title: Comparison of Onsite Versus Online Chart Reviews as Part of the American College of Radiation Oncology Accreditation Program.
abstract: Accreditation based on peer review of professional standards of care is essential in ensuring quality and safety in administration of radiation therapy. Traditionally, medical chart reviews have been performed by a physical onsite visit. The American College of Radiation Oncology Accreditation Program has remodeled its process whereby electronic charts are reviewed remotely.
  
  
  
  Twenty-eight radiation oncology practices undergoing accreditation had three charts per practice undergo both onsite and online review. Onsite review was performed by a single reviewer for each practice. Online review consisted of one or more disease site-specific reviewers for each practice. Onsite and online reviews were blinded and scored on a 100-point scale on the basis of 20 categories. A score of less than 75 was failing, and a score of 75 to 79 was marginal. Any failed charts underwent rereview by a disease site team leader.
  
  
  
  Eighty-four charts underwent both onsite and online review. The mean scores were 86.0 and 86.9 points for charts reviewed onsite and online, respectively. Comparison of onsite and online reviews revealed no statistical difference in chart scores ( P = .43). Of charts reviewed, 21% had a marginal (n = 8) or failing (n = 10) score. There was no difference in failing charts ( P = .48) or combined marginal and failing charts ( P = .13) comparing onsite and online reviews.
  
  
  
