Background: UCHealth pursued and became certified as a Quality Oncology Program from the Quality Oncology Practice Initiative (QOPI) through the American Society of Clinical Oncology (ASCO) in 2015. During our gap analysis to prepare for certification, we identified a deficit in our education, monitoring, and follow up relating to oral anti-cancer therapies. Although we used QOPI as a benchmark, we sought to improve patient care and safety in the realm of oral anti-cancer therapies. Methods: UCHealth has implemented policies surrounding oral chemotherapy to include patient education, consent, use of the EHR for ordering, and patient monitoring of adherence and toxicity through development of a flowsheet. This includes the use of Best Practice Alerts (BPA) to trigger staff to evaluate adherence and compliance, smart texts to pull data into progress notes, silent BPAs to remind staff to call patients within 10 days of starting oral chemotherapy, and weekly reporting of staff compliance with assessing patient adherence. Results: EHR changes were implemented in May, 2015 with reporting of staff compliance beginning in September. At that time, UCHealth was only monitoring adherence and toxicity in 24% of patients on an oral anti-cancer therapy. Through continued quality improvement projects, staff education, and optimization of clinical decision support tools, UCHealth consistently monitors adherence and toxicity in over 85% of patients on an oral anti-cancer therapy. Results have been monitored for over two years with continued improvements seen. Conclusions: Using the reporting data, we are able to identify quality improvement projects to include discrete data such as individual staff member compliance. Continuous refinements of the BPA and report have occurred as a result of discrete data analysis by a multi-disciplinary committee.