The goal of this proposal is to evaluate the effectiveness and utilization of reminders in accessing personalized guidelines within integrated health records to improve the quality and safety of dental care for patients with chronic medical conditions. This 3- arm, 2-year prospective, group-randomized clinical trial, was implemented within 17 of HealthPartners dental clinics to evaluate different interventions to implement reminders and decision support within an integrated EHR system and compare them to usual care. The interventions are either: 1) a point-of-care reminders from the electronic medical record (EMR) to the dentist's electronic dental record (EDR) that a patient has a serious medical condition and 2) reminder letters or emails to patients to remind them to alert the dentist of their medical condition. Patients included those with diabetes mellitus, congestive heart failure, pulmonary disease, and xerostomia. A population of over 4500 subjects and 47 dentists at HealthPartners were studied with regard to utilization and impact of care guidelines using this system. Analysis of data to date suggest that 1) Reminder alerts to both dentists and to patients increase utilization of care guidelines; 2) Both provider alerts and patient alerts have a generalizable effect of increasing the rate at which providers reference care guidelines for all patients compared to usual care and; 3) Automated provider alerts in the EDR are more effective at encouraging the use of care guidelines than personalized alerts sent to patients. This project was supported by AHRQ R18 HS017270.