.
2.2.3 Working with Files
Identify common file types: word processing files, spreadsheet files, database files,
2.2.3.1 presentation files, portable document format files, image files, audio files, video files,
compressed files, temporary files, executable files.
Open a text editing application. Enter text into a file, name and save the file to a location on
2.2.3.2
a drive.

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 Appendix A - Basic Computer Competencies
TIGER Informatics Competencies Recommendations - Basic Computer Competencies
2.2.3.3 Change file status: read-only/locked, read-write.
2.2.3.4 Sort files in ascending order by name, size, type, date modified.
Recognize good practice in folder, file naming: use meaningful names for folders and files to
2.2.3.5
help with recall and organization.
2.2.3.6 Rename files, folders.
2.2.4 Copy, Move
2.2.4.1 Select a file, folder individually or as a group of adjacent, non-adjacent files, folders.
2.2.4.2 Copy files, folders between folders and between drives.
2.2.4.3 Move files, folders between folders and between drives.
2.2.5 Delete, Restore
2.2.5.1 Delete files, folders to the recycle bin/wastebasket/trash.
2.2.5.2 Restore files, folders from the recycle bin/wastebasket/trash.
2.2.5.3 Empty the recycle bin/wastebasket/trash
2.2.6 Searching
2.2.6.1 Use the Find tool to locate a file, folder.
2.2.6.2 Search for files by all or part of file name, by content.
2.2.6.3 Search for files by date modified, by date created, by size.
2.2.6.4 Search for files by using wildcards: file type, first letter of file name.
2.2.6.5 View list of recently used files.
2.3Utilities
2.3.1 File Compression
2.3.1.1 Understand what file compression means.
2.3.1.2 Compress files in a folder on a drive.
2.3.1.3 Extract compressed files from a location on a drive.
2.3.2 Anti-Virus
2.3.2.1 Understand what a virus is and the ways a virus can be transmitted onto a computer.
2.3.2.2 Use anti-virus software to scan specific drives, folders, files.
2.3.2.3 Understand why anti-virus software needs to be updated regularly.
2.4 Print Management
2.4.1 Printer Options
2.4.1.1 Change the default printer from an installed printer list.
2.4.1.2 Install a new printer on the computer.
2.4.2 Print
2.4.2.1 Print a document from a text editing application.
2.4.2.2 View a print job’s progress in a queue using a desktop print manager.
2.4.2.3 Pause, re-start, delete a print job using a desktop print manager.
3.1 Using the Application
3.1.1 Working with Documents
3.1.1.1 Open, close a word processing application. Open, close documents.
Create a new document based on default template, other available template like: memo, fax,
3.1.1.2
agenda.
Save a document to a location on a drive. Save a document under another name to a location
3.1.1.3
on a drive.
Save a document as another file type like: text file, Rich Text Format, template, software
3.1.1.4
specific file extension, version number.
3.1.1.5 Switch between open documents.

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 Appendix A - Basic Computer Competencies
TIGER Informatics Competencies Recommendations - Basic Computer Competencies
7.1 The Internet
7.1.1 Concepts/Terms
7.1.1.1 Understand what the Internet is.
7.1.1.2 Understand what the World Wide Web (WWW) is.
Define and understand the terms: Internet Service Provider (ISP), Uniform Resource Locator (URL),
7.1.1.3
hyperlink.
7.1.1.4 Understand the make-up and structure of a web address.
7.1.1.5 Understand what a web browser is and name different web browsers.
7.1.1.6 Know what a search engine is.
Understand the term Really Simple Syndication (RSS) feed. Understand the purpose of subscribing
7.1.1.7
to an RSS feed.
7.1.1.8 Understand the term podcast. Understand the purpose of subscribing to a podcast.
7.1.2 Security Considerations
7.1.2.1 Know how to identify a secure web site: https, lock symbol.
7.1.2.2 Know what a digital certificate for a web site is.
7.1.2.3 Understand the term encryption.
Know about security threats from web sites like: viruses, worms, Trojan horses, spyware.
7.1.2.4
Understand the term malware.
Understand that regularly updated anti-virus software helps to protect the computer against
7.1.2.5
security threats.
7.1.2.6 Understand that a firewall helps to protect the computer against intrusion.
7.1.2.7 Know that networks should be secured by user names and passwords.
Identify some risks associated with online activity like: unintentional disclosure of personal
7.1.2.8
information, bullying or harassment, targeting of users by predators.
Identify parental control options like: supervision, web browsing restrictions, computer games
7.1.2.9
restrictions, computer usage time limits.
7.2 Using the Browser
7.2.1 Basic Browsing
7.2.1.1 Open, close a web browsing application.
7.2.1.2 Enter a URL in the address bar and go to the URL.
7.2.1.3 Display a web page in a new window, tab.
7.2.1.4 Stop a web page from downloading.
7.2.1.5 Refresh a web page.
7.2.1.6 Use available Help functions.
7.2.2
Settings
7.2.2.1 Set the web browser Home Page/Start page.
7.2.2.2 Delete part, all browsing history.
7.2.2.3 Allow, block pop-ups.
7.2.2.4 Allow, block cookies.
7.2.2.5 Delete cache/temporary Internet files.
7.2.2.6 Display, hide built-in toolbars.
7.2.3 Navigation
7.2.3.1 Activate a hyperlink.
7.2.3.2 Navigate backwards and forwards between previously visited web pages.
7.2.3.3 Navigate to the Home page.

