PHYSICIAN RECORD KEEPING WAS ALTERED BY FOCUSED PROFILING. R.E. White 1 , D. Gray 1 ; 1 Albuquerque VAMC, Albuquerque, NM STATEMENT OF PROBLEM OR QUESTION: Since 1998, attending physicians in our general medicine, continuity clinics have instructed resident practitioners to enter patient problem lists into the electronic medical record. After eighteen months, however, only 45% of patients had an electronic problem list (EPL). OBJECTIVES OF PROGRAM/INTERVENTION: We implemented a profiling system based exclusively on the electronic medical record database. It allowed one person to review 100% of patient and resident records and then provide peer compared feedback. DESCRIPTION OF PROGRAM/INTERVENTION: Data about resident entry of EPLs was extracted from the computerized, medical record database and recurrently fed back to them between February and June 2000. Profile reports were posted in clinic, and all practitioners could compare their patient panel sizes and EPL completion rates with their peers. Several times during the intervention, each resident also received a list of his or her assigned patients who needed EPL action. The profiling intervention was suspended July through September 2000. Since all practitioners in the teaching group practice were profiled, no control group existed. Therefore, the presence of an EPL for each patient and the entry dates of individual problems contained in those lists were analyzed and compared across three time periods: the seven months before profiling (July 1999 through January 2000), the five months during the profiling intervention (February through June 2000), and after profiling ceased (July through September 2000). FINDINGS TO DATE: During the five months of profiling, residents added Electronic Problem Lists to 1087 patients, raising the percentage of patients with EPLs from 45% in January to 88% in June. An unintended, side product of profiling was an 11% increase in the number of patients which residents identified as belonging to their panels, from a total of 2048 in January to 2272 in June. Besides starting more EPLs during profiling months, residents also entered significantly more individual problems into those lists during profiling. During the seven pre-profiling months, they entered an average of 321 individual patient problems per month, and during profiling they entered 757 per month (a 136% increase). Not only did individual residents increase their number of electronic problem entries, but also more residents entered problems. Prior to profiling, 18 of 71 residents did not enter a single problem over seven months, and only 30 residents each month entered problems. During profiling all 71 residents entered problems and 50 did so each month. Forty-two residents were present during all data collection months (July 1999 through September 2000). These 42 residents entered individual problems into EPLs at monthly rates of 220 before, 526 during and 285 after profiling.``Before'' and``after'' periods differed significantly from the profiling period (ANOVA p < .005) but not from each other. The number of residents adding problems each month averaged 20 before, 31 during and 26 after profiling (Chi-square p < .02 for the``before''/`d uring'' comparison). KEY LESSONS LEARNED: Profiling was associated with increased compliance with record keeping policy, and affected all residents. Repeated feedback to practitioners about their specific performance and with peer comparisons is more engaging and motivating than reminders by supervising attendings. Using a computer patient database to review 100% of all patient and physician documents offers an efficient means to enhance physician performance.