Managed care and quality improvement are two driving forces in the current health care environment. The pressure of capitation and the recent focus on outcomes of care have generated new incentives to restructure care delivery to control costs. Intensive care units, once revenue centers, are becoming cost centers. Re-engineering, or redesigning, the process of care entails examining premises for ability to provide services as well as considering how to do things more efficiently. The assumption is that all aspects of a process are legitimately subject to examination and restructuring. Information systems provide a powerful tool to support re-engineering. Nursing informatics, which pertains to nursing data, information, and knowledge has major implications for hospital information systems. This article explores possible changes in intensive care and the role of informatics in a changing health care environment.