RO-ILS Background

Legal Authority

The Patient Safety and Quality Improvement Act of 2005 (PSQIA) authorizes the creation of patient safety organizations (PSOs) to address the needs identified in the 1999 Institute of Medicine (IOM) report "To Err is Human: Building a Safer Health System." Findings within the IOM's report highlighted a serious need to capture information that would help improve quality and reduce harm to patients. The PSQIA allows licensed health care providers to report, investigate and conduct analysis of patient safety events within a confidential and privileged environment.

The Agency for Healthcare Research and Quality (AHRQ), a division in the U.S. Department of Health and Human Services, oversees the activities and compliance of federally listed PSOs. Listed PSOs, such as Clarity PSO, are found on the AHRQ website. As outlined in the PSQIA, PSOs:

• Share the goal of improving the quality and safety of health care delivery.
• Collect and analyze data to identify and reduce the risks and hazards associated with patient care.
• Create a secure, non-punitive environment through confidentiality and privilege protections.

As expected, there have been legal challenges to the confidentiality and privilege protections of the PSQIA. To date the PSQIA protections have been upheld. The RO-ILS October 2015 Tip of the Month explained the privilege protections and recent state challenges. ASTRO and Clarity PSO continue to monitor these cases and, where possible, participate as “friends of the court” in favor of greater protection for patient safety work product and the PSQIA.

History of RO-ILS

In June 2011, ASTRO's Board of Directors approved a proposal to establish a national radiation oncology-specific incident learning system. A standardized system provides an opportunity for shared learning across all radiation oncology institutions and may be an added value to institutions that track incidents independently. This incident learning system represents a key commitment of Target Safely, ASTRO’s patient protection plan, designed to improve the safety and quality of radiation oncology.

ASTRO partnered with the American Association of Physicists in Medicine (AAPM) to develop RO-ILS: Radiation Oncology Incident Learning System^®, the only medical specialty society-sponsored incident learning system for radiation oncology.

ASTRO contracted with Clarity PSO, one of the earliest organizations to be federally listed as a PSO, to build the online interface and provide the affiliated patient safety services outlined in the PSQIA. Clarity PSO is a division of Clarity Group Inc. Clarity PSO and Clarity Group Inc., are independent of ASTRO; these entities provide PSO services to the radiation oncology practices enrolled in RO-ILS.

The Consensus recommendations for incident learning database structures in radiation oncology (Ford et al. 2012) developed by the AAPM Work Group on Prevention of Errors in Radiation Oncology, guided the framework for developing the data elements within RO-ILS. 

RO-ILS launched on June 19, 2014. The announcement and details were unveiled at a Congressional briefing, co-hosted by U.S. Representatives Frank Pallone, (D-N.J.) and Ed Whitfield (R-K.Y.). The then ASTRO Chair, Colleen A.F. Lawton, MD, FASTRO, and AAPM President, John E. Bayouth, PhD, presented at the event, and Jeffrey Brady, MD, MPH, director of the Center for Quality Improvement and Patient Safety at the AHRQ provided perspective.