The delivery of health care online is relatively new. However, early indications suggest that it can improve the experience of care for patients and the health of populations, along with reducing per capita health care costs. HealthPartners in Minnesota launched an online clinic called virtuwell in late 2010. After more than 40,000 cases, we report an average $88 lower cost per episode compared with care received in traditional settings, strong indicators of clinical effectiveness, and a 98 percent "would recommend" rating from customers. The possibility of extrapolating such savings to larger volumes of cases is compelling. We suggest a need for regulatory reform, particularly around state-level statutes that create barriers to the expansion of online care delivery, such as those that require clinicians to be located in the same state as the patient and those requiring clinicians to have had a previous face-to-face visit with a patient. Such reforms would encourage further innovation and lead to cost reduction and improvements in access and convenience for consumers throughout the health care system. O nline health care delivery is a relatively new care option. Recent studies have compared quality between online and face-to-face clinical care, 1 e-visit use by physicians, 2 and cost comparisons between e-visits and care received in traditional settings. Within these studies, findings include comparable quality between online and face-to-face care for selected conditions and indications of cost savings. Other findings suggest less positive outcomes such as slow uptake by physicians and possible increased use of antibiotics.Several fundamental questions drive such investigations. Can online care be performed safely, securely, and in compliance with regulations? Will consumers accept care delivered via these new channels, and will they find their experiences satisfying? Can an online care business model deliver compelling cost savings? In short, can e-visits work?Our organization, HealthPartners, is a Minnesota-based, consumer-governed, nonprofit organization that provides health insurance through a health plan and care through a large integrated health system that includes four hospitals and more than seventy medical and dental clinics, as well as a network of contracted providers. In 2010 we launched an online clinic called virtuwell. Two years later, virtuwell's early results suggest that online care has the potential to meet the "Triple Aim" goals of a better health care experience for patients, improved population health, and more affordable health care 4 -especially for conditions typically associated with primary care.

Electronic health record-based clinical decision support (CDS) can improve key intermediate outcomes of diabetes care in primary care settings and could be deployed in conjunction with additional care improvement strategies. It is important to understand how to incorporate CDS strategies into primary care practices to obtain high provider use rates and satisfaction. This article describes the process for successful implementation of a CDS tool called Diabetes Wizard.

auditing and surveys of staff we present information demonstrating how the VDW is used at the 3 HMOs. Conclusions: The original intent of the VDW was to increase efficiency in the use of data on multi-site studies. However, single site studies can also gain efficiencies from using the VDW and at some HMOs the VDW has become the first data source to use for almost all research. The VDW advantages of standard data structures and standard methods are also useful for single site projects.