Background: Sustainable comprehensive screenings for cancer-related symptoms and distress is a challenge for large multisite cancer centers. Technological solutions are necessary to compile patient-reported outcomes at institutions with high volumes across broad geographic regions. Interdisciplinary collaboration and leadership engagement is required to effectively screen for and manage symptoms. Once integrated, electronic distress screening (EDS) produces large symptom databases for management of cancer related symptoms, strategic programmatic growth, and research. Methods: System-wide (n=44 clinic locations) implementation of EDS at consultation visits and simulations occurred in phases between November 2016-Dec 2016. EDS content, clinical sensitivity thresholds, and referral processes were developed with input from Supportive Oncology Department. Automatic alerts via email based on clinical thresholds developed and various symptoms profiles used to aid referrals to supportive oncology resources. Information and Analytic services ensured clinical integration into the EMR, delineation by clinic site, and troubleshooting. Ongoing completion rate tracked and sent to all practice managers. Results: The network-wide EDS completion rate for January 2017-June 2018 is 69% (26,564 completed out of 38,435 eligible patient encounters). Mean completion time per patient was 8 minutes. 84% of clinic sites (n=37) screened >50% of eligible patients and 46% of clinics (n=20) screened >75%. Triggered referral rates were established for all supportive oncology sections (e.g. 60% of patients reported clinically significant distress and 18% indicated being at risk for malnutrition). All screening data available for ongoing analysis. Conclusions: EDS can be integrated as a solution for distress and cancer related symptoms in multisite cancer centers. Interdisciplinary collaboration is needed to ensure clinical relevance. Phased rollouts, structured education, and completion rate dashboards help establish leader buy-in and consistent symptom screening. Such symptom databases allow large cancer hospital networks to strategically allocate limited resources based on highest volume/acuity/symptom profiles.