Section Menu  

Updates from the CodeX Initiative

By Randi Kudner, Assistant Director of Quality Improvement
Posted: November 2, 2022

Four years ago, ASTRO realized it was time to tackle the issue of access and availability of radiation oncology clinical data. The 2018 publication of the Minimum Data Elements for Radiation Oncology (MDE) was ASTRO’s first step in a Herculean effort toward easing the daily burden of practices. In 2021, Christodouleas et al. provided background in an ASTRO blog post, explaining how the MDE paper was leading to real world outcomes. While ASTRO’s original goal was to develop a way to automatically generate end-of-treatment summaries, the potential has proven to be much greater.

How has ASTRO found a path forward?

During the development of MDE, ASTRO took a calculated leap of faith and joined the Common Oncology Data Elements eXtension (CodeX) initiative during its early days. ASTRO is a founding member of CodeX and sits on the minimum Common Oncology Data Elements (mCODE) Executive Council. ASTRO encouraged involvement from the American Association of Physicists in Medicine (AAPM) and the collaboration has made a huge impact. For years, siloed data projects have been happening, but there hasn’t been an opportunity to move the development in the same direction. CodeX, under the leadership of the MITRE Corporation, has provided that partnership and a forum for many disparate oncology data projects to come together and move toward the same goal. MITRE has provided the technical informatics knowledge that specialty societies, like ASTRO and AAPM, and radiation oncology practices may lack. This technical support has allowed ASTRO and AAPM members to translate complex clinical scenarios into machine readable and transferable information and will soon ease some daily burdens in radiation oncology practices.

The work

In the 2018 ASTRO Membership Survey, 20% of respondents stated that using electronic health records was a key concern in daily practice. Siloed and non-transferable data is an issue throughout health care, and radiation therapy is no different. As a member of CodeX, ASTRO has led the charge to change the status quo of radiation therapy data and, in partnership with AAPM and many vendors, has created solutions to help daily practice. The collaboration between ASTRO and AAPM has been highlighted as the successful model in CodeX. This recognition can be seen in the recent appointment of CodeX Steering Committee representatives from ASTRO (Adam Dicker, MD, PhD, FASTRO, FASCO) and AAPM (Chuck Mayo, PhD, FAAPM, FASTRO). These radiation oncology delegates will shape the future of the initiative and oncology data.

Treatment Summary Automation

Care coordination is central to the experience of patients and caregivers, particularly with cancer care, as they navigate multiple treatment modalities, clinicians and health care settings. To date, the creation of end-of-treatment summaries, a key part of care coordination, has remained a painfully manual process. The work that ASTRO and AAPM have done through CodeX has primarily focused on correcting this issue. Through this multi-year endeavor, radiation oncology-specific vendor systems have automatically aggregated treatment summary data and transferred it successfully to enterprise. This is a huge step forward from the current manual creation of these documents that transmit as an unusable pdf to other systems. Varian, Epic and RaySearch have all successfully tested this functionality and are currently developing implementation plans for their commercial offerings, meaning it should be coming to your practice soon!

Meaningful quality measures

Members of the radiation oncology team, like all health care professionals, are driven by their desire to improve patient outcomes. Measurement is a key component of any sort of improvement, but quality measures have been burdensome, and the aggregated data is normally meaningless. ASTRO’s CodeX work, in parallel with Telligen, a federal contractor, and ASCO, is changing the ability for practices to collect data that are integral to understanding meaningful quality and safety gaps, while also providing insight into treating the whole individual. The CodeX quality measures team is currently updating common measures to assess care provided to different populations, stratifying by gender, race and ethnicity. Once finalized, ASTRO will use the framework to create new quality measures for radiation oncology practices. These modern measures will be critical to measuring and improving the quality of care and essential to promoting equitable health outcomes.

Streamlined prior authorization

Prior authorization has long been a thorn in the side for radiation oncology practices.1,2 While informatics does not resolve the obtrusiveness of prior authorization, it can go a long way to ease burdensome data collection and reporting. Clinical data are essential to ensuring accurate clinical representation for the decision support needed to ensure the right treatments for the right patients. ASTRO is engaged in another CodeX project to reduce clinician and health system burden by developing an informatics solution using the approaches referenced in the Centers for Medicare & Medicaid Services’ (CMS) interoperability rules. Starting with prostate and breast radiation therapy, ASTRO is working with Varian, US Oncology and EverNorth to define an automated prior authorization process using health care data standards to extract and exchange the necessary information to expedite the prior authorization process.

What is next?

Vendor systems have several compliance requirements to meet by the end of 2022 which help support ASTRO’s work toward breaking down the barriers of health care data. Vendors, oncology practices and multidisciplinary oncology groups are engaged with ASTRO and CodeX to make an impact in the future of cancer data. ASTRO has led the way and will continue working to help ease the daily burden related to health care data. ASTRO cannot do it without you; radiation oncology practices need to get involved and to let vendors know that these solutions are needed as soon as possible. Contact Randi Kudner, ASTRO’s Assistant Director of Quality Improvement, to learn how you can get involved with CodeX and ease the burden in your own practice.


  1. Bingham B, Chennupati S, Osmundson EC. Estimating the Practice-Level and National Cost Burden of Treatment-Related Prior Authorization for Academic Radiation Oncology Practices. JCO Oncol Pract. 2022;18(6):e974-e987.
  2. Committee activity. Committee on Small Business. https://smallbusiness.house.gov/calendar/eventsingle.aspx?EventID=2794. Accessed October 26, 2022.
Topics:  CodeX
Leave a comment
Copyright © 2024 American Society for Radiation Oncology