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 Appendix A - Basic Computer Competencies
TIGER Informatics Competencies Recommendations - Basic Computer Competencies
7.2.4 Bookmarks
7.2.4.1 Bookmark a web page. Delete a bookmark.
7.2.4.2 Display a bookmarked web page.
7.2.4.3 Create, delete a bookmark folder.
7.2.4.4 Add web pages to a bookmark folder.
7.3 Using the Web
7.3.1 Forms
Complete a web-based form using: text boxes, drop-down menus, list boxes, check boxes,
7.3.1.1
radio buttons.
7.3.1.2 Submit, reset a web-based form.
7.3.2 Searching
7.3.2.1 Select a specific search engine.
7.3.2.2 Carry out a search for specific information using a keyword, phrase.
Use advanced search features to refine a search: by exact phrase, by excluding words, by date,
7.3.2.3
by file format.
7.3.2.4 Search a web based encyclopedia, dictionary.
7.4 Web Outputs
7.4.1 Saving Files
7.4.1.1 Save a web page to a location on a drive.
7.4.1.2 Download files from a web page to a location on a drive.
7.4.1.3 Copy text, image, URL from a web page to a document.
7.4.2 Prepare and Print
Prepare a web page for printing: change printed page orientation, paper size, printed page
7.4.2.1
margins.
7.4.2.2 Preview a web page.
Choose web page print output options like: entire web page, specific page(s), selected text,
7.4.2.3
number of copies and print.
7.5 Electronic Communication
7.5.1 Concepts/Terms
7.5.1.1 Understand the term e-mail and know its main uses.
7.5.1.2 Understand the make-up and structure of an e-mail address.
7.5.1.3 Understand the term short message service (SMS).
7.5.1.4 Understand the term Voice over Internet Protocol (VoIP) and know its main benefits.
Understand the main benefits of instant messaging (IM) like: real-time communication,
7.5.1.5
knowing whether contacts are online, low cost, ability to transfer files.
Understand the concept of an online (virtual) community. Recognize examples like: social
7.5.1.6
networking websites, Internet forums, chat rooms, online computer games.
7.5.2 Security Considerations
7.5.2.1 Be aware of the possibility of receiving fraudulent and unsolicited email.
7.5.2.2 Understand the term phishing. Recognize attempted phishing.
Be aware of the danger of infecting the computer with a virus by opening an unrecognized e-
7.5.2.3
mail message, by opening an attachment.
7.5.2.4 Understand what a digital signature is.

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 Appendix A - Basic Computer Competencies
TIGER Informatics Competencies Recommendations - Basic Computer Competencies
7.5.3 E-mail Theory
Understand the advantages of e-mail systems like: speed of delivery, low cost, flexibility of using a
7.5.3.1
web-based e-mail account in different locations.
Understand the importance of network etiquette (netiquette) like: using accurate and brief
7.5.3.2 descriptions in e-mail message subject fields, brevity in e-mail responses, spell checking outgoing e-
mail.
Be aware of possible problems when sending file attachments like: file size limits, file type
7.5.3.3
restrictions (for example, executable files).
7.5.3.4 Understand the difference between the To, Copy (Cc), Blind copy (Bcc) fields.

