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Case Studies

York Bureau of Health 2017

PHII Business Analyst Sheereen Brown (second from left) with the staff of the York Bureau of Health.

In 2016, the City of York Bureau of Health was ready to invest in an electronic information system to support its clinical services and community prevention efforts. The bureau partnered with the Public Health Informatics Institute (PHII) and completed PHII’s Collaborative Requirements Development Methodology™ (CRDM) to better understand the agency’s key processes, to explore how these processes could be redesigned to increase effectiveness and efficiency, and to identify the requirements an information system would have to meet in order to support those efforts.

After collaborative efforts to define information system requirements, PHII assisted the York  Bureau of Health in conducting an environmental scan, in which we identified 11 companies offering information solutions that could potentially meet York's needs. Using funding from the Memorial Foundation, York was able to pay for the purchase and implementation of the EHR ultimately selected.

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Joint Learning Network 2012

The Joint Learning Network (JLN) is a cross-learning platform for countries in the midst of implementing health financing reforms aimed at increasing financial protection, improving access to health services, and achieving universal health coverage. Globally, countries are expanding access to health services to more of their citizens by developing national health insurance schemes through effective and scalable information systems. The Public Health Informatics Institute (PHII) was asked to support these efforts by engaging several JLN member countries to work collaboratively and develop country-specific health insurance architectures and common functional requirements for robust information systems. In addition, PHII identified areas of need to assist and support JLN members in the future.

JLN member countries worked together—explaining their processes and needs—and developed common requirements for national health insurance information systems by using PHII’s Collaborative Requirements Development Methodology (CRDM). Participants walked away with key information to enhance or put a national health insurance information system in place. Most importantly, the project moved the JLN closer to their goal of universal health coverage by helping member countries create more efficient insurance systems to strengthen health insurance coverage.

By working through PHII’s CRDM tools, it was evident that JLN countries were strongly aligned when it came to creating standards that promoted interoperability among insurance systems. Together, they developed requirements that gave systems at local healthcare clinics and hospitals the ability to interoperate with biometrics databases to improve health coverage within JLN member countries. 

Common Ground 2010-2011

Image credit: CDC Public Health Image Library and Cleopatra Adedeji

Through a national initiative set forth by the Robert Wood Johnson Foundation, the Public Health Informatics Institute (PHII) developed an information sharing environment for public health agencies to collaboratively design information systems to improve public health preparedness and manage chronic diseases. Known as the Common Ground initiative, PHII engaged public health agency grantees and led the development of requirements for information systems that met their needs and the needs of their communities. PHII served as the national program office for Common Ground, taught grantees informatics principles and methods, and provided guidance to help agencies define common requirements for new information systems.

A significant achievement for the Common Ground initiative, grantees were able to define their role in preparedness situations. With improved information systems, public health practitioners could talk to their emergency response partners and clarify when and how they would be brought into an emergency situation. In addition to preparedness practices, PHII showed public health practitioners how to analyze their work and gave them techniques to improve it, providing them with practical tools to achieve their performance improvement goals and effectively engage their stakeholders.


  • Using PHII’s Common Requirements Development Methodology (CRDM), Common Ground grantees shared ideas and worked together to develop requirements for the information systems they needed for public health preparedness, chronic disease management and performance improvement.   
  • The Common Ground initiative proved that PHII’s CRDM could be taught and used by public health practitioners in a variety of public health areas. 
  • PHII encouraged Common Ground grantees to focus on information needs that would support their work, clarify their roles, and create effective information systems that align with all of their internal and external partners.
  • The Common Ground grantees planned for interoperability by developing common requirements that could be used across public health areas and integrated into the larger eHealth community.

This project resulted in a public health preparedness toolkit, a toolkit on public health chronic disease management and guidance on using CRDM for information systems.

