LUNA GOCO COLLEGES, INC.

DEPARTMENT OF NURSING
NURSING LEADERSHIP AND MANAGEMENT
Module 11
Nursing Informatics: Nursing Management Information System
Objectives:
After working on this module, you should be able to:
1. State the purpose of management information systems (MIS);
2. Describe a healthcare and/or nursing management information system (NMIS);
3. Identify the trends and issues that affect health care MIS today; and
4. Identify the key variables involved in the design of an optimal MIS.
Considering the dynamic nature of the healthcare environment, there is so much data collected that
need to be organized into useful information for running health care service organizations,
managing nursing human resources, and nursing education and research. For nurse administrators
and managers, management information systems offer opportunities for defining, simplifying and
expanding the influence of nursing practice.
Why Management Information Systems (MIS)
Computers are used to support and process highly complex information. They have tremendous
capabilities for manipulation and storage of information. Almost any nursing application can be
implemented through an information system. There are computer systems that assist in client care
documentation, order processing, management and clinical decision making, as well as client and
professional education and research. Ultimately, the nurse in health services management and
administration has an important role in understanding nursing MIS-how it impacts on health care
delivery services, how it facilitates or frustrates the providers of that care.
There is general agreement that all levels of management benefit from an MIS. The operations
nurse manager (usually the head nurse) or the equivalent first-line manager is responsible for day-
to-day decisions. In clinical nursing practice, these decisions have a time frame of days or weeks,
and the MIS would be used to schedule, budget, classify clients/patients, and do unit quality
assurance.
The second level managers-also known as tactical managers-need aggregate data related to the
performance of units or departments, equipment, facilities and services. The broad responsibilities
and longer time horizons of the nursing services director or his/her equivalent need input in major
areas, including financial decisions affecting all their functional areas. Thus, MIS is used for
reports on projected budgets and variances and comparisons of costs and performance. It is also
used to sift data and perform patient comparisons quickly and accurately.
With the use of automated systems, there is an opportunity to seize major cost advantages. In the
figure below, we can see the effect of increased volume on unit cost per service. From points A
and B, we can appreciate the minimum volumes of services where automation will save money,
reducing unit cost of service delivery as the criterion. In the figure we can also see that the decision
between purchasing automated system 1 and 2 would be based on cost as well as the number of
each may increase unit productivity.
LUNA GOCO COLLEGES, INC.
DEPARTMENT OF NURSING
NURSING LEADERSHIP AND MANAGEMENT

The third level of management is the group needing the most information. Its members have a
decision span of several years (3 to 5 years). They need information to support decision making
about their agency’s strategic plan. Some authors refer to the particular MIS developed for them
as decision support systems or executive information systems.
Nursing Informatics and Management Information Systems (NMIS)
In the increasingly technological environment of the 21” century, nurses must be prepared to
practice, direct, and control their work and performance. The nurse manager/administrator must
lead in taking the first step towards computerizations.
Graves and Corcoran (1989) define nursing informatics as the combination of nursing science and
information science to manage and process nursing data, information, and knowledge to facilitate
delivery of health care. The definition stresses the goal of nursing informatics, which is the
effective delivery of nursing care services.
An automated MIS is a combination of hardware, software and human resource or IT people tasked
to do the MIS job. Hardware refers to physical equipment, such as the computer, monitor, modem,
printer, and cables. These days, hardware components have become compact and small, less
expensive, more powerful. Whereas in the past, large framed computers were used to handle the
workload of the health care industry, nowadays many functions are undertaken using laptop or
notebook computers.
In 1992, nursing informatics was officially recognized as a specialty by the American Nurses
Association. Certification became available at the generalist level in 1995 (Milholland, 1992).
Nurses with information technology (IT) expertise assist health care providers in the selection,
implementation, and ongoing monitoring of the adequacy of the MIS. At the same time they assist
vendors in the development of health care applications and the sale of related products.
In the local scene, information technology has been used in the various fields of nursing for more
than a decade. It is a very useful tool in nursing management in practically all settings: hospitals,
schools, health care agencies, and health management and research centers. In the table below,
Newbold and Jaffe (1995) give a summary of the applications of nursing MIS.
LUNA GOCO COLLEGES, INC.
DEPARTMENT OF NURSING
NURSING LEADERSHIP AND MANAGEMENT

Table 11.1 Nursing administration applications of MIS

• Client classification and acuity
• Cost accounting
• Budgeting and financial management Resource scheduling
• Resource utilization
• Quality management
• Office automation

In health care, the classification and acuity system categorize clients individually or in groups,
based on nursing care needs. The results are transferred to systems that manage and schedule nurse
resources. Many of us will agree with Hannah and Shamian (1992) when they say that “the primary
intent of using a nursing MIS is the provision of information to make decisions about the effective
and efficient allocation of resources for the highest quality of patient care.”
Cost accounting systems determine the cost of providing nursing services and running the
operations of the organization. Nursing managers and administrators prepare budgets and payrolls
and manage finances, as well as gather data from automated sources, to provide a “monitoring”
report of department activities related to TOM or CQI systems. There are other word processing
and communication activities of the nursing department that are provided by the various office
automation functions, including databases, spreadsheets, presentation packages and scheduling,
all of them useful for sharing data between the different applications.
Saba, Johnson and Simpson (1994) discuss the benefits of technology leading toward the provision
of improved patient care at affordable cost. The table below summarizes these benefits.
Table 11.2 Benefits of information technology for nursing
• Better utilization of nursing staff resources
• Improved documentation, communication and planning
• Standardized nursing practice
• Tracking of nursing services
• Measurement of outcomes
• Improved cost accountability
• Improved patient care

