ABSTRACT Significance:Electronic-prescribingisnowwidelyadoptedbyUShealthcaresystems,butclinicalfunctionality of e-prescribing falls short in the realm of pediatrics. Medication prescribing is intrinsically more complex for pediatric patients due to weight-based dosing, the lack of widely adopted medication formulation recipes, inconsistent off-label usage of drugs, appropriate drugs for given conditions, and appropriate dose rounding percentages that will still make the drug treatment clinically useful. Clinical decision support (CDS) tools can improveshortcomingsinelectronichealthrecords(EHR),yetmanyfocusonadultonlypatientpopulations,are limited in drug and condition coverage, exist as web-services external to the native EHR environment, and generate excessive pop-up alerts that contribute to provider ?alert-fatigue?. Safety Through E-Prescribing Systems Tools (STEPSTools) is a web-service that was designed to be a comprehensive pediatric dosing knowledge dissemination platform that fills the void of condition based medication usage, expert consensus- baseddosagerounding,andextemporaneousdrugformulationrecipescurrentlymissinginEHRfunctionality. RxCheck is a Prescription Decision Support (PDS) platform built by RxREVU, that is surfaced directly in the provider?s native Epic EHR workflow to ensure the accuracy of information utilization by providers, drive operationalbestpractices,surfaceinformationthatmayormaynotnativelyexistintheEHR,andimprovethe clinical window. Hypothesis: By combining the strengths and expertise of STEPSTools pediatric prescribing technology with RxREVU?s RxCheck Prescription Decision Support platform, a comprehensive pediatric prescribing product will be developed that is scalable, interoperable, and utilized directly at the point of prescribinginordertodriveconsistentevidence-basedprescribingpatternsforpediatricians,andimproveclinical outcomes for pediatric patients. Specific Aims: By the investigators own admission, a pediatric prescribing technologywillnotbeusefulifitisnotcomprehensiveandup-to-date.ThisproposalaimstoupdateSTEPSTools technology from 2011 pediatric prescribing standards to 2016 standards, as new evidence and innovative approachestopediatricprescribinghaveoccurred.RapidandeffectivecommunicationbetweenSTEPSTools, RxCheckandVanderbilt?sEpicEHRiscriticalfortheaccuracyandsafetyoftheprescribingmodule.Thesedata handshakeswillberigorouslytestedforaccuracyinthesecondaim.Provideradoptionandclinicalutilityofan RxCheckpediatricprescribingmoduleiscriticaltotestthefeasibilityofwidespreadscalabilityofthetool.The numberoftimesRxCheckisaccessedcomparedtototalprescriptionswritten,aswellasprovideracceptance ratesoftherecommendationssurfacedbyRxCheckinEpicwillbemeasuredandsuccessofthisPhaseISBIR proposalwillbedeterminedhere.