Project Optimize 2010

In collaboration with PATH and the World Health Organization (WHO), Project Optimize was initiated to establish architecture and reusable tools to systematically build global health information systems. The Public Health Informatics Institute (PHII) applied its Collaborative Requirements Development Methodology (CRDM) to produce requirements that would support a vaccine supply chain flexible and robust enough to handle an increasingly large and costly portfolio of vaccines. PHII and PATH facilitated sessions using the CRDM with the Ministries of Health in Kenya, Rwanda, Senegal and Vietnam. Outlining one of the core functional domains of a national health system, the group defined and documented the ideal characteristics and information requirements for creating and optimizing logistics management information systems (LMIS) that handle vaccines and other medical supplies.

Working together, participants created a roadmap for the global health community showing how to manage their vaccines and improve vaccine coverage to levels that would lead to reduced mortality. The Project Optimize requirements have established the foundation for future information systems and clarified the common business processes that underpin every global immunization supply chain. PHII’s CRDM demonstrated to programs and countries that  while they are indeed different in many ways—when carefully examining the work of handling pharmaceuticals, vaccines, and medical supplies—they have a great deal in common. This was a critical insight that set the stage for the development of common requirements that can be applied universally for health information systems.


  • With PHII’s CRDM, participants generated user and system requirements that are understandable, adoptable, and useful to stakeholders and managers for acquiring, enhancing, or developing a LMIS for any health product. 
  • Using nontechnical language familiar to users and subject matter experts, the CRDM approach created greater clarity and accuracy when communicating the needs of users to software and system engineers, as well as vendors of LMIS applications.
  • PHII’s CRDM led to a greater understanding of how the various functions of a country’s entire immunization supply chain and the related web of activities fit together—and what information is needed from each of these functional processes to feed the others. 

Taking Care of Business 2005-2006

Image credit: CDC Public Health Image Library and Amanda Mills

In collaboration with the National Association of County and City Health Officials (NACCHO) and leaders from several local health departments, PHII set out to define the work of public health in a project known as Taking Care of Business. PHII applied Collaborative Requirements Development Methodology (CRDM) in a series of workgroup sessions where participants refined and created common business processes and system requirements that meet the needs of all local health departments. Taking Care of Business demonstrated that a common understanding of local health department business processes can be achieved through a collaborative approach—a giant step toward changing the paradigm of how public health developed its information systems.

Taking Care of Business highlights a pivotal point for PHII. At the start of the project, the CRDM was solely used as a way to redefine business processes. Participants, however, wanted to learn how to use the CRDM for performance improvement within their own local health departments. Beyond defining business processes and creating common requirements, this project proved that the CRDM could be a useful tool for local health departments for long-term information system transformations and as a process improvement strategy. For the first time, PHII’s CRDM helped create a common understanding about the work of public health, from disaster relief and emergency preparedness to disease reporting.

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Connections Community of Practice 2001-2010

Image credit: CDC Public Health Image Library and Amanda Mills

Siloed child health information systems can result in fragmented care and individual children falling through the cracks of both health care and public health intervention. PHII's longest running project and an outgrowth of All Kids Count, the Connections Community of Practice was made up of a group of individuals and organizations focused on supporting open and dynamic participation in the integration of child health information systems, community efforts to exchange health information, and enhancing informatics knowledge. A large and important project undertaken by the Connections Community was the development of Newborn Dried Bloodspot Screening (NDBS) processes, requirements, and information system needs. In addition to NDBS, the Connections Community explored how Health Information Exchange entities (HIEs) and Immunization Information Systems (IISs) could work together to add value to each other, build on one another´s strengths, and better and more cost-effectively achieve their overall—and largely shared—missions.

The work of the Connections Community of Practice created integrated information systems that support data exchange between public health and health care—improving interoperability for multiple stakeholders. Through the NDBS project, they created a consolidated record of the services children receive from public health agencies to pediatricians, and increased the adoption and use of integrated health information systems to improve health outcomes for children. Their collaborative work contributed to the development of future information systems that conformed to National Health Information Network (NHIN) interoperability standards.