A task force of the American Nurses Association in 1994 came up with The Scope of Practice for
Nursing Informatics, which indicates minimum informatics competencies for all graduates of basic
nursing programs. Based on their study, it is the work of all nurses to:
Identify, collect, and record data relevant to the nursing care of patients; analyze and interpret
patient and nursing information as part of the planning for and provision of nursing services;
employ health care informatics applications designed for the clinical practice of nursing; and
implement public and institutional policies related to privacy, confidentiality, and security of
LUNA GOCO COLLEGES, INC.
DEPARTMENT OF NURSING
NURSING LEADERSHIP AND MANAGEMENT
information. These include patient care information, confidential employer information, and other
information gained in the nurse’s professional capacity.
By now we can appreciate the need of nurse executives to be aware of opportunities to use
technology and prepare clinicians to confidently make
Full use of technology’s potential contribution to information management. Also, nurse managers
can use technology to promote better use of staff resources both at the nursing administration office
and at the patient's bedside. Some of these uses are documentation of patient progress notes, word
processing for correspondence, electronic mail, personnel databases, and budget spreadsheets. The
use of standardized assessment and documentation forms online are useful tools to promote a
consistently high level of patient care. Similarly, services to clients, like nursing interventions and
their cost, can be tracked and outcomes of care documented and measured. In the long run, all
these benefits of technology significantly contribute to the improvement of health services, through
management decisions that redound to the effective and efficient use of resources and at the same
time reduce cost of services.
Key Variables in MIS Design
In designing an optimal MIS, we need to consider both human resource and computer variables.
The nurse manager must actively participate in the selection, installation and evaluation of any
system that involves delivery of health services, particularly one that affects patient care. In clinical
nursing, nurse managers and administrators must involve the nursing staff to make sure that the
system selected meets client needs and the needs of the nursing workforce. The key variables are
summarized by Emery (1987) as follows:
A. Human resource or people variables
1. Availability of relevant inputs
2. Timeliness of the database, including response time between an event and its recording in the
database
3. Accuracy; agreement between stored and actual data
4. Backup, redundancy, frequency with which copies are made to provide protection against loss
5. Adequacy of training programs
6. Performance standards that include computer-based reports and presentations
B. Hardware variables
1. Variety of transactions that can be handled
2. Flexibility, relative ease with which the system can be modified 3. Reliability, probability that
the system will operate satisfactorily without breakdowns
4. Availability of support and maintenance personnel, including that supplied by contract from the
vendor
5. Space and special environmental requirements, such as air conditioning and electricity demands
LUNA GOCO COLLEGES, INC.
DEPARTMENT OF NURSING
NURSING LEADERSHIP AND MANAGEMENT
6. Peripherals available, input and output devices
7. Capability of network server for internal communications 8. Cost to purchase and to maintain
C. Software variables
1. Robustness or the extent that the system safeguards against user errors
2. User friendliness or the degree of familiarity with computer language that the user needs in
learning the system
3. Security or protection against unauthorized access or loss of system resources
4. Generality or the range of functions provided
5. Degree of “intelligence” or the complexity of logical steps the programs can perform
6. Availability of packaged programs versus programmer-created programs
7. Transportability of programs between computers and of information between programs
8. Lack of errors in the source code (program itself)
9. Maintainability or ease of updating and correcting
Issues and Strategies in Nursing MIS
1. There is a demand for health care organizations today to meet enterprise-wide needs for data
while continuing to manage financial, human resource, and clinical data systems. There is a need,
for example, for health care organizations to integrate existing information systems and add new
information systems. An example is the integration of clinical and financial data across a
continuum of care that supports case management, managed care and capitated payment schemes.
This situation requires that the health care (including and/or involving nursing) organizations move
from charged-based accounting systems to cost accounting. Furthermore, the linking of clinical
data with financial and administrative data will define cost, quality, and outcome components of
health services offered by health care organizations.
2. There is also a new environmental demand for the collection and analysis of significant amounts
of data to measure clinical outcomes. This is necessary in moving towards standardization of
nomenclature, establishing clinical pathways and protocols of care, as well as in comparing quality
and outcomes data between health service delivery organizations.
3. Hannah and Shamian (1992) suggest as strategies, establishing solid nursing informatics
expertise in the department or organization to remain current with health care information system
innovations, educating nonclinical administrators about clinical care, and learning the language
and detail of data requirements.
4. Information technology (IT) changes so fast that it is imperative to monitor the need to upgrade
hardware and software. To remain competitive, the nurse manager or administrator or executive
must recruit an expert in IT or train a member of the management team to be an expert in IT, and
assign this person to head the design, implementation and ongoing maintenance of IT components.
LUNA GOCO COLLEGES, INC.
DEPARTMENT OF NURSING
NURSING LEADERSHIP AND MANAGEMENT
5. Finally, the need for nurse administrators to be involved in strategic management for the entire
organization requires them to participate in crafting a strategic vision for the technology that
supports health services and the work of nurses. The challenge of using an information system will
always be one of integrating human resource and computer systems to increase productivity and
quality while decreasing cost.