ANA

TIGER International Competency Synthesis Project Global Health Informatics Competency Recommendation Frameworks April 2020

Global Perspective

Local Perspective

relevance of core competency areas

validation and clustering of core competency areas

validation and illustration of core competency areas

survey workshop

case studies

International recommendation

framework

TIGER International Competency Synthesis Project Global Health Informatics Competency Recommendation Frameworks The TIGER International Task Force began comprehensive activities to compile recommended core international

informatics competencies reflective of many countries, scientific societies, and research projects. The project involved

three phases:

1. Compilation of national case studies submitted by our global Committee members from Australia, Brazil, China/

Taiwan, Finland, Germany (inclusive of Austria and Switzerland), Ireland, New Zealand, the Philippines, Portugal,

Scotland and the United States.

2. Deployment of a survey composed of 24 areas of core competencies in clinical informatics within five domains:

1) clinical nursing 2) nursing management 3) quality management 4) IT management in nursing 5) coordination of

interprofessional care. The questionnaire was sent to 21 countries yielding participation from 43 experts to truly

capture a global perspective.

3. Creation of the Recommendation Framework 1.0 (nursing centric) derived from case studies, survey results, and

stakeholder input. This framework was populated with international recommendations for cognitive competencies in

nursing, aimed at providing a grid to host knowledge about informatics competencies, professional roles, priorities and

practical experience.

Subsequently, the TIGER International Competency Synthesis Project (ICSP) and the EU*US eHealth Work Project joined

forces to describe and validate the TIGER Initiative’s framework of global health informatics core competencies focused on

a broad range of health professionals and their interprofessional collaboration with expert survey input from 51 countries

and 22 global case studies. Together, the findings populated Recommendation Framework 2.0 to help measure, inform,

educate and advance the development of a skilled workforce throughout the EU, US and around the world.

Recommendation Framework 1.0 – nursing focus

Table 1. Top 10 core competency areas in the five roles and related mean relevance (REL) (0…100).

Core competency

area

REL ± SD

n=41

1

Nursing

documentation

(including

terminologies)

94.4 ±

16.7

2 Information

and knowledge

management

82.2 ±

23.5

3 Principles of

nursing informatics

80.5 ±

23.1

4 Data protection

and security

80.0 ±

23.2

5 Ethics and IT 79.5 ±

21.6

6 Information and

communication

systems

75.1 ±

24.4

7 Quality

management

72.0 ±

22.3

8 Decision support

by IT

70.2 ±

28.5

9 eHealth,

telematics and

telehealth

(including

interoperability)

69.5 ±

25.0

10 Assistive

technology for

ageing people

69.0 ±

25.5

Core competency

area

REL ± SD

n=41

1 Quality

management

96.1 ±

13.2

2 Process

management

86.8 ±

17.4

3

Nursing

documentation

(including

terminologies)

84.4 ±

22.5

4 Information

and knowledge

management

83.2 ±

20.3

5

Information and

communication

systems

(including

interoperability)

80.2 ±

22.0

6 Principles of

nursing informatics

80.2 ±

22.0

7 Data protection

and security

79.5 ±

23.3

8 Project

management

78.5 ±

21.0

9 Principles of

management

78.5 ±

20.8

10

Change

management

and stakeholder

management

77.6 ±

25.5

Core competency

area

REL ± SD

n=41

1 Data protection

and security

85.9 ±

20.2

2 Information

and knowledge

management

85.4 ±

20.1

3

Nursing

documentation

(including

terminologies)

83.4 ±

21.4

4 Process

management

83.2 ±

20.8

5

Information and

communication

systems

(including

interoperability)

81.5 ±

23.0

6 Ethics and IT 78.8 ±

23.7

7

eHealth,

telematics and

telehealth

(including

interoperability)

77.6 ±

22.8

8 Quality

management

77.1 ±

22.6

9 Principles of

nursing informatics

74.6 ±

23.4

10 Principles of

management

74.6 ±

23.5

Clinical Nursing (Direct Patient Care)

Coordination of inter-professional care

Quality Management

Continuation of Table 1.

