Background: Kaiser Permanente (KP) is an integrated health care delivery system that provides clinical services to over 10 million members in nine states and the District of Columbia. Since 2007, KP oncology community collaborates at the national level to systematically improve safety and quality of care. Our improvements are accelerated by rapid adoption of evidence based protocols, leveraging of EMR and integration of quality improvement methods into clinical operations. Methods: KP created a team that included oncologists, hepatologists, rheumatologist, pharmacy, and quality improvement experts to evaluate safety of existing practice. Based on internal findings, we decided to focus on screening and prophylaxis of Hepatitis B in immunosuppressed patients. Hepatitis B primary infection can be self-limited with viral elimination and lasting immunity or can result in a state of chronic infection with persistent viremia. Hepatitis B can be reactivated with, or after withdrawal of, immune suppressive cancer therapy. Reactivation can result in clinical hepatitis, treatment interruptions, and not infrequently death from fulminant hepatitis. The goal of this initiative is to save lives (i.e. track % patients on chemotherapy who were not tested for Hepatitis B surface Antigen and Hepatitis B core Antibody and for those with a positive test, to determine if they received appropriate prophylaxis). Results: The multidisciplinary group initiated interventions: 1) Defined the patient safety measure of a rate of patients on anti-CD 20 therapies who had a Hepatitis B test prior to therapy; 2) Completed a baseline analyses and shared results with KP regions for appropriate actions; 3) Created an alert and incorporated into KP oncology/ rheumatology Beacon module; 4) Developed KP National screening and prophylaxis resource for hepatitis B in immunosuppressed patients; 5) Developed capacity for ongoing monitoring. Conclusions: We determined a need to educate clinicians and to standardize recommendations for screening and prophylaxis of Hepatitis B in patients receiving Anti-CD20 therapy. Changes were instituted in the Beacon protocols to check baseline labs. Ongoing surveillance using a safety net will be developed.