The City of York Bureau of Health has 12 full-time employees, 13 program areas, and serves the city’s 40,000 residents with free or low-cost clinic services and prevention initiatives. The bureau’s director, Barbara Kovacs, contacted PHII in June 2016 because the agency had just received a grant to support internal capacity building, and she was interested in investing this money in an electronic information system.

When this project began, nearly all the bureau’s clinic operations and data collection activities were performed via manual and paper-based processes. (Think patient records in manila folders, circa your doctor’s office in 1992.) Manual processes require a significant amount of staff time devoted to tedious activities, like repetitive data entry or searching all those paper records for the details of a patient’s medical history. Additionally, without an electronic database and query system, evaluating population impact and meeting reporting requirements were both difficult tasks.

PHII’s Collaborative Requirements Development Methodology (CRDM)™ provides agencies like York with tools and best practices to better understand how they do business and to identify ways an information system can help work more efficiently. As part of applying CRDM™, I had the opportunity to interview all of the bureau’s staff to learn about their business processes and goals for a new system. I also met with York team as part of a three-day workshop. During our time together, we validated business processes, redesigned those business processes to improve efficiency and identified functional system requirements. When I got back home, I worked with colleagues at PHII to conduct an environmental scan of existing electronic health record (EHR) systems to determine which ones would meet the bureau’s requirements. In the end, we identified 11 possible software solutions, which the team at York will evaluate in order to select an EHR that meets their needs.

For me, the time I spent with staff during the in-person workshop is what CRDM™ is all about. At first, many staff members were unsure of the goals for the session and were hesitant to participate. They needed a bit of time to warm up to the process and how it could support them in their daily work. By the end of Day 3, the team was anticipating what standard operating procedures (SOPs) they still needed to develop and which functional requirements any future system would need to have. They were brainstorming and making these decisions with minimal guidance from PHII. This experience reminded me that the methodology is a powerful tool because it’s a process of self-discovery and learning. The people who do the work are the subject matter experts in what they do and how they can do it more efficiently. And since process improvement is always agile and never stagnant, CRDM™ also provides the tools necessary for the team to repeat the requirements process again in the future.

Through CRDM™, the York Bureau of Health identified 287 functional requirements for an electronic health record system and 16 additional procedures for which they need to develop SOPs. This is another facet of CRDM: it’s really just the beginning of a process by which agencies discover how they can use technology to work more smoothly and efficiently. By working together to identify their requirements, the York team built a strong foundation for the work ahead, and I am excited to see how the EHR impacts their work… and what they will do with the additional space once they don’t need all those manila folders!