  The American College of Radiation Oncology accreditation process of online chart review results in comparable review scores and rate of failing scores compared with traditional on-site review. However, the modern online process holds less potential for bias by using multiple reviewers per practice and allows for greater oversight via disease site team leader rereview.
authors.affiliation: Rhode Island Hospital, Brown University, Providence, RI; Tufts Medical Center, Tufts University, Boston, MA; University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh; Penn State Hershey St Joseph Cancer Center, Reading, PA; University of California San Diego, La Jolla CA; University of Maryland School of Medicine, Baltimore; American College of Radiation Oncology, Bethesda, MD; Private Practice, Apex, NC; Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY; University of Washington Medical Center, Seattle, WA; and Nacogdoches Medical Center, Nacogdoches, TX.
authors.forename: Jaroslaw T
authors.initials: JT
authors.lastname: Hepel
authors.affiliation: Rhode Island Hospital, Brown University, Providence, RI; Tufts Medical Center, Tufts University, Boston, MA; University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh; Penn State Hershey St Joseph Cancer Center, Reading, PA; University of California San Diego, La Jolla CA; University of Maryland School of Medicine, Baltimore; American College of Radiation Oncology, Bethesda, MD; Private Practice, Apex, NC; Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY; University of Washington Medical Center, Seattle, WA; and Nacogdoches Medical Center, Nacogdoches, TX.
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.affiliation: Rhode Island Hospital, Brown University, Providence, RI; Tufts Medical Center, Tufts University, Boston, MA; University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh; Penn State Hershey St Joseph Cancer Center, Reading, PA; University of California San Diego, La Jolla CA; University of Maryland School of Medicine, Baltimore; American College of Radiation Oncology, Bethesda, MD; Private Practice, Apex, NC; Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY; University of Washington Medical Center, Seattle, WA; and Nacogdoches Medical Center, Nacogdoches, TX.
authors.forename: Arno J
authors.initials: AJ
authors.lastname: Mundt
authors.affiliation: Rhode Island Hospital, Brown University, Providence, RI; Tufts Medical Center, Tufts University, Boston, MA; University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh; Penn State Hershey St Joseph Cancer Center, Reading, PA; University of California San Diego, La Jolla CA; University of Maryland School of Medicine, Baltimore; American College of Radiation Oncology, Bethesda, MD; Private Practice, Apex, NC; Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY; University of Washington Medical Center, Seattle, WA; and Nacogdoches Medical Center, Nacogdoches, TX.
authors.forename: Catheryn
authors.initials: C
authors.lastname: Yashar
authors.affiliation: Rhode Island Hospital, Brown University, Providence, RI; Tufts Medical Center, Tufts University, Boston, MA; University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh; Penn State Hershey St Joseph Cancer Center, Reading, PA; University of California San Diego, La Jolla CA; University of Maryland School of Medicine, Baltimore; American College of Radiation Oncology, Bethesda, MD; Private Practice, Apex, NC; Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY; University of Washington Medical Center, Seattle, WA; and Nacogdoches Medical Center, Nacogdoches, TX.
authors.forename: Steven
authors.initials: S
authors.lastname: Feigenberg
authors.affiliation: Rhode Island Hospital, Brown University, Providence, RI; Tufts Medical Center, Tufts University, Boston, MA; University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh; Penn State Hershey St Joseph Cancer Center, Reading, PA; University of California San Diego, La Jolla CA; University of Maryland School of Medicine, Baltimore; American College of Radiation Oncology, Bethesda, MD; Private Practice, Apex, NC; Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY; University of Washington Medical Center, Seattle, WA; and Nacogdoches Medical Center, Nacogdoches, TX.
authors.forename: Gordon
authors.initials: G
authors.lastname: Koltis
authors.affiliation: Rhode Island Hospital, Brown University, Providence, RI; Tufts Medical Center, Tufts University, Boston, MA; University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh; Penn State Hershey St Joseph Cancer Center, Reading, PA; University of California San Diego, La Jolla CA; University of Maryland School of Medicine, Baltimore; American College of Radiation Oncology, Bethesda, MD; Private Practice, Apex, NC; Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY; University of Washington Medical Center, Seattle, WA; and Nacogdoches Medical Center, Nacogdoches, TX.
authors.forename: William F
authors.initials: WF
authors.lastname: Regine
authors.affiliation: Rhode Island Hospital, Brown University, Providence, RI; Tufts Medical Center, Tufts University, Boston, MA; University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh; Penn State Hershey St Joseph Cancer Center, Reading, PA; University of California San Diego, La Jolla CA; University of Maryland School of Medicine, Baltimore; American College of Radiation Oncology, Bethesda, MD; Private Practice, Apex, NC; Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY; University of Washington Medical Center, Seattle, WA; and Nacogdoches Medical Center, Nacogdoches, TX.
authors.forename: Dheerendra
authors.initials: D
authors.lastname: Prasad
authors.affiliation: Rhode Island Hospital, Brown University, Providence, RI; Tufts Medical Center, Tufts University, Boston, MA; University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh; Penn State Hershey St Joseph Cancer Center, Reading, PA; University of California San Diego, La Jolla CA; University of Maryland School of Medicine, Baltimore; American College of Radiation Oncology, Bethesda, MD; Private Practice, Apex, NC; Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY; University of Washington Medical Center, Seattle, WA; and Nacogdoches Medical Center, Nacogdoches, TX.
authors.forename: Shilpen
authors.initials: S
authors.lastname: Patel
authors.affiliation: Rhode Island Hospital, Brown University, Providence, RI; Tufts Medical Center, Tufts University, Boston, MA; University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh; Penn State Hershey St Joseph Cancer Center, Reading, PA; University of California San Diego, La Jolla CA; University of Maryland School of Medicine, Baltimore; American College of Radiation Oncology, Bethesda, MD; Private Practice, Apex, NC; Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY; University of Washington Medical Center, Seattle, WA; and Nacogdoches Medical Center, Nacogdoches, TX.
authors.forename: Navesh
authors.initials: N
authors.lastname: Sharma
authors.affiliation: Rhode Island Hospital, Brown University, Providence, RI; Tufts Medical Center, Tufts University, Boston, MA; University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh; Penn State Hershey St Joseph Cancer Center, Reading, PA; University of California San Diego, La Jolla CA; University of Maryland School of Medicine, Baltimore; American College of Radiation Oncology, Bethesda, MD; Private Practice, Apex, NC; Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY; University of Washington Medical Center, Seattle, WA; and Nacogdoches Medical Center, Nacogdoches, TX.
authors.forename: Mary
authors.initials: M
authors.lastname: Hebert
authors.affiliation: Rhode Island Hospital, Brown University, Providence, RI; Tufts Medical Center, Tufts University, Boston, MA; University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh; Penn State Hershey St Joseph Cancer Center, Reading, PA; University of California San Diego, La Jolla CA; University of Maryland School of Medicine, Baltimore; American College of Radiation Oncology, Bethesda, MD; Private Practice, Apex, NC; Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY; University of Washington Medical Center, Seattle, WA; and Nacogdoches Medical Center, Nacogdoches, TX.
authors.forename: Norman
authors.initials: N
authors.lastname: Wallis
authors.affiliation: Rhode Island Hospital, Brown University, Providence, RI; Tufts Medical Center, Tufts University, Boston, MA; University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pittsburgh; Penn State Hershey St Joseph Cancer Center, Reading, PA; University of California San Diego, La Jolla CA; University of Maryland School of Medicine, Baltimore; American College of Radiation Oncology, Bethesda, MD; Private Practice, Apex, NC; Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY; University of Washington Medical Center, Seattle, WA; and Nacogdoches Medical Center, Nacogdoches, TX.
authors.forename: Michael
authors.initials: M
authors.lastname: Kuettel
mesh_terms: D000068:Accreditation; D003131:Combined Modality Therapy; D006801:Humans; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy; D010380:Peer Review / Q000379:methods; D011785:Quality Assurance, Health Care; D018787:Radiation Oncology / Q000592:standards*; D061089:Radiotherapy, Image-Guided; D050397:Radiotherapy, Intensity-Modulated; D012955:Societies, Medical