The largest improvement in reportable rates was seen when the entire office staff became involved in the process of asking and documenting all preventive measures in preparation for participation in the 2010 PQRI program. During the initial encounter at the front desk patients were given a Preventive Care Checklist to complete while waiting to be seen.  This Preventive Care Checklist was given to the nursing staff, who then interviewed the patient and documented past histories into the EHR. In addition, the staff utilized the EHR system's Rules Manager, a component that prompted electronic, patient specific clinical support recommendations for timely preventive services.  When the patient's office visit was completed, patient specific referral letters were then faxed or printed through a mail merge module within the system and automatically stored within the EHR, saving time.