7.6 Using e-mail

7.6.1 Send an e-mail
7.6.1.1 Open, close an e-mail application. Open, close an e-mail.
7.6.1.2 Create a new e-mail.
7.6.1.3 Enter an e-mail address in the To, Copy (Cc), Blind copy (Bcc) fields.
7.6.1.4 Enter a title in the Subject field.
7.6.1.5 Copy text from another source into an e-mail.
7.6.1.6 Insert, remove a file attachment.
7.6.1.7 Save a draft of an e-mail.
7.6.1.8 Use a spell checking tool and correct spelling errors.
7.6.1.9 Send an e-mail, send an e-mail with a low, high priority.
7.6.2 Receiving e-mail
7.6.2.1 Use the reply, reply to all function.
7.6.2.2 Forward an e-mail.
7.6.2.3 Save a file attachment to a location on a drive and open the file.
7.6.2.4 Preview, print a message using available printing options.
7.6.3 Enhancing Productivity
7.6.3.1 Add, remove message inbox headings like: sender, subject, date received.
7.6.3.2 Apply a setting to reply with, without original message insertion.
7.6.3.3 Flag an e-mail. Remove a flag mark from an e-mail.
7.6.3.4 Identify an e-mail as read, unread. Mark an e-mail as unread, read.
7.6.3.5 Display, hide built-in toolbars. Restore, minimize the ribbon.
7.6.3.6 Use available Help functions.
7.7 e-mail Management
7.7.1 Organize
7.7.1.1 Search for an e-mail by sender, subject, e-mail content.
7.7.1.2 Sort e-mails by name, by date, by size.
7.7.1.3 Create, delete an e-mail folder.
7.7.1.4 Move e-mails to an e-mail folder.
7.7.1.5 Delete an e-mail.
7.7.1.6 Restore a deleted e-mail.
7.7.1.7 Empty the e-mail bin/deleted items/trash folder.
7.7.2 Address Book
7.7.2.1 Add contact details to an address book. Delete contact details from an address book.
7.7.2.2 Update an address book from incoming e-mail.
7.7.2.3 Create, update a distribution list/mailing list.

25
 Appendix B - Information Literacy Competencies
TIGER Recommendations -Information Literacy Competencies

[Source: Modified from American Library Association's Information Literacy Competency Standards for Higher
Education (2000).]

Information Literacy Competencies

All practicing nurses and graduating nursing students will have the ability to:

1. Knowledge - Determine the nature and extent of the information needed.

1.1 Recognize a specific information need

1.2 Focus and articulate the information need into a researchable question.

Understand that the type and amount of information selected is determined in part by the
1.3
parameters of the need, as well as by the information available.

2. Access - Access needed information effectively and efficiently

2.1 Recognize the availability of a variety of sources and of assistance with using them.

Identify types of information resources in a variety of formats (e.g., primary or secondary,

2.2
journals, policies and procedures, electronic references) and understand their characteristics.

2.3 Select types of information resources appropriate to a specific information need.

Understand that different information sources and formats require different searching
2.4
techniques, including browsing.

2.5 Select the search strategies appropriate to the topic and resource.

Understand that various resources may use different controlled vocabularies to refer to the
2.5
same topic.

Use search language appropriate to the source, such as a controlled vocabulary, key words,
2.6 natural language, author and title searches to locate relevant items in print and electronic
resources.

Use online search techniques and tools to locate relevant citations and to further refine the
2.7
search.

Understand that the Internet may be a useful resource for locating, retrieving and transferring
2.8
information electronically.

2.9 Understand how to use classification systems and their rationale.

26
 Appendix B - Information Literacy Competencies
TIGER Recommendations -Information Literacy Competencies

[Source: Modified from American Library Association's Information Literacy Competency Standards for Higher
Education (2000).]

3. Evaluate information and its sources critically and incorporates selected information into his or her
knowledge base and value system

Understand that search results may be presented according to various ordering principles (e.g.,
3.1
relevance ranking, author, title, date, or publisher).

Assess the number and relevance of sources cited to determine whether the search strategy
3.2
must be refined.

Use the components of a citation (e.g., currency, reputation of author or source, format, or
3.3
elements of a URL) to choose those most suitable for the information need.

