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Cardiovascular disease is one of the leading causes of death, yet most evidence is collected from small clinical trials or individual hospital providers. Achieving scalable data to enable quality improvements (QIs) remains a challenge. We investigate whether a registry that is shared by multiple providers and integrates data longitudinally could help drive QIs across a large rural geographic region.We describe a case study involving the development of an informatics infrastructure across the entire state of Wyoming. This rural, regional, community-based cardiovascular system of care involved all interventional hospitals in the state as well as all surrounding states. Data exchange was initiated between 36 hospitals, and 56 ambulance agencies, to a centralized registry for clinical analytics and QI for patients with acute myocardial infarction.After 3 years, the registry maintained all documented acute myocardial infarctions across Wyoming. Median total ischemic time (time from patient's symptom onset to definitive treatment) had a 36.7% improvement during the program. Changes in quality for the rural community included reduction in overall treatment times, as well as enhanced training, standardized protocols, and community awareness. We also share key lessons learned.Collaborative data registries for emergency cardiovascular care can help providers and communities measure and improve the quality of the care across regions.