Table 2. Four domains of core competency areas workshop attendees rated as highly relevant and

corresponding items and competencies mentioned by the workshop attendees

Core competency area REL ± SD

n=43

1 Nursing documentation

(including terminologies)

92.1 ±

13.9

2 Principles of management 87.9 ±

18.6

3 Strategic management and leadership 86.7 ±

19.9

4 Quality management 85.1 ±

20.3

5 Human resource management 84.4 ±

18.8

6 Change management and stakeholder

management

84.2 ±

19.8

7 Information and knowledge management 84.0 ±

22.1

8 Principles of nursing informatics 82.3 ±

20.1

9 Process management 81.2 ±

20.4

10 Ethics and IT 80.5 ±

26.0

Data, information and knowledge (DIK) domain

Associated core competency areas (main similarities)

1) know how to use data/information not only how to enter data

Principles of nursing informatics

Information management and knowledge management in patient care

Decision support by IT

2) perform care planning and use of data

Nursing documentation (including terminologies)

Resource planning and logistics

Decision support by IT

3) make use of indicators (information) for decision making Information management and knowledge management in patient care

Decision support by IT

4) analyze what data are needed and are useful, link to data/

information science

Principles of nursing informatics

Information management in research

Information management and knowledge management in patient care

Information management in teaching, training and education

Core competency area REL ± SD

n=41

1 Information and communication systems

(including interoperability)

89.5 ±

15.3

2 Principles of nursing informatics 89.5 ±

19.2

3 Data protection and security 89.0 ±

17.3

4 IT risk management 86.8 ±

19.3

5 Project management 86.8 ±

17.8

6 Process management 86.1 ±

16.2

7 Information and knowledge management 86.1 ±

22.7

8 Decision support by IT 85.4 ±

19.8

9 Applied computer science/informatics 83.4 ±

19.7

10 Nursing documentation

(including terminologies)

83.4 ±

22.2

Nursing Management IT Management in Nursing

Data, information and knowledge (DIK) domain

Associated core competency areas (main similarities)

5) nurses as knowledge workers: access and use evidence based &

structured information Information management and knowledge management in patient care

6) use data for research and development Information management in research

7) information governance

Information management in research

Information management and knowledge management in patient care

Information management in teaching, training and education

Information exchange and information sharing (IEIS) domain

1) continuity of care Information and communication systems

eHealth, telematics and telehealth

2) sharing of information with the patient, work in partnership, learn to

listen

eHealth, telematics and telehealth

Assistive technology for ageing people

3) provide information map of caring for the citizens Assistive technology for ageing people

4) health information exchange Information and communication systems

eHealth, telematics and telehealth

5) interoperability Information and communication systems

Ethics and legal issues (EL) domain

1) ethics Ethics and IT

2) security and privacy Data protection and security

3) use of social media and ethical use of data Ethics and IT, data protection and security

Systems life cycle management (SLCM) domain

1) address requirements Applied computer science/informatics

2) communicate with engineers Project management

3) design thinking

Information and communication systems

Applied computer science/informatics

Project management

IT risk management

4) process design Process management

Continuation of Table 2.

Table 3. Cronbach’s alpha for the six final domains in each professional role with the related core competency areas

within the domains

Domains Clinical nursing (n=41)

Quality management

(n=41)

Coordination of inter-

professional care (n=41)

Nursing management

(n=43)

IT management

in nursing (n=41)

Data, information and knowledge (DIK) 0.87 0.89 0.90 0.88 0.87

Principles of nursing informatics

Information management and knowledge management in

patient care

Nursing documentation (including terminologies)

Decision support by IT

Information management in research

Information management in teaching,

training and education

Resource planning and logistics

Information exchange and information sharing (IEIS) 0.78 0.79 0.76 0.87 0.76

eHealth, telematics and telehealth

Assistive technology for ageing people

Information and communication systems

Ethics and legal issues (EL) 0.87 0.85 0.84 0.67 0.76

Data protection and security

Ethics and IT

Systems life cycle management (SLCM) 0.84 0.78 0.91 0.84 0.91

Information and communication systems

Applied computer science/informatics

Process management

Project management

IT risk management

Management in informatics (MAN) 0.94 0.87 0.96 0.90 0.93

Principles of management

Strategic management and leadership

Quality management

Change management and stakeholder management

Financial management

Human resource management

Biostatistics and medical technology (STAT&TECH) 0.77 0.81 0.77 0.90 0.87

Assistive technology for ageing people

Biomedical imaging and signal processing

Biostatistics/statistics

Table 4. Recommendation framework of health informatics for nurses. Legend: DIK = data, information, knowledge; IEIS =

information exchange and information sharing; SLCM = system life cycle management; MAN = management in informatics;

STAT&TECH = biostatistics and medical technology; REL = mean relevance from 0 … 100.

