Background: All cancer patients experience some level of distress associated with cancer and its treatment at all stages of the disease. Psychological and social problems created or exacerbated by cancer cause additional suffering, weaken adherence to prescribed treatments and threaten patients' return to health." Health care providers often tend to under estimate psychological distress. Screening and early identification of distress promote improved management of symptoms, which facilitates medical care. Psychosocial care must be integrated into the routine treatment of cancer patients, per the Institute of Medicine's 2008 report "Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs."Methods: Developing operational standards for Distress Screening our cancer center both NCCN guideline, Commission on Cancer Standards. These operational standards integrated our Electronic Medical Record to create "best practice advisories" to alert the physician to the possible need for further evaluation of distress and the possible need for referral to Social Work staff or the on-site Psychologist. Results: Referrals to our on-site staff Psychologist at our main campus were monitored. 306 unique patients were referred to our staff psychologist for evaluation and treatment during the 2014 calendar year. In the first three quarters of the 2015 a total of 445 were made. Surgical oncology clinics (Head & Neck, Breast & Upper Gastro-Intestinal) made the majority of referrals. Conclusions: In accordance with published guidelines and accrediting standards our cancer center utilized our electronic medical record to increase our ability to identify psychosocial distress in our population.