3.4 Perceive gaps in information retrieved and determine whether the search should be refined.

Understand that the Internet may be a useful resource for locating, retrieving and transferring
3.5
information electronically.

Use a variety of criteria, such as author's credentials, peer review, and reputation of the
3.6
publisher, to assess the authority of the source.

Assess the relevancy of a source to an information need by examining publication date,

3.7
purpose, and intended audience.

3.8 Recognize omission in the coverage of a topic.

Distinguish between primary and secondary sources in different disciplines and evaluate their
3.9
appropriateness to the information need.

3.10 Apply evaluation criteria to all information formats.

3.11 Integrate the new information into existing body of knowledge.

4. Individually or as a member of a group, use information effectively to accomplish a specific purpose

Recognize and evaluate documentation for the information source, such as research
4.1
methodology, bibliography or footnotes.

4.2 Use appropriate documentation style to cite sources used.

4.3 Summarize the information retrieved (e.g., write an abstract or construct an outline).

4.4 Recognize and accept the ambiguity of multiple points of view.

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 Appendix B - Information Literacy Competencies
TIGER Recommendations -Information Literacy Competencies

[Source: Modified from American Library Association's Information Literacy Competency Standards for Higher
Education (2000).]

4.5 Organize the information in a logical and useful manner.

4.6 Synthesize the ideas and concepts from the information sources collected.

4.7 Determine the extent to which the information can be applied to the information need.

4.8 Create a logical argument based on information retrieved.

5. Evaluate outcomes of the use of information

Describe the criteria used to make decisions and choices at each step of the particular
5.1
process used.

Assess effectiveness of each step of the process and refine the search process in order to
5.2
make it more effective.

Understand that many of the components of an information seeking process are

5.3
transferable and, therefore, are applicable to a variety of information needs.

Understand the structure of the information environment and the process by which both
5.4
scholarly and popular information is produced, organized and disseminated.

Understand the ethics of information use, such as knowing how and when to give credit to
5.5 information and ideas gleaned from others by appropriately citing sources in order to avoid
plagiarism.

5.6 Respect intellectual property rights by respecting copyright.

Understand concepts and issues relating to censorship, intellectual freedom, and respect
5.7
for differing points of view.

5.8 Understand the social/political issues affecting information, such as:

a) privacy

b) privatization and access to government information

c) electronic access to information

d) the exponential growth of information

e) equal access to information

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 Appendix C - Information Management Competencies
TIGER Recommendations - Information Management Competencies
[Source: Modified from the Health Language 7 (HL7) EHRs Functional Model]
3. Clinical Information Management Competencies

Concepts
Verbalize the importance of Health Information Systems to clinical practice

Have knowledge of various types of Health Information Systems and their

clinical and administrative uses

Due Care
Assure Confidentiality of protected patient health information when using
Health Information Systems under his or her control
Assure Access Control in the use of Health Information Systems under his or
her control

Assure the Security of Health Information Systems under his or her control

Policy and Procedure

Understand the Principles upon which organizational and professional Health
Information System use by healthcare professionals and consumers are based.

User Skills

Have the User Skills as outlined in direct care component of the HL7 EHRS
model (see below: Using and EHRS, the nurse can:) , which includes all of the
ECDL-Health User Skills of Navigation, Decision Support,

29
 Appendix C - Information Management Competencies
TIGER Recommendations - Information Management Competencies
[Source: Modified from the Health Language 7 (HL7) EHRs Functional Model]

Example Competency Statements: Using an EHR, the nurse can:

