Background: Clinical Treatment Decisions in radiation oncology direct the patient’s treatment plans. There is a need for Clinical Decisions to be peer reviewed preferably in real time before the patient plan is completed. Traditional peer review of clinical decisions which ensure high quality patient treatments can be challenging in a busy radiation oncology clinic. Leveraging Electronic Medical Records (EMR) to query standard patient staging and demographics data per disease type allows for efficient peer review of the clinical decision. Methods: Through the use of EMR system (Aria, Varian Medical Systems, Palo Alto CA), data is entered into the radiation oncology chart by the primary radiation oncologist during a patient’s work up. Tools within the EMR have been configured to automatically query patient charts and summarize the data. A second Oncologist runs the query, reviews the data and peer reviews clinical decision for radiotherapy including treatment intent, dose and target contours. The radiation oncologist can then discuss modifications with the original oncologist, or indicate to the dosimetrist to continue planning. Those clinical decisions that are uncertain are escalated to review in a traditional peer review setting. Results: The EMR queries have allowed a shift to real time peer review of clinical decisions. The summary of disease specific staging and demographics data has added to efficiency in clinic in both the oncologists’ ability to complete a timely peer review and the lowering the amount of planning rework. Traditional peer review setting is then used to discuss the controversial and complex cases that would receive the most benefit. Conclusions: The ability to leverage electronic medical record data has made the peer review of clinical decisions in our institution more efficient and therefore the majority can be completed in real time.