Roles Clinical nursing {direct patient care) Quality management Coordination of inter-professional care

Core competency area

domains REL n=41

REL n=41

REL n=41

Principles of nursing

informatics DIK 80.5 UK-SCO

NZ

BR

TW-CHN 80.2 NZ 74.6 NZ

Information

management

and knowledge

management in

patient care

DIK 82.2

UK-SCO

NZ

BR

USA

TW-CHN

83.2 85.4 NZ

Nursing

documentation

(including

terminologies)

DIK 80.5 UK-SCO

BR

TW-CHN 84.4 83.4 NZ

Decision support

by IT DIK 70.2 UK-SCO

BR

USA

TW-CHN 72.7 70.0 NZ

Information

management in

research

DIK 51.0 NZ

USA

72.4 60.5 NZ

Information

management in

teaching, training

and education

DIK 61.7 67.1 66.1

Resource planning

and logistics DIK 56.6 TW-CHN 65.4 71.7

Data protection and

security EL 80.0 UK-SCO

NZ

BR

79.5 NZ 85.9 NZ

Ethics and IT EL 79.5 UK-SCO

NZ

BR

USA 75.9 NZ 78.8 NZ

eHealth. telematics

and telehealth IEIS 69.5 UK-SCO

USA

TW-CHN 69.8 NZ 77.6

Assistive technology

for ageing people

IEIS /

STAT &

TECH

69.0 UK-SCO

NZ

TW-CHN 54.9 NZ 70.2 NZ

Information and

communication

systems

IEIS /

SLCM 75.1 UK-SCO

NZ

USA

TW-CHN 82.0 NZ 81.5 NZ

Applied computer

science/informatics SLCM 53.7 NZ

USA

TW-CHN 63.7 NZ

64.9

NZ

Process

management SLCM 67.8

TW-CHN 86.8 83.2

Project management SLCM 55.6 78.5 72.4

IT risk management SLCM 61.2

NZ 73.9

NZ 67.8

NZ

Principles of

management MAN 59.8 78.5 74.6

Strategic

management and

leadership

MAN 57.1

USA 77.1 72.7

Roles Clinical nursing {direct patient care) Quality management Coordination of inter-professional care

Core competency area

domains REL n=41

REL n=41

REL n=41

Quality management MAN 72.0 NZ

USA

TW-CHN 96.1

NZ 77.1 NZ

Change

management

and stakeholder

management

MAN 58.0 77.6 73.7

Financial

management MAN 47.6 65.4 62.0

Human resource

management MAN 57.1 68.8 68.0

Biomedical

imaging and signal

processing

STAT &

TECH 55.6 49.5 55.4

Biostatistics/statistics STAT &

TECH 47.8 76.6 55.6

Principles of nursing

informatics DIK 82.3 NZ

GER 89.5

NZ

Information

management

and knowledge

management in

patient care

DIK 84.0 GER

NZ

USA 86.1 NZ

USA

Nursing

documentation

(including

terminologies)

DIK 92.1 GER

NZ

83.4

Decision support

by IT DIK 74.7 USA

85.4 NZ

USA

Information

management in

research

DIK 63.3 NZ

USA

71.5 NZ

USA

Information

management in

teaching, training

and education

DIK 70.0 74.4

Resource planning

and logistics DIK 76.0 71.7

Data protection and

security EL 80.2 NZ

USA

89.0 NZ

USA

Ethics and IT EL 80.5 NZ

USA

83.4 NZ

USA

eHealth. telematics

and telehealth IEIS 66.3 USA

80.0 USA

Assistive technology

for ageing people IEIS 66.3 NZ

70.2 NZ

Information and

communication

systems

IEIS /

STAT &

TECH

75.1 NZ

USA

89.5 NZ

USA

Applied computer

science/ informatics SLCM 57.4 NZ

USA

83.4 NZ

USA

Roles Nursing management IT management in nursing

Core competency area

domains REL

n=43 REL n=41

Continuation of Table 4.

