These slides are from the Dartmouth Jones Lecture of May 2008 by Benjamin Littenberg. They describe the development and evaluation of the Vermedx Diabetes Information System

1. Automated Use of Clinical Laboratory Results in Adults Benjamin Littenberg, MD University of Vermont and Vermont Clinical Decision Support, LLC

9. VDIS Architecture VDIS Computer Primary Care Provider Patient Clinical Lab Clinical Lab Electronic medical record or fax Mail Secure Network Public Health Surveillance

20. Health Care Utilization *Linear regression adjusted for age, sex, marital status, education, health literacy, race, insulin use, comorbidity, hospital, and clustering within practices. 0.033 -$2426 $3202 $4937 Costs $/y 0.044 -0.08 0.15 0.23 Specialty visits/y 0.010 -0.81 2.04 2.86 Primary care visits/y 0.020 -0.23 0.55 0.72 Emergency room visits/y 0.047 -1.01 1.18 1.89 Hospital days/y P Adjusted Effect* Intervention Control Outcome

21. Health Care Utilization *Linear regression adjusted for age, sex, marital status, education, health literacy, race, insulin use, comorbidity, hospital, and clustering within practices. The VDIS registry with patient outreach saves over $2,400 per patient per year. 0.033 -$2426 $3202 $4937 Costs $/y 0.044 -0.08 0.15 0.23 Specialty visits/y 0.010 -0.81 2.04 2.86 Primary care visits/y 0.020 -0.23 0.55 0.72 Emergency room visits/y 0.047 -1.01 1.18 1.89 Hospital days/y P Adjusted Effect* Intervention Control Outcome

30. Current Vermedx Registries None None Opt-out Patient consent Yes Yes No Surveillance No Pilot phase Yes Outreach A1C only A1C only A1C, lipids, renal Scope ~210,000? ~600,000 ~3,000 Patients Health Department Health Department Integrated provider group, insurer Sponsor May 2008 2006 2002 Started San Antonio New York City Vermont