BACKGROUND: Screening programs for depression often fail to improve care because of lack of adequate communication and follow-up. The purpose of this study was to examine a primary care depression screening program that utilized an electronic medical record (EMR) to improve communication and follow-up. METHOD: All adult patients in a family practice office were screened for depression using the Center for Epidemiological Studies Depression Scale (CES-D) during the period March 2000 through March 2001. Screening results were communicated to the primary physician via the EMR, and the physician communicated his or her plan back to the nurse via the EMR. In this retrospective cohort study, we included all persons who screened positive on the CES-D and examined their rate of new psychiatric diagnoses, new psychotropic medications, and change in CES-D scores 3 months after the initial screening. RESULTS: Of 1092 patients who completed the CES-D, 247 (22.6%) screened positive for depression. Among these, 35% had a new psychiatric diagnosis, 31% were prescribed new psychotropic medications, and 46% had a change in psychotropic medications. The vast majority of these were depression diagnoses and antidepressant medications. For the 94 persons who completed the CES-D at 3-month follow-up, there was a mean decrease in CES-D scores of 2.87 (p <.05). CONCLUSION: This study demonstrates a positive impact of a depression screening program that utilized an EMR to facilitate communication and follow-up. Such programs could help to improve detection and treatment of depression in other primary care settings.