Management of Information Systems

Adriana Galan, IT specialist

Institute of Public Health Bucharest
Definitions and basic concepts
There are many definitions of Information Systems, based on the definition of a general system,
representing a group of interrelated elements organized to achieve a common purpose. Out of
these definitions, I present two of them:
Information System represents that type of system trying to solve the problems in an
appropriate manner, able to generate the information at right time and place, in an
understandable format, in order to be used in the managerial process.
An Information System is a special class of system whose components are people,
procedures and equipment that work interdependently under some means of control to process
data and provide information to users (1).
Management of Information Systems (MIS): are orderly methods of gathering, storing,
organizing, analyzing, and reporting data in a manner that is meaningful, useful, and quickly to
retrieve.
MIS provides a foundation upon which a hospital / health organization can develop its
information resources and enhance decision making, strategic planning, and quality of clinical
services.
Basically, any Information System is working with three key concepts:

data: are facts obtained by observation, counting, measuring, weighing from the surrounding
environment (for example: patient temperature is measured as 39.5 oC)

information: follows that data which have been analyzed, summarized or processed in
some fashion to produce a message or a report; becomes information only if it is understood
by the recipient (for example: T=39.5oC, head ache, photophobia possible meningitis)

knowledge: represent the result of combining meaningful information

There is not a clear distinction between the three concepts, many times information can be
considered as data for the higher level inference.

Existing types of applications in the medical field

The main types of IT applications in the medical field developed worldwide are:
patient registration and hospital admission systems
The main functions of this application are:

data collection: demographic, clinical and financial

reporting: generates different types of documents based on data analysis and also
administrative reports

operations management: keep track of patient transfers and discharges

patient accounting

prices of provided services per patient: attach a price for each service received by
a patient. The price can be established according to different criteria:

based on the range of services contracted with the insurer

based on DRG system (Diagnosis Related Groups)

based on the type of patient: inpatient, outpatient, emergency

patient bill: calculate the patient bill to be sent to the insurer

electronic data interchange: between the health care provider and the insurance

financial management

Payroll system: calculate employees workload, calculate the taxes. Produces the
salaries forms together with control reports, forms for tax declaration

Staff registry: manages a history of employment for each employee (payment

reports, licenses, continuous education training, etc.)

Assets registry: manages the registry of organizational assets (fix properties,

physical site, depreciation planning etc.)

General financial registry: collect data from all financial applications having as result
the financial balance sheet (debts and credits) and the annual financial management.

Patient registry and management of care

Patient index: collects and manage a summary of patient record for all in-patients
and out-patients
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Procedures and diagnosis coding: check the accuracy of disease codification

according to international codification system, build the DRG classes

Monitoring the transfers: monitor the link between clinical wards and ancillary
departments (radiology, pharmacy, labs, etc.)

Pharmacy systems
Physicians orders for drugs are registered. The system is monitoring each patient: what and
when must receive the drugs. Also keeps a drug inventory and can act as a warning system for
the incompatibility of 2 or more drugs for a patient.
Management of primary care patient
Big efforts were done in the last decade for developing this system due to the increasing weight
of ambulatory care.
Some functions can be mentioned:

Visit scheduling

Patient registration

Medical records and monitoring the consultations

Financial module

Pharmacy module

Communication module (electronic data interchange)

Electronic Medical Records (3)

Very modern in USA, even if at early stages of implementation, is the concept of Electronic
Medical Record (EMR). The traditional medical record has been exposed to a rethinking
process, in order to provide the needed information for:

Clinical Care

Billing

Research tool

Communication tool

Communication was a key issue in this modern clinical systems, unlike the old clinical systems.
EMR must be accessible for all the clinical care providers of a patient (family doctor, outpatient
clinics, hospitals), but can be accessed by the patient himself. At the same time, clinical
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databases are a powerful research tool. Another important step forward is represented by the
accessibility of EMR via INTERNET.
What are the main information areas in an EMR:

ID

History of Present Illness

Current Medication

Past medical history

Past surgical history

Family history

Physical examination

Laboratory Database (including images)

