title: An automated electronic system for managing radiation treatment plan peer review reduces missed reviews at a large, high-volume academic center.
abstract: BACKGROUND
  Assuring quality in cancer care through peer review has become increasingly important in radiation oncology. In 2012, our department implemented an automated electronic system for managing radiation treatment plan peer review. The purpose of this study was to compare the overall impact of this electronic system to our previous manual, paper-based system.
  
  
  METHODS
  In an effort to improve management, an automated electronic system for case finding and documentation of review was developed and implemented. The rates of missed initial reviews, late reviews, and missed re-reviews were compared for the pre- versus postelectronic system cohorts using Pearson χ2test and relative risk. Major and minor changes or recommendations were documented and shared with the assigned clinical provider.
  
  
  RESULTS
  The overall rate of missed reviews was 7.6% (38/500) before system implementation versus 0.4% (28/6985) under the electronic system (P < .001). In terms of relative risk, courses were 19.0 times (95% confidence interval, 11.8-30.7) more likely to be missed for initial review before the automated system. Missed re-reviews occurred in 23.1% (3/13) of courses in the preelectronic system cohort and 6.6% (10/152) of courses in the postelectronic system cohort (P = .034). Late reviews were more frequent during high travel or major holiday periods. Major changes were recommended in 2.2% and 2.8% in the pre- versus postelectronic systems, respectively. Minor changes were recommended in 5.3% of all postelectronic cases.
  
  
  CONCLUSIONS
  The implementation of an automated electronic system for managing peer review in a large, complex department was effective in significantly reducing the number of missed reviews and missed re-reviews when compared to our previous manual system.
authors.affiliation: Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: peter.gabriel@uphs.upenn.edu.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Gabriel
authors.affiliation: Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Kristina D
authors.initials: KD
authors.lastname: Woodhouse
authors.affiliation: Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lin
authors.affiliation: Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jarod C
authors.initials: JC
authors.lastname: Finlay
authors.affiliation: University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Young
authors.affiliation: Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Edna
authors.initials: E
authors.lastname: Volz
authors.affiliation: Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Hahn
authors.affiliation: Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: James M
authors.initials: JM
authors.lastname: Metz
authors.affiliation: Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Amit
authors.initials: A
authors.lastname: Maity
mesh_terms: D000046:Academic Medical Centers; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D007256:Information Systems; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000532:radiotherapy*; D010347:Patient Care Planning; D018024:Peer Review, Health Care / Q000379:methods*; D011785:Quality Assurance, Health Care