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North Regions Administration

Mobile Remote Workforce (MRW) Innovation: BPR

For more information send us an email or phone 760-616-5996.

The General Management Team is the administration for the North Central, North Coastal & North Inland Regions. Managers oversee Children's Services, Family Resource & Public Health Centers, as well as the countywide California Children Services program. GMT also includes staff of support programs.

Facilities where this Service is offered


Mobile Remote Workforce (MRW) is an award-winning Business Process Reengineering (BPR) Project of the County of San Diego Health and Human Services Agency (HHSA). The goal of MRW is to streamline and improve service delivery in the field. In 2005, the MRW pilot project reengineered the day-to-day work processes for public health nurses and introduced cutting edge remote technology that expedites the intake process and reduces administrative tasks.

Once fully implemented across the County, the process will significantly reduce time elapsed between case referral and customer contact, increase productivity of public health nurse visits in the field, dramatically serve more at-risk families, and avoid considerable government costs.

General Information



John Fontanesi, PhD, is the director of UCSD's Center for Management Science in Health and a professor in the university Department of Pediatrics and Department of Family and Preventive Medicine. Dr. Fontanesi is a recognized expert in operational research in health care and is the principle investigator on a number of studies examining the operational conditions and organizational structures that facilitate or constrain organizational effectiveness. Recent research has included an analysis of California's accines for Children program and a quality improvement project involving the emergency, orthopedic, and nephrology departments at Rady Children's Hospital in San Diego. He holds a bachelor of arts degree and master of education degree from the University of Arizona, as well as a PhD in clinical psychology from United States International University.

To request a copy of the following Mobile Remote Workforce Rollout Reports, please email Nick Macchione:

  • Final Evaluation Report
  • Societal Cost-Benefits Analysis


Strategic Health Care Communications' eHealthcare Leadership Award for Best e-Business Site, Silver Award (November 2007)

California State Association of Counties' Annual 2007 2007 Challenge Awards Honorable Mention (November 2007)

Center for Digital Government's 2007 Best of Web and Digital Government Achievement Awards in the Government to Business Category (for Agency-wide e-Referral System, which includes MRW) (September 2007)

San Diego Business Journal's First Annual Health Care Champions Award Finalist in the area of Health Care Innovation and Research (August 2007)

Public Technology Institute's Technology Solutions Award (Telecommunications and Information Technology) (May 2007)

E-Government Institute's Knowledge Management Award for Successfully Using Innovative Knowledge Management Practices (April 2007)

Federal Computer Week's Federal 100 Award, McLean, Virginia (March 2007)

California State Association of Counties' Annual 2006 Challenge Awards Honorable Mention (November 2006)

Center for Digital Government's Best of California Awards, Sacramento, California (November 2006)

  • Most Innovative Use of Technology Demonstrated
  • Leadership in Project Delivery (to Nick Macchione)

Federal Computer Week's 2006 Rising Star Award, Washington DC (October 2006)

National Association of Counties 2006 Achievement Award, Washington DC (June 2006)

Major Presentations at National Conferences

Macchione, Nick and Ekard, Walt. Applying Technology to Improve Health Care Effectiveness, Government Health IT 2006 Conference, The e-Gov Institute, Washington, DC.

Macchione, Nick and Robbins-Meyer, Helen. A Different Way of Working: Empowering the Mobile Workforce and Improving Public Health. Managing Technology 2006: Policy, Politics and Leadership Conference, Governing Magazine, Philadelphia, PA.

Macchione, Nick. Mobile Remote Workforce Innovation for Health & Human Services: Using Business Process Reengineering to Increase Productivity, American Public Health Association 134th Annual Meeting, 2006.

Macchione, Nick and Moore, Michael. Making Citizen-Centered Care a Reality. Connected Health: Creating a Seamless Information Network Conference (2006). Government Technology, San Diego, CA.

Macchione, Nick and Moore, Michael. Mobile Remote Workforce Business Process Reengineering: A Story of Innovation at County Public Health Centers (2006). 3rd Annual CIO Summit, Center for Digital Government, San Diego, CA.

Macchione, Nick. Mobile Remote Workforce. 2006 Conference, County Welfare Directors Association Of California, Westlake Village, CA.

Professional Publication and Article Links

eHealthcare Strategy and Trends
Macchione, Nick. A Mobile Remote Workforce Innovation Equals Faster, Better and Smarter Solutions, August 2006 (must purchase or be a member to view)

The Public Manager
Macchione, Nick and Shepard, Jean. Improving Health Care Access in San Diego County, Volume, 35 Issue 2, Summer 2006

KM Tackles Tough E-Gov Challenges, May 2007

HHSA Connection
The Information Connection: Countywide "Mobile Remote Workforce" Initiative Improves Services to Clients, page 4, September 2005

Government Technology
Nurses Without Wires, July 2006

County News Online (National Association of Counties)
San Diego County Nurses See More Patients through Technology, May 2006

County News (County of San Diego)
Walt's Words, page 2, May 2006

San Diego Union-Tribune
Program Lets Nurses Assist More Patients, April 2006

North County Times
Pilot Program Launches Nurses into Technological Age, April 2006
Nurses Go Paper Free to See More Patients

Nurses Go Paper Free to See More Patients
Nurses Go Paper Free to See More Patients


Nick Macchione, MS, MPH, FACHE
Deputy Director
Health and Human Services Agency
8965 Balboa Avenue
San Diego, CA 92123
(858) 616-5996


For more information send us an email or phone 760-616-5996.