1.0 Demographic/patient info
1.1 Identify and Maintain a Patient Record
1.2 Manage Patient Demographics
1.3 Capture Data and Documentation from External Clinical Sources
1.4 Capture Patient-Originated Data
1.5 Capture Patient Health Data Derived from Administrative and
1.6 Interact with Financial Data and Documentation
1.7 Produce a Summary Record of Care
1.8 Present Ad Hoc Views of the Health Record
1.9 Manage Patient History
2.0 Consents and Authorizations
2.1 Manage Patient and Family Preferences
2.2 Manage Patient Advance Directives
2.3 Manage Consents and Authorizations
3.0 Medication Management
3.1 Manage Allergy, Intolerance and Adverse Reaction Lists
3.2 Manage Medication Lists
3.3 Manage Problem Lists
3.4 Manage Immunization Lists
3.5 Manage Medication Administration
3.6 Manage Immunization Administration
3.7 Manage Medication Orders as appropriate for her scope of practice
4.0 Planning Care
4.1 Interact with Guidelines and Protocols for Planning Care
4.2 Manage Patient-Specific Care and Treatment Plans
4.3 Interact with Clinical Workflow Tasking
4.4 Interact with Clinical Task Assignment and Routing
4.5 Interact with Clinical Task Linking
4.6 Interact with Clinical Task Tracking
5.0 Order/Results Management
5.1 Manage Non-Medication Patient Care Orders
5.2 Manage Orders for Diagnostic Tests
5.3 Manage Orders for Blood Products and Other Biologics
5.4 Manage Referrals
5.5 Manage Order Sets
5.6 Manage Results
6.0 Care Documentation
6.1 Manage Patient Clinical Measurements
6.2 Manage Clinical Documents and Notes
6.3 Manage Documentation of Clinician Response to Decision Support Prompts
6.4 Generate and Record Patient-Specific Instructions

30
 Appendix C - Information Management Competencies
TIGER Recommendations - Information Management Competencies
[Source: Modified from the Health Language 7 (HL7) EHRs Functional Model]
Example Competency Statements: Using an EHR, the nurse can:
7.0 Decision Support
7.1 Manage Health Information to Provide Decision Support for Standard Assessments
Manage Health Information to Provide Decision Support for Patient Context- Driven
7.2
assessments
Manage Health Information to Provide Decision Support for Identification of Potential Problems
7.3
and Trends
7.4 Manage Health Information to Provide Decision Support for Patient and Family Preferences
7.5 Interact with decision Support for Standard Care Plans, Guidelines, and Protocols
7.6 Interact with decision Support for Context-Sensitive Care Plans, Guidelines, and Protocols
7.7 Manage Health Information to Provide Decision Support Consistent Healthcare
7.8 Management of Patient Groups or Populations
Manage Health Information to Provide Decision Support for Research Protocols Relative to
7.9
Individual Patient Care
7.10 Manage Health Information to Provide Decision Support for Self-Care
Interact with decision support for Medication and Immunization Ordering as appropriate for her
7.11
scope of practice
7.12 Interact with decision Support for Drug Interaction Checking
7.13 Interact with decision Support for Patient Specific Dosing and Warnings
7.14 Interact with decision Support for Medication Recommendations
7.15 Interact with decision Support for Medication and Immunization Administration
7.16 Interact with decision Support for Non-Medication Ordering
7.17 Interact with decision Support for Result Interpretation
7.18 Interact with decision Support for Referral Process
7.19 Interact with decision Support for Referral Recommendations
7.20 Interact with decision Support for Safe Blood Administration
7.21 Interact with decision Support for Accurate Specimen Collection
8.0 Notifications
8.1 Interact with decision support that Presents Alerts for Preventive Services and Wellness
Interact with decision Support for Notifications and Reminders for Preventive Services and
8.2
Wellness
8.3 Manage Health Information to Provide Decision Support for Epidemiological
8.4 Investigations of Clinical Health Within a Population.
Manage Health Information to Provide Decision Support for Notification and Response
8.5
regarding population health issues
8.6 Manage Health Information to Provide Decision Support for Monitoring Response
8.7 Notifications Regarding a Specific Patient’s Health
8.8 Access Healthcare Guidance
9.0 Facilitating Communications
9.1 Facilitate Inter-Provider Communication
9.2 Facilitate Provider -Pharmacy Communication
9.3 Facilitate Communications Between Provider and Patient and/or the Patient Representative
9.4 Facilitate Patient, Family and Care Giver Education
9.5 Facilitate Communication with Medical Devices

