We have chosen to focus on physician behavior in prescribing HMG-CoA reductase inhibitors (statins) to patients with elevated cardiac risk and elevated low density lipoprotein cholesterol (LDL-C) as recommended by cholesterol management guidelines. In a cluster randomized trial at several private, community-based, multispecialty practices, we propose to compare usual care to a system of automated, default, opt-out clinical decision support that prescribes statins as appropriate.