Learning Objective #1: to describe health information technology implementation in Miami and Caribbean VA healthcare systems and the impact on the nursing workforce and Caribbean community.

Learning Objective #2: to discuss barriers and facilitators to implementing health information technology in a large national health care system with a bilingual nursing workforce and community.

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Background: Evidence supports patient safety concerns in healthcare around the world along with health information technology (HIT) development. The Department of Veterans Affairs (VA) HIT helps keep patients safe and is one of the world's most widely used. It includes an electronic health record and bar code medication administration which is used in VA healthcare systems across the continental United States, Caribbean, Philippines, Guam and American Samoa spanning a wide range of patient care and geographic settings. Nurse executives play a critical role in implementing HIT. Organizational and community impact of HIT implementation has not been described in terms of a geographically and culturally diverse and predominantly bilingual nursing workforce.

Purpose: 1) To describe HIT implementation in Miami and Caribbean VA healthcare systems and impact on the nursing workforce and Caribbean community. 2) To discuss barriers and facilitators to enterprise VA HIT implementation in a diverse and predominantly bilingual nursing workforce.

Description: Miami and Caribbean VA healthcare systems have implemented the proprietary VA HIT; electronic health record and bar code medication administration system. Implementation experiences will be discussed by nursing leaders from each VA system. Organization and technology culture, successes and challenges in each system implementation will be discussed and timelines provided. Administrative dashboards will illustrate nursing workforce demographics and skill mix. Workforce and community computer literacy, information management and literacy, impact of HIT on local community, including students will be discussed.

Implications: Healthcare globalization continues while priority for patient safety and nursing and workforce diversity increases. Nurse executives are responsible for assessing the impact of HIT on the workforce, students, organization, and community, in terms of human capital and fiscal resources. Community assessment is needed in understanding a truly global and predominantly bilingual nursing workforce and can assist health care executives in a successful international enterprise HIT implementation.