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 Acknowledgements
The TIGER Initiative would like to acknowledge EDITORS
and extend its thanks to the hundreds of Marie McCarren, not a TICC member, is
volunteers and nursing professional
gratefully acknowledged for her editing and
organizations who lent their leadership,
editorial guidance.
expertise, and support to the development of
Sunmoo Yoon, Columbia University Graduate
the TIGER Initiative Collaborative Reports.
Student, helped to create the appendices of
The TIGER Usability and Clinical Application
competencies listed within this document.
Development Collaborative was led by two
industry expert co-chairs:
COLLABORATIVE PARTICIPANTS
We would also like to thank and acknowledge all
CO-CHAIRS of the participants of the TIGER Usability
Brian Gugerty DNS, RN Collaborative team. The richness of their
Clinical Informatician expertise and contributions not only facilitated
Principal Consultant the development of this report but their
Gugerty Consulting, LLC willingness to share their experiences with
others will add to further development related
Connie Delaney PhD, RN, FAAN, FACMI to usability and clinical application development.
Dean and Professor
School of Nursing Deborah Aldridge, Stanly Medical Services;
University of Minnesota Christel Anderson, HIMSS; Tami Austin, OSF
Healthcare; Donna Bailey, University of North
Their efforts were supported by the TIGER Carolina; Janet Baker, Ursuline College; Marion
Executive Program Director. Ball, IBM; A. Barry, TJUH; Melissa Foster
Barthold, Homestead Hospital; Estelle Bartley,
PROGRAM DIRECTOR Redland Hospital; Susan Boedefeld, Good
Samaritan Hospital; Charles Boicey, City of Hope;
Donna DuLong, BSN
Ken Bowman, Lancaster General Hospital;
TIGER Initiative
Victoria Bradley, Eclipsys; Phyllis Brenner,
Madonna University; Jane Brokel, University of
Special thanks are also in order to the Iowa; Robyn Carr, IMIA-NI; Pam Charney,
following individual who provided significant University of Washington; Hardy T. Clark, Baton
leadership and contributions to the various Rouge General Medical Center; P. Ann Coleman,
sub-components of this report: Texas Woman's University; Karen Colorafi,
Apollo College; Phyllis M. Connolly, San Jose
CONTRIBUTING AUTHORS State University; Deborah Cremin, Littleton
P. Ann Coleman, EdD, RN, MPA, PMP Regional Hospital; Jessie S. Cristobal, Kaiser
Texas Woman's University Permanente; Joan Culley, University of
Massachusetts Amherst; Chris Curran, Ohio
Wanda Kelley, RN, MSN State; Nina Darisse, Philips Healthcare; Janice
Catholic Healthcare Initiatives Unruh Davidson, Covenant Consulting Services;
Connie Delaney, University of Minnesota; Brian
Dixon, AHRQ; Penny Dodson, Arkansas Children's
Denise Tyler, RN-BC, MSN, MBA
Hospital; Donna DuLong, TIGER; Lisa Easterly,
Kaweah Delta Health Care District
Our Lady of Lourdes School of Nursing; Peggy
Esch, Citizens Memorial; Sharon Eshelman,
Sarah Tupper Montrose Memorial Hospital; Rosario Estrada,
Taylor-Tupper and Associates

