 At Brigham and Womens Hospital, we undertook a comprehensive program aimed at increasing the frequency of VTE prophylaxis in high risk patients. This novel strategy required: 1 devising a risk score that reliably and quickly identified patients at high risk of VTE, and 2 conducting a randomized controlled trial in which high risk patients without prophylaxis were randomized into an intervention or control group. The intervention groups physicians received a single alert explaining that the patient was at high risk, was not receiving prophylaxis, and urged that prophylaxis be selected from a template of available pharmacological and mechanical options. In contrast, the control groups physicians received no alert. 