From understanding the updated requirements to streamlining workflows, Kathleen Hintenlang, PhD, FAAPM, FACR, FASTRO, and Kelsey Riffle MPH, RT(T), quality and safety leaders at the Ohio State University, share valuable insights for any practice preparing for the APEx accreditation process. The conversation highlights the evolving standards, improvements in processes and the benefits that radiation oncology practices realize through APEx.
Randi Kudner: Thank you for joining us today. As Ohio has undergone both initial accreditation and reaccreditation with APEx, we'd love to hear your insights into the updated APEx portal and standards. Let's start at the beginning: Why did your facility originally choose to become APEx accredited, and what motivated your decision to pursue reaccreditation?
Kathleen Hintenlang: Our decision to seek APEx accreditation was largely influenced by Doug Martin, MD, FASTRO, one of our radiation oncologists, who was an ASTRO charter member for the implementation of the APEx program. His role as a surveyor made it a natural educational progression for both Monica Fullenkamp, our Director of Business Operations, and me to also become surveyors. Given Dr. Martin’s current role as chair of the ASTRO Clinical Affairs and Quality Council and as a member of the ASTRO Board of Directors, it was a natural extension for us to pursue reaccreditation. Additionally, we had opened a new facility that included proton therapy, and we were eager to add that modality to our accreditation.
RK: That makes sense. How would you describe your overall experience with the updated APEx platform compared to the previous version?
Kelsey Riffle: The new platform is much more user-friendly. We appreciated that it clearly displayed our progress throughout the process and allowed us to save our work for later. It also provided submission timestamps, eliminating any uncertainty about the status of our application. Additionally, the feedback feature within the portal is particularly useful. We could easily review and respond to comments, re-upload documents and keep all correspondence in one place.
RK: That’s great to hear. Were there any specific improvements that stood out to you in the new platform?
KH: One major improvement was the integration of AAPM’s medical physics practice guidelines (MPPGs) into the task group reports and resources. It was exciting to see APEx adopt this so quickly, making it the first accrediting body we’re aware of to incorporate them. This addition was particularly beneficial to our team.
RK: Were there any aspects of the previous platform that you preferred or found clearer?
KR: Honestly, nothing significant stands out from the previous platform that we felt was missing in this update. The new version is intuitive and made the process smoother overall.
RK: Now, regarding the updated APEx standards, how do they compare to the previous version in terms of clarity and applicability?
KH: The new standards are clear and very applicable. One notable change is the additional requirements related to radioactive materials (RAM). Given that RAM is already well-regulated by the NRC and corresponding agreement states, incorporating our Radiation Safety Officer and radiation safety team into the accreditation process was a welcome enhancement. It reinforced a more integrated team approach.
RK: Were there any challenges presented by the new or revised standards during your accreditation cycle?
KH: The biggest takeaway was the realization that our standard operating procedures (SOPs) needed to be more dynamic. As an academic center, our practice evolves rapidly, so SOPs can no longer be static documents reviewed every few years. Accreditation made us recognize the need for continuously updating our SOPs in real time, integrating dashboards and new technologies to maintain live, adaptable workflows.
RK: That’s an interesting point. Given this shift, how do you think accrediting bodies can encourage and support this change?
KH: The accreditation process should not require facilities to revert to outdated documentation methods. For example, in our initial accreditation, we demonstrated our workflows electronically rather than providing static documents. Our team strongly believes that accreditation should reflect modern practices, incorporating real-time workflows rather than simply checking boxes. Involving vendors in these discussions has also been instrumental in bridging clinical needs, regulatory requirements and accreditation expectations.
RK: That’s a great perspective. Do you feel the new standards better align with industry best practices compared to previous versions?
KH: Yes. Dr. Martin has been actively involved in initiatives like mCODE, which standardizes end-of-treatment notes in hospital EMRs. He emphasized that accreditation should drive meaningful results, not just add extra steps for compliance. The goal should be interoperability, ensuring information is seamlessly shared between systems rather than just being stored passively.
RK: Has the update made the accreditation process easier, more complex, or about the same?
KR: One notable feature was the ability to click on a standard reference within the application and immediately view its details. This made navigation much more efficient. However, the removal of Level 1 and Level 2 indicators was surprising. While it didn’t impact us significantly, it was helpful in the past to know which standards APEx prioritized. That said, we understand the shift toward a more objective approach where all standards are viewed as equally important.
RK: That change has certainly sparked discussion. Moving on to the updated resources, how did they compare to previous versions?
KR: The standards guide remained an invaluable resource, especially for training and process improvement. The addition of in-depth explanations was particularly helpful in aligning team members who may have different interpretations of the standards. This was critical in ensuring convergence across our growing staff, including new physicians and locum therapists who benefit from the structure of an accredited facility.
RK: That’s an important point. Have you taken advantage of other APEx resources, such as virtual discussion sessions or one-on-one meetings with APEx staff?
KH: Absolutely. We attended both in-person and virtual sessions, and the ASTRO Annual Meeting session, which proved invaluable. Right before our site visit, we had to make a significant pivot, and those resources helped us navigate the situation smoothly. Additionally, the responsiveness of the APEx staff was phenomenal — having direct and timely communication made a huge difference.
RK: It’s great to hear that those resources were useful. Lastly, any final thoughts on how APEx accreditation has impacted your facility?
KH: Beyond the formal accreditation, the process has reinforced our commitment to quality improvement and adaptability. The structure provided by APEx ensures that we remain proactive rather than reactive in our clinical and operational practices. As the industry evolves, so should accreditation, and we appreciate APEx’s efforts to align with modern practices and facilitate meaningful discussions within radiation oncology.
Also, we know there are staffing issues, like the therapist shortage. We have a lot of locums in several roles. I think it’s helpful for them to know that they're coming into a facility that's accredited. It shows them that we’ve put the time and effort in to make sure that we are operating at a high standard.
RK: Thank you for sharing your experience. It’s valuable to hear firsthand how the accreditation process is evolving and impacting facilities like yours.
APEx, through its evolving standards and user-friendly platform, continues to play a pivotal role in advancing excellence in radiation oncology practices. APEx’s updated program ensures that the standards align closely with clinical realities and industry best practices, ultimately improving patient care.
For more information on how your practice can benefit from APEx accreditation, and to join a community dedicated to advancing excellence in patient care, consider exploring the resources and support APEx offers. Contact APEx to discover how your practice can get started.
This article was originally published in the May/June 2025 AAPM newsletter.