Procedure note

Problem list (assessment)

Plan (diagnostic / therapeutic)

Managerial cycle and information support

Information systems can essentially contribute to increase the managers degree of confidence
in the validity of alternatives which are the basis of organizational strategic decisions. Also
within the health units, information can represent a valid support for problem solving, like:

cost control and productivity enhancement (financial information systems)

medical quality assurance and outcomes assessment (clinical information systems)

health care organizations must frequently monitor and evaluate their performance, both for
internal purposes and to meet external regulations and accreditation criteria ( administrative
information systems)

The basic management process in any health care organization can be described in terms of a
cycle that includes the following components (4):

establish goals and objectives

estimate demand for services

allocate resources to meet demand

control the quality of performance

evaluate programs impact

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Cycle is repeated after each evaluation. Information management should play an important role
in each element of this basic management cycle.
Examples of types of information that can help decision making in each category can be
described as follows:
1. Establishment of institutional goals and objectives
problem indicators, direct and indirect (direct: morbidity and mortality data, social
indicators, economic data on the community; indirect: data on personal health habits
of members of the community)
data on services being delivered by other community health organizations
available resources
2. Demand estimation
historical data on utilization of health services
demographic data
community projections
3. Resource allocation
work force data
financial information
short-term demand forecasts
4. Performance and quality control
output measures (statistics: number of inpatient days, patient visits in outpatient
department, number of delivered procedures etc)
quality control data
work sampling and measurement
medical audit
5. Evaluation of program impact
changes in problem indicators
cost-benefit analysis
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Types of decisions and the related information systems

From the informational point of view, Herbert Simon (5) has described 2 types of decisions:

programmed (structured) decisions these are periodical decisions, repetitive and

routine

nonprogrammed (unstructured) decisions these are atypical decisions, irregular and

must be treated in a new manner each time they occur

Simon classification is based on the manner in which a manager deals with existing problems. A
well-designed information system is obviously influenced by the periodicity or non-periodicity of
decision.
There are two approaches for an information system to meet the need of nonprogrammed
decision making process:

to organize special studies in order to collect necessary information, involving a big

effort and being time-consuming; costs and benefits of this approach must be
analyzed in advance

to be operational a general information management system, where relevant

information have to be only retrieved and analyzed

Robert Anthony (6) has developed a theory which represent the basis of the process of
analyzing and planning the information systems. He described the managerial activity consisting
of three categories, arguing that these categories are activities sufficiently different to require
the development of different information systems.

strategic planning is the process of deciding on organizational objectives, changes of

objectives, resource allocation to attain these objectives and on policies that govern the
acquisition and use of these resources.

The major problem of this type of activity is to predict the future of the organization and its
environment.
This level typically involves a small number of high-level people who operate in a very creative
way.
The complexity of problems that arise at this level, as well as the nonroutine way in which they
are handled, make it difficult to design an adequate information system. Usually, in this planning
process aggregated information are needed, most often obtained from external information
systems. At this level most of the decisions are unstructured (see definition above) and irregular.
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management control the process by which managers assure that resources are obtained
and used effectively and efficiently for the accomplishment of the organizations objectives.

This type of activity involves interpersonal interaction. It also takes place within the context of
the policies and objectives developed in the strategic planning process. The main goal of
management control is the assurance of effective and efficient performance.
The relevant information for this level is mainly obtained during the human interaction process.

operational control represents the process of assuring that specific tasks are carried out
effectively and efficiently

The basic distinction between management control and operational control is that operational
control is concerned with tasks, whereas management control is mostly often concerned with
people.
This level requests clearly defined information for very specific tasks. Information must be
detailed, accurate and is obtained mainly from inside the organization.
For each managerial level described by Anthony, a specific information system must be
designed (7).