Roles Nursing management IT management in nursing

Core competency area

domains REL

n=43 REL n=41

Process

management SLCM 81 GER 86.1

Project management SLCM 76.3 86.8

IT risk management SLCM 73.3 NZ

86.8

NZ

Principles of

management MAN 87.9 GER 79.3

Strategic

management and

leadership

MAN 86.7 GER

USA

79.5 USA

Quality management MAN 85.1 GER

NZ

80.7 NZ

Change

management

and stakeholder

management

MAN 84.2 GER

NZ 80.5 NZ

Human resource

management MAN 84.4 GER

69.8

Biomedical

imaging and signal

processing

STAT &

TECH 54.7 62.4

Biostatistics/statistics STAT&

TECH 59.5 GER

67.3

Conclusion:

This international recommendation framework for core competency areas in health informatics for nurses aims at providing a grid to

embrace knowledge about competencies, professional roles, priorities and practical experience. The framework refers to the term

health informatics in nursing to demonstrate its rooting in nursing informatics and its openness towards other healthcare professionals

and their interaction with nurses. We contend that learning and teaching on the individual level are active processes of constructing

the educational space. Therefore, our recommendations should work as a framework that guides and stimulates learners and teachers

alike. It should leave enough room for individual creativity, aspiration for innovation and personal fulfillment. Due to technology being a

moving target, this recommendation framework should be revised and updated regularly. We propose a five-year period of validity.

Resources:

Methods Inf Med 2018; 57(Open 1): e30-e42

TIGER International Competency Synthesis Project

Continuation of Table 4.

Recommendation Framework 2.0 – interdisciplinary focus

In fall 2019, Recommendation Framework 2.0 was released with expert input from 51 countries. Findings from the EU*US

eHealth Work Project’s scope of work, funded by the European Commission’s Horizon 2020 research and innovation grant

program, were executed to empirically describe and validate the TIGER framework of health informatics competencies for

a broad range of health professionals and their interprofessional collaboration.

Table 1. Core competency areas in alphabetical order

Table 2. Top 10 core competency areas in the six roles and related mean relevance (REL - 0…100)

Applied computer science

Assistive technology

Change/stakeholder management

Clinical decision support by IT

Communication

Consumer health informatics

Data analytics

Data protection and security

Documentation

e/mHealth, telematics, telehealth

Ethics in health IT

Financial management

Care processes and IT integration

ICT / systems (applications)

ICT / systems (architectures)

Information management research

Information and knowledge management in patient care

Interoperability and integration

IT risk management

Leadership

Learning techniques

Legal issues in health IT

Medical technology

Principles of health informatics

Principles of management

Process management

Project management

Public health informatics

Quality and safety management

Resource planning & management

Strategic management

System lifecycle management

Teaching, training, education

Direct patient care (DPC) (nurses/physicians/therapists)

Core competencies REL ± SD

1 Communication [n=335] 92.4 ± 14.5

2 Documentation [n=337] 91.7 ± 17.2

3 Information & knowledge management in patient care [n=335] 89.9 ± 17.5

4 Quality & safety management [n=333] 87.5 ± 18.9

5 Leadership [n=336] 86.2 ± 19.0

6 Learning techniques [n=334] 85.6 ± 18.8

7 Teaching, training & education in healthcare [n=333] 84.4 ± 21.0

8 Ethics in health IT [n=334] 83.8 ± 22.9

9 Information & communication technology (applications) [n=332] 81.6 ± 20.5

10 Care processes & IT integration [n=333] 81.1 ± 21.3

Health information management (HIM)

Core competencies REL ± SD

1 Communication [n=184] 90.1 ± 19.0

2 Documentation [n=184] 87.7 ± 18.0

3 Data analytics [n=183] 87.7 ± 17.9

4 Leadership [n=184] 87.0 ± 19.0

5 Data protection & security [n=184] 86.9 ± 19.3

6 Information & knowledge management in patient care [n=182] 86.2 ± 19.4

7 Ethics in health IT [n=184] 85.6 ± 20.2

8 Principles of health informatics [n=182] 85.1 ± 18.4

9 Care processes & IT integration [n=183] 84.8 ± 19.1

10 Learning techniques [n=184] 84.2 ± 20.2

Executives (EXC) (clinical and administrative)

