OBJECTIVES: The VA Center for Medication Safety has developed a data-extract driven, web-based, user-interface application for a medication utilization evaluation tracker (MUET).  MUET identifies at-risk patients as well as records, stores, and tracks clinical interventions in a centralized interactive VA database accessible to all 152 VA Medical Centers (VAMCs).  The objective of this study is to describe the impact of a MUET tool designed to address the safety and monitoring needs of at-risk patients on erythropoiesis stimulating agents (ESAs) and to enable interventions to be tracked in a centralized database.  METHODS: Data are extracted from the VA PBM prescription and laboratory databases each month, and potentially at-risk patients on ESA therapy are loaded into the MUET tool.  Four trigger groups indicating quality of care issues are identified: No Hgb, Hgb > 12 and ≤ 13 g/dL, Hgb > 13 g/dL, and Hgb < 9 g/dL with no recent ferritin assessment.  Upon log-in to MUET, clinicians are prompted to address the safety needs of each patient by selecting from a list of interventions that are recorded and tracked over time.  RESULTS: Approximately 2.5 years after ESA MUET initiation, chi-square tests showed decreases in patients without Hgb labs (11.4% to 3.0%, p<0.0001); in patients with Hgb ≥ 12 g/dL and ≤ 13 g/dL (12.7% - 7.3%, p<0.0001); and in patients with Hgb > 13 g/dL (5.7% - 3.0%, p<0.0001).  A non-significant decrease was observed in patients with Hgb > 9 g/dL and without a ferritin assessment (3.1% - 2.8%, p=0.3960).  CONCLUSIONS: The ESA MUET is a real-time web application tool accessible by all medical centers within the VA health care network to identify and intervene on patients at potential risk.  Data trends demonstrate significant improvements in 3 out of 4 ESA risk groups.