We now have 37 countries that are working with the TIGER Initiative. Okay. Some of them have already integrated it into their nursing schools, but the first leader was Taiwan, they're making a major effort now to copy what's in Taiwan. In two months, I'll go to Xi'an where the terracotta soldiers are. A cardiology hospital there is wanting to put that into their hospital. They're looking at translating all of what we have in the virtual learning environment. We also had a very- this is also interesting for you to see, the IOM. Well, now the National Academy of Science, they have a core inter-professional competencies that we have been now working with the European Union and really moving into making this a global initiative. The institutions in our- let me show it this way, too. Yeah, so the tiger. That's the symbol. This is our TIGER logo, so to say. It says around here, Technology Informatics Guiding Education Reform. These are the major universities that now give degrees in nursing informatics. As you know, we've just recently have in the ANIA and in our professional organizations, you can get a certification. Well, a specialty in medical informatics. So, we're moving and you can get certified through the academies also in nursing. It also shows you that if you really believe in something, that you can make a difference. Just the three of us started that. We invited Brailer to come to Hopkins which he did to the School of Nursing. Challenged him not chess dice but invited him to make sure that we end up- it turns out his mother was a nurse. So that helped us too. It's just fun to see. Then here too, in "The History of Medical Informatics," there's a whole chapter here written by Patty Walker who's the one who was the dean at that time at the School of Nursing. So, this is all 15 years ago and we're going strong and more and more international. But the important thing is, now going into professionally and using the HIMSS organization which is the Health Information Management Systems Society and bringing their technologies. Bringing their constituents. They are over 70,000 members of the HIMSS organization. I heart here about 6,000 of ANIA, and the ANIA would be the more academic if we want to go some of the terminology above the line and below the line. Yeah. That would be the two populations. They have to work together and I think they're slowly coming together. So it's an amazing story, Marion, of how the TIGER Initiative found a home within HIMSS. I think a really great example of something that was very grassroots. Really grassroots. It started at Hopkins, by the way, which I think we mustn't forget. We did get the support from the dean at the time. Yeah. Again, if you don't get support from the top, even if it's tacit, you can still move forward. But if they say no, you're dead in the water. Right. Right. I think it's something that we do take for granted. These days when providers are being trained on computerized systems. Let's say back in the era of meaningful use, and hospitals were switching from paper to electronic medical records, it was nursing informaticists who were leading a lot of the training. So, I was trained in an era where that inter-professional collaboration was happening. We just started [inaudible] Yeah. So my perspective was different and we read about the times where there was more resistance and more silos. But in my day-to-day work, I'm working with pharmacists. Respectfully and not having the status. The hierarchy. The hierarchy. I mean, the team effort is really showing and the respect for the nurses. What we've learned also in the years here with Peter Pronovost, bringing the nurses in who were able to say in some of his studies if the physician was so busy, did not have a chance to wash their hands that the nurse was able to say, "Look. Before you touch the patient, you may need to do-," in a nice way that there's camaraderie to work towards what's the safest for the patient. Teamwork is so impressive and that's what's a big plus in the last five or six years, even 10, before that they were still like, "How dare you say anything to me. I'm the doctor and you're the nurse." That type of a thing? Yeah. Not there anymore. I think that's a good way to wrap up with you talking about that voice that other professions need to have in the operating room, in the clinic. Civility. Just plain civility. You're absolute, good point. Having that voice when designing software that's going to have an impact on patients, on families, in the health care setting. It's important to make sure that you're relying on the voice of the professions who will be using the tools, who will be at the front lines. That's so crucial. The point you make so well is that's why we're training nurses and physicians so that they too will go into industry. Work with industry, so that the tools that then are sold and adopted by healthcare organizations have been developed and understand the culture and the workflow and the whole way of doing things from those who are doing it rather than good super engineers who top-down tell you use that, and you can't figure out because they have a completely different mindset. Yeah. So a lot of our nurses that we're training, they're working for Epic. They're working for Cerner. They're working for MEDITECH. They're working for all of the hospital information systems and lab systems. Yeah, and having the clinicians and the developers working elbow-to-elbow is so important. Exactly. Because they're graduates of some of these programs where they have the clinical background including the informatics training. So, that was a really great historical perspective on the evolution of the TIGER Initiative. Something that students will certainly need- To know about and get big European study which is on competencies. I mean it's a fabulous study on competencies because you need to have, it's like reading, writing and arithmetic. What is the the competence you need to feel comfortable using enabling technologies? That's available, well published in open source, so it's all out there. Just for the taking. Fantastic. Thank you, Marion. It's a pleasure to have done this with you. Great. Thanks for the invitation.