Strategic Level
(senior management)

PLANNING
Control level
(middle management)

CONTROL

Operational level
(junior management)

PROCESS
COMMON DATABASE

Hierarchical model proposed by Anthony

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Within the managerial process of decision making, an information system can offer support for
the following areas (4):
Medical quality assurance and outcomes assessment
Clinical information abstracted from patient medical records provide the basis for health
professionals in peer review systems to assess diagnosis and treatment practices. Such
information must be readily accessible and retrievable from a central patient data file.
Cost control and productivity enhancement
Such systems require the ability to integrate clinical and financial information system.
Computerized information systems offer the possibility for providing cost analysis and
productivity reports in order to improve the efficiency of operation.
Utilization analysis and demand estimation
Such systems should be able to provide current and historical data on utilization of health
services. These data assist in current analysis of utilization of resources and also provide a
basis for predicting future demand for services.
Program planning and evaluation
Information obtained for the previous above-mentioned domains serves as the basic input for
management decisions related to evaluation of present programs and services. When combined
with projections about future changes in the demographic characteristics of the population and
other external information about the service market, the information system can be an important
resource for planning future programs and services.
Simplification of reporting
Information processing costs consume an important proportion of the budget of a complex
health organization. On the other hand, external reporting requirements are growing
exponentially. Therefore, an important goal for an information system is to simplify the
preparation of these various reports, often a difficult repetitive task.

References
1. Reynolds G.W.. Information Systems for Managers. Second edition, 1992; p.24-39
2. Austin C.J. Hospital Information Systems and the Development of a National Health
Information System. Journal of Medical Systems 6, 1982; p.4-5
3. Van Bemmel J.H., Musen M.A. Handbook of Medical Informatics. Springer, 1997; p. 331-356
4. Austin C.J. Information Systems for Health Services Administration. AUPHA Press, 1992;
chap.1 (3-26)
5. Simon H.A. The New Science of Management Decision. New York: Harper & Row, 1960, p.
5-6
6. Anthony R.N. Planning and Control Systems: A Framework for Analysis. Boston: Harvard
Business School Division of Research Press, 1965
7. Gorry G.A., Scott Morton M.S. A framework for Management Information Systems. Sloan
Management Review, 1989; p.49-61
Recommended Readings
In BMJ collection (http://bmj.com ): search/archive keywords: HealthCare Information Systems
Peter Littlejohns, Jeremy C Wyatt, Linda Garvican Evaluating computerised health
information systems: hard lessons still to be learnt, BMJ April 2003
Heather Heathfield, David Pitty, Rudolph Hanka - Evaluating information technology in health
care: barriers and challenges, BMJ June 1998
Kenneth D Mandl, Peter Szolovits Public Standards and patients control: how to keep
electronic medical records accessible but private, BMJ February 2001
Michael Rigby, Ruth Roberts Integrated record keeping as an essential aspect of a primary
care led health service, BMJ August 1998
Michael Rigby, Jari Forsstrom, Ruth Roberts, Jeremy Wyatt Verifying quality and safety in
health informatics services, BMJ September 2001
Nicholas Terry, Benedict A Stanberry Regulating health information: a US perspective;
Legal aspects of health on internet: a European perspective, BMJ March 2002
Azeem Majeed, Andrew B Bindman, Jonathan P Weiner - Use of risk adjustment in setting
budgets and measuring performance in primary care II: advantages, disadvantages, and
practicalities, BMJ September 2001
Keith Simpson, Mike Gordon - The anatomy of a clinical information system, BMJ May 1998
Hallvard Lrum, Gunnar Ellingsen, Arild Faxvaag - Doctors' use of electronic medical
records systems in hospitals: cross sectional survey, BMJ December 2001
Thomas Bodenheimer, Azeem Majeed, Andrew B Bindman - Primary care in the United
States: Innovations in primary care in the United States Commentary: What can primary
care in the United States learn from the United Kingdom?, BMJ April 2003
Nikki Rousseau, Elaine McColl, John Newton, Jeremy Grimshaw, Martin Eccles - Practice
based, longitudinal, qualitative interview study of computerised evidence based guidelines
in primary care, BMJ February 2003
Thomas G Rundall, Stephen M Shortell, Margaret C Wang - As good as it gets? Chronic
care management in nine leading US physician organisations, BMJ October 2002
Roderick Neame, Eike-Henner Kluge - Computerisation and health care: some worries
behind the promises, BMJ November 1999
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 Steven H Woolf, Richard Grol, Allen Hutchinson, Martin Eccles, Jeremy Grimshaw - Clinical
guidelines: Potential benefits, limitations, and harms of clinical guidelines, BMJ February
1999
Krish Thiru, Alan Hassey, Frank Sullivan - Systematic review of scope and quality of
electronic patient record data in primary care, BMJ May 2003
Brendan C Delaney, David A Fitzmaurice, Amjid Riaz, F D Richard Hobbs - Can
computerised decision support systems deliver improved quality in primary care?, BMJ
November 1999
Frances Mair, Pamela Whitten - Systematic review of studies of patient satisfaction with
telemedicine, BMJ June 2000
In National Academy Press books collection (www.nap.edu ): serach all text: HealthCare
Information Systems
Committee on Enhancing the Internet for Health Applications - Networking Health:
Prescriptions for the Internet (2000, 388 pp.)
Committee on Maintaining Privacy and Security in Health Care Applications of the National
Information Infrastructure, National Research Council - For the Record: Protecting Electronic
Health Information (1997, 288 pp.)
Edward B. Perrin, Jane S. Durch, and Susan M. Skillman - Health Performance
Measurement in the Public Sector: Principles and Policies for Implementing an Information
Network (1999, 192 pp.)
Richard S. Dick, Elaine B. Steen, and Don E. Detmer - The Computer-Based Patient
Record: An Essential Technology for Health Care, Revised Edition (1997, 256 pp.)
Maria Hewitt and Joseph V. Simone - Enhancing Data Systems to Improve the Quality of
Cancer Care (2000, 176 pp.)
Committee on Quality of Health Care in America - Crossing the Quality Chasm: A New
Health System for the 21st Century (2001, 364 pp.)

