In January, 1997, the Rhode Island Department of Public Health inaugurated KIDSNET, an effort to harness the power of information technology to ensure that all children in the state received proper preventive care. The medical “informatics” system was designed to track essential public-health data—such as immunizations—and make it accessible to the  health care providers and public health programs across the state. “Informatics,” in other words, was to improve child health by making sure that any doctor or emergency room in the state could quickly and conveniently become aware of key aspects of any child’s medical history. The system was to be fully operational by the year 2000. The marriage of computer records and public health did not go smoothly, however, and, in late 1999, a consultant found that the system was “grossly underutilized.” KIDSNET was tracking immunizations for but  43 percent of infants  and only 31 percent of the clinics and doctors’ offices in Rhode Island were submitting immunization data.

This case describes the complexities and conflicts which arose in making the informatics system operational  and which slowed its progress toward full implementation. It specifically frames the question of how the Family Health Division of the Rhode Island Health Department should assess the program’s problems and  how those problems might be fixed. The case is designed to support discussion of how information technology systems can best be utilized to improve public sector performance—and to examine bureaucratic barriers to implementation—why they arise and how they can be overcome.