• Assessor Notebook
• Quality Management Partnership Update
• Peer Redesign Update
• Meet CPSO Peer Assessor Dr. Jeff Habert
• Meet CPSO Assessment Coordinator Alden Cudanin

Assessor Notebook

Notices:

• Changes to the Peer Assessment Statement of Services Rendered (SSR) Forms
  These forms previously reflected the peer assessment attendance fee based on a “half day” (i.e., 3 hours), but they have recently been updated to reflect an hourly rate. This will enable you to more accurately reflect the actual time spent conducting a peer assessment.
  
  In addition, a slight increase to the mileage rate also came into effect May 1, 2015.


• Assessment Reimbursement
  Please remember to let us know whether you wish to be reimbursed to your corporation or as an individual. 
  
  If you choose to be reimbursed to your corporation, you require a certificate of authorization that must be renewed annually.


• CPSO makes submission on oversight of Out-of-Hospital Facilities
  The College has made a submission to Health Quality Ontario outlining its experience with regulating OHPs and put forth a proposal for a single regulatory framework to oversee these facilities.

Reminders:

• Completion of Assessor Orientation Modules
  Many of you have already completed the three online modules to support Assessor Orientation that were launched in early February 2015.
  
  If you have not yet done so, please use the user ID and temporary access code that were sent to you by email to access the Assessor Modules online. The modules were designed for assessors across the College and provide an introduction to the importance of the assessor role, how the assessor supports the work of the College, and how the College supports assessors.
  
  We continue to look forward to your participation in this new venture, and your feedback. You will be remunerated automatically once you have successfully completed the required modules.


• Discussing Findings and Providing Feedback Following your Medical Record Review
  The interview with the physician, following your medical record review, is a vital component of the assessment. The discussion should be fulsome and include your assessment findings, recommendations and suggestions. As well, a clear narrative should be provided about clinical care and chart maintenance.
  
  When you assess a completely satisfactory practice, you have an ideal opportunity to promote continuous quality improvement by validating care provided and discussing additional opportunities for practice improvement. This discussion should also be reflected in the assessment report.


• Completing the Online Assessment Report Protocols
  When completing the online assessment report protocols, please remember the following:
   
  1. Open the protocols in Adobe Reader (the program is free to download).
  2. Download the assessment protocols onto your provided encrypted USB drive.  Please note that protocols cannot be downloaded in batch form. This is a limitation of the software.
  3. Ensure that your comments do not exceed the size of the text box.
  
  Although the encrypted USB drive should be used for storage of the assessment reports, the protocols still need to be printed, signed, and mailed to the College.

Final Reminder:

• The Pan Am/Parapan Am 2015 Games are Almost Here
  Toronto is hosting the Pan Am/Parapan Am 2015 Games on the following dates:
  Pan Am Games: July 10 – 26, 2015
  Parapan Am Games: August 7 – 15, 2015
  
  Hotel bookings in the city, the surrounding Greater Toronto Area (GTA), and possibly beyond these boundaries, may be difficult during these times. Hotel rates will likely also increase temporarily. Therefore, College-related meetings onsite will be avoided during this time, and you are strongly encouraged to schedule assessments in the identified areas outside of this time period.

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Quality Management Partnership Update

The Quality Management Partnership (the Partnership) submitted its Phase 2 report, which focused on program design elements for each of the three service areas, mammography, colonoscopy and pathology, to the Ministry for approval at the end of March.  We are now moving into the implementation phase, which will include completing and evaluating a set of Early Quality Initiatives (EQIs) in each specialty.

EQIs in mammography have already been completed, and EQIs for colonoscopy and pathology are well underway. A Clinical Working Group consisting of field experts has been established for pathology to provide feedback and recommendations on practices related to tissue exemption and tissue release. For colonoscopy, the Clinical Working Group submitted its recommendation report and supporting documents to the Partnership on March 31, 2015; this included a systematic literature review, jurisdictional scan, and the development of the following tools/guidelines for use in the clinical setting:

• Bowel preparation dosing tool
• Guideline for endoscopy reports for referring physicians
• Guideline for patient discharge information
• Pre and post-procedure check list tool

Based on this initial work, the Clinical Working Group recommended launching a pilot  of the tools and guidelines in a limited number of clinical settings across the province, to evaluate and assess their ease of use, usefulness and completeness. Evaluation planning is underway; the assessment and pilot will be conducted and completed in 2015/16. Stay tuned for more information on how you can engage in the evaluation process and be the first users of the colonoscopy EQIs in the coming months!

