To identify key design features of point-of-care diabetes clinical decision support (CDS) that have high use rates, high provider satisfaction rates, and have improved control of major CV risk factors. Based on a series of NIH-funded projects to develop point-of-care Electronic Health Record (EHR)-linked Web based clinical decision support systems, we have identified design features that contribute to observed high use rates (60-80%) at targeted visits, and high primary care provider (PCP) satisfaction rates (94-95%), and positive effects on glucose and blood pressure control in adults with diabetes. Key features of successful outpatient chronic disease care clinical decision support system include the following: (a) co-designed by PCPs and researchers, (b) supported by clinic and medical group leaders, (c) designed to improve publicly-reported quality measures, (d) introspective identification of targeted encounters, (e) target patients with potential for substantive clinical benefit, (f) have rooming nurse launch CDS early in encounter workflow, (g) have PCP see CDS early in workflow for visit planning, (h) have patient review CDS before PCP enters room, (i) simple visual display of potential benefits for patients, (j) prioritization of treatment options based on potential benefit to patient, (k) ongoing feedback of CDS use rates to PCP and clinics, (l) compensate clinics to cover training costs, (m) locate algorithms in Web service to facilitate updates and scalability, (n) build in EHR order sets to facilitate clinical actions. These CDS design and implementation features are generally associated with high use rates, high PCP satisfaction rates, and clinical improvement. However, tailoring the features to particular practice settings is necessary.