32
 Acknowledgements
UMDNJ; Eva Feldman, St. Agnes Hospital; Medical Center; Theresa A. Miller, VA LB
Melissa Finnegan, Philips Healthcare/American Healthcare System; Vicki Morgan-Cramer,
Radiology Nurses Society; Joleen Frank, Beaver Catholic Health System of WNY; Liz Morris,
Dam Community Hospital; Susan Fulginiti, Kettering Medical Center; Beth Morrissette,
Kennedy Health System; Danniele J. Fullard, The Baptist Medical Center South; Susan Newbold,
Children's Institute; Colette Garton, AORN; Vanderbilt/CARING; Donna M. Mickitas, Hunter
Carole A. Gassert, ANI; Michael Gay; Denise College, CUNY; Anthony Norcio, UMBC; Ogo
Goldsmith, Brigham and Women's Hospital; Nwosu, CARING; Sue Olenick, Saint Clares Health
Anita Ground; Margaret Groves, Asante Health System; Carolyn Padovano, CAP; Karen Pancheri,
System; Kelly Grube, DuBois Regional Medical TWU & PVAM; Joel Parker, NNMC; Karen
Center; Brian Gugerty, Gugerty Consulting LLC; Peddicord, AWHONN; Daniel Pesut, Indiana
Cheryl Hager, Advocate Christ Medical Center; University School of Nursing; Joanne Pohl,
Cynthia Hake, Capital Region Medical Center; NONPF; Lisa Rabideau, CVPH Medical Center;
Diane K. Heine, Queen of the Valley Medical Patrick Riley, Healthia Consulting; Susan
Center; Helen Heiskell, Medical College of Rosenberg, McKesson; Nancy Rothman, National
Georgia; Lori Hendrickx, American Association of Nursing Centers Consortium; Kay Sackett,
Critical Care Nurses; Sylvia Suszka Hildebrandt, University at Buffalo, SUNY; Kathryn Sapnas,
Group Health Cooperative; Katherine Miami VA Healthcare System; Shirley Schiavone,
Holzmacher, Stony Brook University Medical South Jersey Healthcare; Ruth Schleyer,
Center; Elaine Hooper, Ontario Nursing Providence Health & Services; Tess Settergren,
Informatics Association; Patricia Hinton Walker, Minnesota Nursing Informatics Group (MINING);
USUHS; Christine A. Hudak, Case Western Pamela Sherwill-Navarro, University of Florida;
Reserve University; Krysia Hudson, Johns Florence Shrager, Gulfside Regional Hospice;
Hopkins University; Dolly Ireland, Mount Diane J. Skiba, UC Denver; Linda J. Smith,
Clemens Regional Medical Center/ASPAN; Cathy Portland VA Medical Center; Ann Smith-Flango,
Ivory, Tennessee AWHONN; Susan Jacobs, New Altoona VAMC; Lena Sorensen, NYU College of
York University; Berit Jasion, Duke University Nursing; Lee Stabler, Cape Canaveral
Health System; Constance Johnson, Duke Hospital/Health First; Nancy Staggers, University
University; Josette Jones, IUPUI; Eva Karp, Cerner of Utah; Edward Stern, NothingBEtter; Linda J.
Corporation; Wanda Kelley, Catholic Health Stierle, American Nurses Association; Cynthia
Initiatives, Julie Kenney, Advocate Christ Medical Struk, INFO; Darinda Sutton, Cerner Corporation;
Center; Nicole Kerkenbush, US Army; Charles Margaret Swanson, OSF Saint Anthony Medical
Killingsworth, California Pacific Medical Center; Center; Laura Taylor, Johns Hopkins University
Julie Kliewer, Alameda County Medical Center; School of Nursing; Kathy Terman, BHHS; Beth A.
Nancy Kranawetter, Southeast Hospital; Dina Tomasek, Perot Systems; Portia Towns, Keane;
Krenzischek, American Society of PeriAnesthesia Trish Trangenstein, Vanderbilt University School
Nurses;Caterina Lasome, Tricare Management of Nursing; Sarah Tupper, Taylor -Tupper
Activity; Margaret Louis, UNLV; Gary Loving, Consulting; Denise Tyler, Kaweah Delta/ANIA;
University of Oklahoma; Abdel latif Marini, Judy Underwood, HCA; Barbara Van de Castle,
American University of Beirut Medical Center; Johns Hopkins Cancer Center; Susan Vaughn,
Sherri Martin; Iredell Memorial Hospital; Debi Bloomington Hospital; Judith J. Warren,
Martoccio, University Community Hospital; University of Kansas School of Nursing; Kirby
Patricia McCartney, AWHONN; Cindy McCoy, Wilkerson, North Kansas City Hospital; Barbara
Troy University; Jacqueline McDonald, Stony Wroblewski, Cooley Dickinson Hospital; Sharon
Brook University Medical Center; Shannon Yearous, Mount Mercy College; Sunmoo Yoon,
McIntire, Iowa Veterans Home; Lois McMahon, Columbia University; Mary Zasada, Saint Mary's
Sanford Health; Brenda Meyer, Mille Lacs Health Hospital; and Kevin Zimmerman, Kaiser
Ssytem; Bonna Miller, New Hanover Regional Permanente.

33
 Acknowledgements

For additional information, please contact:

Brian Gugerty, RN, DNS

Gugerty Consulting, LLC
brian_gugerty@hotmail.com

Connie Delaney, RN, PhD, FACMI, FAAN

University of Minnesota
delaney@umn.com

Pat Hinton Walker, PhD, RN, FAAN, PCC

TIGER Initiative Phase III
phintonwalker@comcast.net

TIGER Website
www.thetigerinitiative.org

34