OBJECTIVES: Develop a database tool to allow the administration, acquisition and integration of disparate medical, pharmacy, enrollment, and provider-specific data to measure adherence to a regional antibiotic treatment guideline program. Critical, innovative data management and patient confidentiality measures were developed and implemented to build a unified data set of antibiotic prescribing episodes. METHODS: Strong Square, LLC incorporated the medical, pharmacy and professional claims from seven participating health plans in Washington state to create an integrated database of patient-specific longitudinal data. This database was used to measure the impact of previously distributed antibiotic prescribing guidelines. Recent U.S. Federal regulations (HIPAA) require non-disclosure of patient-specific data and additional reporting limitations imposed by participating health plans submitting data required that all personal-identifiers be masked. To address this, Strong Square, LLC developed a cipher application that masks all personal identifiers without hindering the ability to distinguish one individual from another, even across multiple health plans. In developing this longitudinal dataset, a series of administrative and technical issues were addressed - the evaluation of claims data as proxies for evaluating clinical measures, methods for standardizing data from multiple sources, the identification of providers from multiple data sources and with multiple identifiers, building time-horizons and data integrity checks that work across the disparate data sources. RESULTS: Strong Square, LLC has datasets that contain masked patient-specific data and unique provider identification that allows for tracking a patient's utilization of antibiotic prescriptions over time and over multiple health plans. CONCLUSIONS: This project provided physicians with a single, unified reporting mechanism that measures each physician's antibiotic prescribing patterns. Because of the data methods, tools and processes developed for this initiative, we are reporting a complete 'picture' of physician antibiotic prescribing patterns across all major health care payors in the State of Washington over time without revealing patient-identity.