REVIEW

Introduction

A management information system (MIS) is an information system used for decision-making, and for the coordination, control, analysis, and visualization of information in an organization. The study of management information systems examines people, processes and technology in an organizational context. This system gathers data from internal and external sources of an organization and processes it to assist managers and heads in the process of decision making [1,2].

Evolution of clinical MIS

Even after the standardization of entire clinical system across Kauvery, a common platform was missing for the clinical service departments to share their knowledge and best practices followed in their respective units.

Even though the clinical incidents, clinical service related complaints and most of the challenges faced in each unit were similar, individual units handled them differently as there was no common forum to discuss about them and find an appropriate solution.

The idea of this MIS emerged after seeing the successful evolution of group operational MIS. This forum was initiated at the beginning as nursing MIS & monitoring of nursing key performance indicators (KPI) but slowly evolved to include more clinical parameters. Medical administrator and nursing heads were the key participants, and unit heads participated at times. So, this forum was later named as group clinical MIS. It was started with around 15 parameters. The 80% data was captured manually and the rest were IT supported. This forum has now been utilized for the past five years. The number of parameters has now reached around 46 which are analysed every month. Now most of the data are harvested through the IT enabled hospital management system.

Objectives

1. Streamline overall clinical process and increase efficiency of hospitals
2. Maintain high patient satisfaction index through quality health care services
3. Effective management of available resources
4. Monitor the Quality indicators of the hospitals
5. Structure the training that is being provided across the hospitals
6. To share the best practices followed among units.
7. Comprehensive drug management and consumption monitoring

Scope

Streamline the treatment flow of patients in the hospital, while allowing doctors and other staff to perform to their peak ability, in an optimized and efficient manner.

Challenges faced and resolved

1. Periodical and structured orientation and training of stakeholders given to promote engagement of health workers in data capturing, and to improve compliance among health care workers.
2. Proposed ownership for this work at each unit and identified responsible professionals and staff to increase accountability in data capturing.
3. Supported the clinical team with non-clinical team (nursing secretary) in data entry and data collation saved time for clinical work. Nursing secretaries played a vital role in preparing the data for clinical MIS.
4. Central support team establishment enabled overall day to day review, data validation and addressing challenges met by the data capturing team within IT and non-IT areas.
5. Monthly review of meetings suggested improvement in the clinical MIS structure from numbers to percentages, for keeping it proportionate for comparison.
6. A structured and uniform format was developed at the group level for reporting which enabled comparison from unit to unit.
7. Validation of manual data sent from the respective unit was difficult as the manual data has the vulnerability for manipulation. Hence most of the data harvesting was automated with the help of IT software health management system.
8. Meeting was structured and the minutes of the meeting (MoM) was standardized; hence the follow-up was successful.
9. Communication and implementation of key decisions taken in the forum did not percolate to the staff working on floor and hence the key persons like middle level leaders and initiative nurses were involved in presenting the data to ensure that the concerned staff is informed about key points discussed.
10. Initiated unit clinical MIS meeting lead by medical admin and nursing leaders before sending the data for group MIS to verify and validate data for presentation at the group forum.

Components of clinical MIS

1. Data sources: Data is received from HMS platform used in the hospitals by the nurses to input patient related information.
2. KPIs: Key performance indicators are the metrics most important to users. These are represented in dashboards either as such or as a part of tables. Some common KPIs are AMA (discharge against medical advice), deaths, incidents, pressure injury etc.

Clinical MIS parameters

CMIS – Clinical management information system, AMA – Against medical advice, CNE – Continuing nursing education, MEAT – Medical emergency aid team, CPR – Cardio pulmonary resuscitation, CVC – Central venous catheter, DVT – Deep vein thrombosis, PAAT – Pain assessment and aid team, CP – Clinical pharmacist, MRD – Medical records department.

Policy

1. Schedule of Clinical MIS

1. Clinical MIS shall be scheduled on 2^nd Tuesday of every month.
2. If Tuesday is as institutional holiday, then the immediate next day i.e 2nd wed shall be the Clinical MIS Meeting.
3. Every month, during the first week, dry run of the unit level MIS shall happen with the Executive Director / Unit head.

2. Chairperson of monthly review

1. One Medical Administrator (MA) shall be the chairperson in turn monthly and shall be leading the Clinical MIS along with Group Medical Director (GMD).
2. Each MA shall be the representing chair of Clinical Governance Office for each unit.
3. Managing Director will oversee the clinical MIS summary every month and may participate in any meeting at his convenience.

3. Clinical MIS meeting

1. Data shall be consolidated at the central level in the clinical governance team and the consolidated report shall be prepared with discussion highlights and questions.
2. Minutes of the clinical MIS shall be posted by end of the three working days.
3. Action tracker shall be followed weekly basis.
4. Apart from monthly review, quarterly analysis, half –yearly analysis and one-year trend analysis comparing it with the previous year and to the set benchmark for each KPI is also done.

Benefits of clinical MIS

Improved Goal-setting

Sharing of knowledge in this forum, and the discussions, enable us to make more data driven decisions with goal setting. This enable the hospital to focus on their goals and improve performance.

Improved performance

Comparing the KPIs between the hospitals not only help them to improve their goal setting but enable them work towards their goal and to achieve it in a way better than the other hospitals comparatively.

Sharing best practices and insights

This forum helps the hospitals to share the best practices followed in each unit and to compare each other and to determine whether their management methods are effective.

Better decision making

The biggest benefit of the Clinical MIS is better decision-making. It allows the unit heads to look at summaries of aggregated data to make informed clinical decisions as per their concern

Prevention of incidents

Focusing on the goals set and sharing of insights among each unit will prevent recurrence of the same. Ex: Preventable deaths

Easy retrieval of data

As this forum is having monthly reviews and half-yearly & yearly trend analysis, any data can be retrieved at the group level anytime.

Builds a transparent and open culture

Open discussions and non-threatening approaches in the Clinical MIS help in bringing in transparency and open culture.

Improves accountability

Targets, deadlines and defined time duration increases accountability among team members. Ex: raising of clinical incidents within 24 hours and RCA and CAPA within 48 hours.

Apart from all this, there are many more benefits from having this central forum of discussion that happens every month. It improves communication, quality of services provided across Kauvery, reduces health care costs through sharing of best practices, make care more efficient and improves patient safety. Besides this, it creates an environment to connect with people of other units.

Conclusion

Thus this forum plays a major role in focusing on improved goal setting and to achieve the goals and targets. It functions as a platform to discuss about patients, treatment measures, incidents & it’s prevention. It helps in quality improvement and thereby brings patient delight, employee satisfaction and clinical excellence.

References

1. Bourgeois DT. Information Systems for Business and Beyond. The Saylo Academy. 2014; p. 500.
2. Steven LA. How Effective Managers Use Information Systems Harvard Business Review. 1976.