Core competencies REL ± SD

1 Communication [n=184] 90.1 ± 19.0

2 Documentation [n=184] 87.7 ± 18.0

3 Data analytics [n=183] 87.7 ± 17.9

4 Leadership [n=184] 87.0 ± 19.0

5 Data protection & security [n=184] 86.9 ± 19.3

6 Information & knowledge management in patient care [n=182] 86.2 ± 19.4

7 Ethics in health IT [n=184] 85.6 ± 20.2

8 Principles of health informatics [n=182] 85.1 ± 18.4

9 Care processes & IT integration [n=183] 84.8 ± 19.1

10 Learning techniques [n=184] 84.2 ± 20.2

Chief information officers (CIO) (clinical and technical)

Core competencies REL ± SD

1 Leadership [n=62] 93.8 ± 9.6

2 Communication [n=62] 93.1 ± 10.6

3 Care processes & IT integration [n=62] 91.8 ± 13.7

4 Principles of management [n=61] 90.8 ± 12.2

Continuation of Table 2.

5 Quality & safety management [n=61] 90.5 ± 12.7

6 Strategic management [n=61] 90.0 ± 13.4

7 Process management [n=62] 89.6 ± 13.6

8 Change & stakeholder management [n=61] 89.6 ± 12.6

9 Ethics in health IT [n=61] 88.7 ± 18.0

10 Resource planning & management [n=61] 88.4 ± 18.7

Engineering or health IT specialist (ENG)

Core competencies REL ± SD

1 Communication [n=172] 91.3 ± 14.2

2 Care processes & IT integration [n=171] 87.5 ± 18.9

3 Information & communication technology (applications) [n=171] 87.2 ± 18.0

4 Leadership [n=172] 86.1 ± 17.8

5 Project management [n=172] 85.4 ± 19.7

6 Data protection & security [n=171] 84.3 ± 22.6

7 Ethics in health IT [n=170] 83.4 ± 22.2

8 Interoperability & integration [n=172] 83.0 ± 21.7

9 Documentation [n=172] 82.1 ± 22.6

10 Process management [n=172] 82.0 ± 21.7

Science and education (S&E)

Core competencies REL ± SD

1 Communication [n=218] 91.6 ± 16.1

2 Teaching, training & education in health care [n=220] 89.2 ± 17.8

3 Leadership [n=218] 88.2 ± 17.3

4 Learning techniques [n=218] 88.1 ± 18.8

5 Ethics in health IT [n=219] 86.5 ± 21.3

6 Documentation [n=222] 86.3 ± 21.2

7 Information & knowledge management in patient care [n=221] 86.3 ± 20.2

8 Principles of health informatics [n=218] 83.3 ± 23.2

9 Quality & safety management [n=220] 83.1 ± 22.9

10 Data analytics [n=218] 81.9 ± 23.6

Continuation of Table 2.

Table 3. Cronbach’s Alpha values for the roles and clusters (no. core competency areas)

Clusters Roles

DPC ENG HIM EXC CIO S&E

DIK (8) 0.86 0.88 0.90 0.86 0.82 0.92

n 322 161 174 54 51 211

IEIS (8) 0.88 0.88 0.91 0.91 0.88 0.92

n 321 160 171 54 59 207

EL (3) 0.82 0.87 0.90 0.79 0.87 0.89

n 330 169 182 55 51 217

SYS (4) 0.85 0.85 0.88 0.90 0.85 0.91

n 324 167 176 54 51 212

MAN (10) 0.92 0.92 0.95 0.92 0.92 0.95

n 326 166 175 54 51 212

TECH (2) 0.49 0.71 0.65 0.68 0.73 0.76

n 325 163 175 55 59 211

LRN (2) 0.68 0.57 0.83 0.63 0.81 0.80

n 332 166 181 54 62 218

The combined projects Recommendation Framework 2.0 was extract from the full publication “Towards the TIGER International

Framework for Recommendations of Core Competencies in Health Informatics 2.0 — Extending the Scope and the Roles”.

Conclusion:

The TIGER International Recommendation Framework of Core Competencies in Health Informatics 2.0 is based on a proven

methodology and well on its way with global findings and local exemplar case studies. It contributes to the overall discourse how to

shape health informatics education to improve quality and safety of care by enabling useful and successful health information systems.

Furthermore, these findings should help stimulate the discussion within IMIA’s work on educational recommendations.

Resources:

EU*US eHealth Work Project

Global case studies

To learn more about the HIMSS Technology Informatics Guiding Education Reform (TIGER)

Interprofessional Community and to get involved, please visit:

www.himss.org/membership/get-involved/communities/tiger.