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AN USUAL WORKING DAY OF A MANAGER

Case study#
By 15.01.2002, the user of different types of information systems was doctor ....escu, the
director of Wonderland District Public Health Authority (DPHA). Doctor ....escu has the
responsibility of developing and implementing health policies at Wonderland district level.
Doctor ....escu lives in a neighborhood located far enough from DPHA site. In the morning, after
waking up, he listen first the radio news in order to decide if he would rather use his own car or
the DPHA car. Because bad weather was forecasted, he decided to use the office car. On the
way to DPHA location, the driver didnt give priority to the pedestrians, so that a policeman
stopped him. Apart from the fine, he was also registered in the Police files.
Once arrived at DPHA, doctor ....escu turns on the computer and check first his meetings
schedule for the day, file already updated by his secretary. After reading his messages, he
answers himself to two of them. For the rest of the messages, he forwards the messages to the
secretary and ask her to answer.
After that, he invites the head of Human Resources Department and the economic manager to
try to solve together the problem of the hundred junior physicians applying for a job in the
district.
At lunch time a meeting with a foreign experts team was scheduled. The foreign experts were
willing to help the DPHA to implement an intervention project to reduce some risk factors in
order to improve the health status of Wonderland district population. The experts were
bringing a computer software for simulation and modeling the impact on health of reducing the
risk factors. Doctor ....escu has also invited to attend this meeting the head of Health Status
Evaluation Department, as well as public health specialists and epidemiologists.
Around 18.00, doctor ....escu leaves the DPHA, and on the way back he stops to a supermarket
to make some shopping.
Once arrived at home, he watches the TV news, then he reads the financial report for the
previous month in order to prepare the next day meeting with the economic manager. Finally he
decides to go to bed because he felt very tired.
Please observe carefully the activity of doctor ....escu during the whole working day and
determine what type of information systems he was using in each circumstance. For
each information system you discovered, please mention for what type of decision it was
useful (use Anthony theory and mention if the decision was programmed or
nonprogrammed).
Please fill the table below.

Case study adapted by Adriana Galan, based on a case study developed by G.Lucas Jr.

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Moment of the
day
During the
morning

What type of information system

was used

Type of decision

During afternoon

During the
evening

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