Sometimes, it's the little things. A phone call, perhaps, just to see how you're doing. Or maybe it's a note, or a friendly visit.

And when it's a phone call from a nurse, checking to see if you've scheduled a followup appointment, or a note from your doctor, giving easy-to-understand instructions on how a patient can manage a chronic disease, those little things can keep patients healthy and out of the hospital, and save thousands - even millions - of dollars in the process. That, at least, is what Snohomish County's largest medical center has discovered.

The clinic is just starting to implement the new procedures, and savings won't come overnight, says Rick Cooper, Everett Clinic CEO.

"Health care is incredibly complicated. It's a multivariable equation," he says. "We can't solve it, but we can make a difference."

The clinic's experiments in ways to improve health care and cut costs have given it national recognition. In September, it received the American Medical Group Association's 2007 Acclaim Award, which recognized the clinic for its efforts to improve the treatment of chronic diseases like diabetes, high blood pressure and asthma. The clinic also was picked to take part in a national study of ways to cut the cost of treating senior citizens on Medicare.

The Everett Clinic is a health care system of its own, with 250 doctors treating some 225,000 patients at eight locations throughout Snohomish County. Its main campus sprawls over three blocks in north-central Everett. One of the big problems with America's health care system is the way it is organized, Everett Clinic executives say.

Physicians are "not good businessmen," says Dr. Harold Dash, the clinic's chairman and president. "Medicine is one of the few remaining cottage industries in this country."

Many of us go to doctors who have their own independent practices. While there are standards of care for how patients are treated industrywide, there is no standard for how the business is run from practice to practice. Each has its own relationships with vendors and insurance companies; each has its own procedures for handling patient records and billing.

As a result, many health care organizations are not taking advantage of new technologies designed to make businesses run better. Many rely on paper records filed in old-fashioned cabinets. Doctors still scribble out prescription orders on notepads, which pharmacists struggle to decipher.

"If the airline business operated at the same error rate as the medical business," says Albert Fisk, the clinic's medical director, "there'd be an airliner going down every day." Replacing the scribbled notes with an electronic ordering system cut down the clinic's errors by 60 percent.

The Everett Clinic took a bold step this year, spending $18 million on a computerized medical records system.

The goal is to have one centralized medical record that contains all the information any health professional might need to know about a patient. Specialists would have access to a primary care doctor's notes, so they could check such vital things as whether the drugs they're prescribing are going to interact adversely with medication the patient's already taking.

Having one central electronic record, instead of a half-dozen or more paper ones, should cut down errors and improve the quality of care for patients.

The clinic started rolling out the electronic records at its Mill Creek branch in September, and plans to have it implemented systemwide by next year, says Fisk.

One of Everett Clinic's most effective costcutting initiatives is more than a decade old. The clinic in 1998 banned drug company sales reps from its offices. It was a highly contested decision - particularly with the drug companies. More than 100 sales representatives showed up for a meeting to argue against the proposal, recalls Chief Operating Officer Mark Mantei.