Adolescents bear a disproportionate burden of the sexually transmitted infections (STIs) gonorrhea, chlamydia, and HIV, with the incidence of infections continuing to climb. The Centers for Disease Control and Prevention (CDC) recommends yearly testing for these infections in all sexually active females as well as men from high risk populations, or men who have sex with men, however few pediatricians adhere to these recommendations. The pediatric primary care clinics associated with Washington University have highly variable practices, with few of them perform STI screening in accordance with these recommendations. This proposal seeks to integrate an electronic STI risk assessment tool for adolescents, initially developed for use in the emergency department, into four pediatric primary care clinics. This program, E-STIRA (electronic sexually transmitted infection risk assessment), combines a branch- logic questionnaire, completed by the patient, with a clinical decision support tool, to identify youth at-risk for STIs. Adolescents receiving care in the St. Louis Children's Hospital ED are asked to complete this brief intervention, regardless of the reason for their ED visit. The City of St. Louis has a high incidence of STIs, with adolescents bearing a disproportionate share of these infections. This program was implemented to increase our ability to identify adolescents in need of STI testing and provide them the appropriate care. After patients complete E-STIRA, it provides recommendation for STI testing. Patients responses and STI testing recommendations are integrated into the electronic health record, enabling healthcare providers to easily identify patients in need of STI testing. In its first year in use in our ED, approximately 1600 patients completed E-STIRA. Nearly 50% were classified as in need of STI testing, 80% of whom presented for reasons unrelated to STIs. Among patients who presented for reasons not related to STIs and were in need of testing, 20% were positive for chlamydia and 8% for gonorrhea, and appropriate treatment plans were created for all patients. We now seek to integrate this program into four pediatric primary care practices for use during yearly preventive maintenance visits ("well-child checks"), where such screening is ideally performed. The Specific Aims of this study are 1) To adapt our electronic STI risk assessment program (E-STIRA) and clinical workflows for successful scale up in pediatric clinics. 2) To implement E-STIRA in four pediatric clinics and assess for changes in STI testing and treatment. The proposed work is innovative because of its combined use of D&I science and clinical informatics, the adaptation of a program developed in the ED setting for use in primary care, and the potential to significantly improve STI care in adolescents. We will take an existing clinical decision support tool and implement it in a new setting, and also develop a checklist of interventions necessary to facilitate d...