Automating Radiation Oncology Prior Auth with SMART on FHIR

The Challenge of Prior Authorization in Radiation Oncology

Radiation oncology departments frequently encounter prior authorization requirements for high-cost, high-complexity treatments. Procedures such as Intensity-Modulated Radiation Therapy (IMRT), proton beam therapy, Stereotactic Body Radiation Therapy (SBRT), and brachytherapy are often subject to stringent payer scrutiny, demanding detailed clinical documentation aligned with guidelines from bodies like NCCN or ACR. The manual processes typically involved introduce significant administrative burden and potential for errors.

Current Prior Auth Workflow: A Barrier to Efficiency

Without a SMART on FHIR-launched application, the typical prior authorization workflow in radiation oncology involves multiple disruptive steps. Clinicians or coordinators must identify PA-required services, then open separate applications—such as PA software or payer portals—forcing a context-switch out of the EMR. This necessitates manual transfer of critical patient and encounter data, leading to transcription errors and documentation gaps, particularly for complex radiation therapy plans. The outcome is often recorded back into the EMR manually, resulting in inconsistent and unstructured data.

Key Failure Modes of Manual Prior Auth in Radiation Oncology:

• **Context-switching cost:** Clinicians and staff repeatedly exit the EMR, disrupting workflow for critical radiation therapy planning.
• **Manual context-transfer errors:** Retyping patient demographics, member IDs, and clinical details for IMRT or proton beam therapy leads to submission rejections.
• **Documentation-pull gaps:** Incomplete or inaccurate clinical documentation, often due to screen-scraping or manual retyping, delays approvals for complex treatments like SBRT.
• **Outcome write-back inconsistency:** Manual entry of PA decisions into the EMR results in unstructured data that is difficult to query for status updates or audit for brachytherapy cases.

Klivira's SMART on FHIR Solution for Radiation Oncology

Klivira's platform leverages SMART on FHIR to embed prior authorization directly within your EMR's clinical UI. This automated workflow allows radiation oncologists and coordinators to launch the Klivira application from within Epic Hyperspace/Hyperdrive, Cerner PowerChart, athenaOne, or MEDITECH Expanse. Patient and encounter context are automatically delivered via standard SMART parameters, and Klivira reads US Core resources directly from the EMR's FHIR endpoint, eliminating manual transcription for therapies like IMRT and SBRT.

Leveraging Da Vinci Standards for Enhanced Automation

Beyond SMART on FHIR, Klivira integrates Da Vinci Implementation Guides (IGs) to further streamline radiation oncology prior authorizations. Coverage Requirements Discovery (CRD) informs staff of PA needs at the point of order entry. Documentation Templates and Rules (DTR) guide the assembly of necessary clinical data, populating questionnaires directly from EHR FHIR data. Finally, Prior Authorization Support (PAS) facilitates the electronic submission of requests, ensuring that complex documentation for proton beam therapy or brachytherapy is accurately transmitted to payers.

Benefits for Radiation Oncology Departments

By integrating SMART on FHIR and Da Vinci standards, Klivira significantly reduces the administrative burden associated with radiation oncology prior authorizations. This approach eliminates context-switching, mitigates manual data entry errors, ensures comprehensive documentation for high-cost treatments, and provides structured write-back of PA decisions to the EMR. The result is a more efficient, accurate, and transparent prior authorization process that supports timely patient care and optimizes revenue cycles for IMRT, SBRT, and other advanced radiation therapies.