The Peer Review Process - General Information
The Peer Assessment Committee (PAC) is mandated by the College of Physicians and Surgeons of New Brunswick to provide for physician peer review in the province. The program operates at arm’s length from the College, and continues the work begun in 1993 by the now-dissolved Atlantic Provinces Medical Peer Review. The PAC will strive to assess physicians on a regular basis to achieve a mean frequency of every five years, to a maximum of ten years. Risk factors established by the Committee will ultimately be used to determine the frequency of assessment for individual physicians; those with higher risk factors will be assessed more frequently.
- The Peer Review Process
- What The Assessors Look For
- Common Office Observations and Deficiencies
- CMA Codes of Ethics
- Adequate Medical Records
- Infection Prevention and Control for Clinical Office Practice
The Selection Process - Pre-screening
Each year, the Peer Assessment Committee (PAC) selects physicians to be assessed through the onsite, virtual or offsite review process. Those determined to be eligible are subsequently asked to complete a detailed “Supplemental Information for Assessment” (SIA) questionnaire to give the PAC and the assessor assigned to the review more information about the physician and the type and scope of the practice. It should be noted that participation in the peer review process is mandatory under the Medical Act.
In an onsite assessment, an assessor is named to visit the practice, a process which usually requires about three hours, and includes a review of patient files selected at random by the assessor. Following the chart review, the assessor will meet with the physician for about an hour to discuss the impressions reached from the review. Although physicians may be present for the entire process if desired, their presence is only actually required for the interview portion. in which the assessor will discuss the strengths and weaknesses of the practice and outline possible areas for improvement. Following the visit, the assessor’s written report is submitted to the Peer Assessment Committee. It will be deternined if the practice is:
Category 1: satisfactory – no further action needed
Category 2: unsatisfactory (deficiencies identified) -reassessment is required within a specified time frame; CPD in specific areas may be required
Category 3: personal interview (serious concerns) – a second look at the charts is necessary.
Physicians normally receive the results of the review about three months or so following the onsite visit.
Below are samples of the forms used for onsite assessment. These forms are for information only.
- Supplemental Information for Assessment
- Questionnaire for Pathologists (additional information required for pathologists)
- Assessment Report Forms:
Note: report forms are used with the permission of the College of Physicians and Surgeons of Ontario. We thank them for their support and generosity.
Virtual Remote Assessment
Virtual remote assessment is similar in nature to an onsite review in that an assessor reviews a number of patient charts, meets with the physician being assessed, and determines an appropriate “scoring” for the assessment. The difference is that the review is done electronically with the assessor having direct remote access to charts, and the physician and the assessor meeting via an electronic chat platform such as Zoom or Facetime. In order to participate in a virtual remote review, the practice must be EMR-based. Physicians who can access their EMR from a remote location and view all the contents of their patient files, may be eligible for a virtual remote assessment. We believe that virtual-remote review may be a more convenient process, with the review being done at a time which works for both the physician and the assessor – and not necessarily in the middle of a busy office day.
The virtual remote review will be done by an experienced assessor who will discuss the process with the physician being assessed in advance online or by phone; carry out the chart review electronically with approved access to the patient records; and meet with the physician electronically following the review to discuss the results. In order to participate in virtual-remote review, physicians will confirm the following:
a) the EMR can be accessed remotely (i.e. from home);
b) the physician is able to provide an assessor with log-in credentials to allow access on a read-only basis to the complete patient chart;
c) the EMR will allow for both the assessor and the physician to view the same record simultaneously if needed.
A detailed explanation of the role of both the assessor and the physician being assessed may be found in the document “The Virtual Remote Review Process” here.
Report forms used in a virtual remote assessment are the same as those used for an onsite review. These may be read in The Assessment Process section “Onsite Assessment” above. Virtual Remote review uses a different post-review evaluation form: “Physician’s Evaluation of Virtual Peer Review.”
Offsite assessment is less in-depth than onsite review; it is a process which has been piloted and statistically proven to be a valid first-level review tool designed for physicians with a previous history of successful peer reviews, and occasionally for new physicians. It is currently limited to a small number of office-based practices including Cardiology, Family Medicine, Internal Medicine, Obstetrics & Gynaecology and Paediatrics. Consideration of demographic factors, along with a chart review, make up the offsite assessment process.
Physicians being assessed are asked to submit the “Supplemental Information for Assessment” questionnaire and copies of five patient charts, chosen from among patients with specific disease entities relative to the practice.
The type of charts to be submitted is noted in the “Instructions to Physicians” below. For example, Family Physicians will be requested to include Hypertension, Chronic Pain and Type II Diabetes. Paediatricians send charts from patients with Autism, Asthma and Seizure Management. An experienced assessor will evaluate the structure and contents of the charts, as well as the management of the disease entities, to determine if the practice appears to be satisfactory, or whether an onsite visit is required. It is important to note that the PAC will not normally provide physicians with the offsite assessment option each time they are reviewed. It is likely that a physician with a successful onsite review will be offered offsite the next time (s)he is eligible (in 5-7 years), but onsite again the time following.
Below are the forms used for offsite assessment. These forms are for information only.
- Supplemental Information for Assessment
- Instructions to Physicians – Family Medicine
- Instructions to Physicians – Paediatrics
- Instructions to Physicians – Cardiology
- Demographics Form
- Chart Review Form
- Physicians’ Evaluation of Offsite Assessment