Data sharing needed to increase quality and decrease costs.

tronic systems must talk with each other or the whole process falls apart. the Wisconsin Pharmacy Quality collaborative is a program of the Pharmacy Society of Wisconsin that received an innovation award from centers for Medicare & Medicaid Services to improve medication management for the people of Wisconsin. the special article in this issue of the WMJ describes the project and its goals and makes the case— if one still needs to be made—that pharmacists will play a crucial role in improving quality and decreasing costs of care through collaboration with patients and physicians.4 Having expressed skepticism about the potential for eHRs to address quality and cost, i have no doubt that getting pharmacists more engaged with patient care can only add value to a system of medication management. and data from electronic health records are essential to Immunizations are primary prevention. We all learned that in medical school. the first regularly recommended immunizations were against early 20th century killers like diphtheria, pertussis, and tetanus. they were successful for a variety of reasons, not the least of which was that universal immunization was a public health campaign that worked. Photos from the 1930s in the heart of the Depression show lines of kids presenting their arms for the shot or squirming away from the needles. During my clinical lifetime, we have seen the disappearance of polio, measles, rubella, H influenzae meningitis, and significant decreases in other communicable diseases. younger doctors—those under 50—almost forget why we immunize patients against many diseases, since in many cases it is the consequences of those diseases rather than the diseases themselves that are the rationale for immunization. they not only have never seen the disease, but they have not seen the consequences. Having a record of immunizations is crucial for both individual health and “herd immunity” and we see how cracks in universal immunizations have led to outbreaks of pertussis, measles and other, now rare infections. When we all carried around little folded paper records of immunizations that had been received from a number of sources, the portability was great and it led to real communication between public health clinics and practices. now with the onset of electronic data collection, we have new challenges. Patients don’t carry their own records; they rely on their doctors and the data systems to do that. but those data systems contain human flaws that require both fixes to the technical process and assurance that in tHiS iSSue