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While also helping align the health care industry with quality expectations in other industries, dialogue about the use of technology, nursing terminologies, and consistent specifications for data capture, including physician order entry, diagnoses, interventions, and decision support, became part of the quality discussion. Harnessing complex technology for quality improvement and reporting purposes has become crucial.

Data collection burdens, the accuracy of electronic data extractions, the timeliness of data reporting and analysis, the ability to have timely comparisons to benchmarks—all of these impact not only the performance improvement process, but also the ability to ensure that patients are receiving the care they deserve within a safety culture. This was particularly relevant during the COVID‐19 pandemic, when nurse staffing was at a crisis level due to tremendous patient loads. Further, most electronic health record systems do not collect meaningful data that would allow sufficient analysis about social determinants of health, often leading to inequitable care delivery.

The challenge of many electronic systems is that while many data go into the system, particularly in the delivery of nursing care, it can be nearly impossible to extract them for reporting and analysis. Further, decision supports based on data that identify a patient with a stage‐two pressure ulcer, for instance, must also incorporate, in a timely way from the patient perspective, an evidence‐based, appropriate plan of action to both prevent further skin breakdown and begin healing. From a public reporting perspective, is it enough to know that a patient is at risk of experiencing a pressure sore while hospitalized? Engaged consumers and insurers will want to know what the data show about not only the prevention of decubiti, but also the appropriateness of treatment, the speediness of recovery, lost work days, and impact on the quality of life. Policy‐makers are interested in lengths of stay and other factors that drive up the cost of such hospital‐acquired conditions.

Nursing continues to drive forward in the development of electronic measures (eMeasures), particularly data collection on the incidence of pressure ulcers. As of yet, no pressure ulcer eMeasure has been endorsed by NQF, nor is there national‐level public reporting of any nursing measures.

Nursing informatics and the use of nursing terminologies are central to capturing key data elements in a consistent way. Adherence to consensus‐based terminologies, both for the collection of data around the nursing‐sensitive measures but also the processes of care, is necessary to articulate the actual contributions of nurses, their importance in keeping patients safe, and improving the quality of care, as identified in both the IOM reports and the QSEN competencies (Cronenwett et al., 2007, 2009).

A major contributor to this agenda was the Technology Informatics Guiding Education Reform (TIGER) initiative, launched as a result of a 2006 conference convened to create a vision for the future of nursing, bridging the quality chasm with IT, enabling nurses to use informatics in practice and education to provide safer, high‐quality patient care. The development and implementation of the TIGER initiative are described in Chapter 9. Although the EU*US eHealth Work Project has ended, TIGER is currently compiling global case studies to continue bringing the work to life, with a focus on all states within the EU (https://www.himss.org/tiger‐initiative‐international‐competency‐synthesis‐project).