For more information on the Partnership, visit the website at qmpontario.ca

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Peer Redesign Update

Four of the 14 discipline working groups that are participating in peer redesign are now testing the new tool using simulated patient records. These testing sessions allow assessors to immediately see where they are consistent in their judgement and where they need to come to a consensus. Similarly, these sessions allow assessors to reflect on where the handbook is useful in guiding their thinking or where more detail is needed. This is a critical step towards improving the utility of the handbooks and the inter-rater reliability of the assessor cohort. Once this milestone is achieved, the tool will undergo an external review followed by implementation to live assessment. The first live assessments using the new assessment tool are expected to take place this fall.

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Meet Peer Assessor, Dr. Jeffrey (Jeff) Habert

Practice Location: Thornhill, Ontario

Area of Practice: Family Physician for 26 years in a large group practice

Teaching:  Assistant Professor, Department of Family and Community Medicine, University of Toronto.

I became involved with the CPSO in 2002 as a Peer Assessor. My CPSO Peer Assessor role is one of the most rewarding of my career. I have met physicians across Canada. The peer assessment process is not only a necessary aspect of physician self-governance, but a very effective educational tool for the assessed physician in terms of self-evaluation and reflection.

The vast majority of peer assessments have a favourable outcome ( over 85%) and, for the remainder, the process serves as an educational template for physician self-improvement. I really do try to bring a sense of mutual respect into every assessment I perform, and I totally look at the assessment as an educational process, not at all a punitive one.

What do you focus on when conducting assessments?

I conduct all my assessments in a similar fashion. I pick charts prior to the assessment (i.e. 10 random charts and around 15 condition-specific charts).  Specifically, I have four areas of focus:

• A complete Cumulative Patient Profile (CPP) which is the back bone of all charts
• Note organization and completeness in a SOAP format
• Preventative care (vaccines, appropriate cancer screening, well baby and adult care)
• Evidence-based care for the major conditions seen in Family Practice (Diabetes, BP, CAD, Asthma, COPD, Depression, Osteoporosis,  Pain-acute and chronic, acute infections such as URI and UTI)
• The use of unrealistic prefabricated templates (create your own)

What advice would you give a new assessor about conducting assessments?

• Be fair and consistent with your expectations
• Apply your expectations, and tailor your assessment to the individual situation (i.e. rural Ontario is very different than the GTA in terms of available resources)
• There are certain medical record and practice expectations required from all physicians, but I believe that different circumstances require different approaches (i.e. a 75-year-old physician has been trained very differently in this regard compared to a 35-year-old physician), so this must be taken into consideration.
• Expectations of care should be evidence based and realistic (something "most" physicians would do), not what the "perfect" physician would do

What advice would you share with assessors when assessing electronic medical records (EMR)?

An EMR can be a very effective tool for the physician and organization of the medical record, but it is still completely dependent on the physician. I often use the quote "garbage in equals garbage out" to emphasize this point. The EMR can be a great tool, but must be personalized to suit your own needs. An EMR is not a "plug and play" application.

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Meet Alden Cudanin, Assessment Coordinator

How has your role at the College evolved?

I started in a split role as an administrative assistant for the Investigations and Resolutions (I&R) Department and as program assistant for the Practice Assessment & Enhancement (PA&E) Department six years ago. Eventually, I became permanent in PA&E.

In 2013, I participated in an initiative that offered program assistants a hands-on opportunity to learn the assessment coordinator role while maintaining our regular duties. I worked in the dual role for six months, adding new responsibilities, increasing interactions with assessors and gaining a better understanding of the peer review process.  This prepared me for my current role, where my focus is on peer reviews in internal medicine and related subspecialties.

What do you enjoy most about your job?

Helping physicians understand their practice through the peer assessment process.  Like in any project or job, we never know how far we’ve come until we reflect on what we have accomplished and what we still need to do to achieve our goal.  On a personal level, this is something that I strongly believe and it also holds true as a principle for our peer review process.

What do you do for fun when you’re not working?

I enjoy photography, art and history.  Recently, I have been able to combine all three by entering into the craft of Rephotography, the combination of historical and present day photographs into one.

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For more information or help with any of the above items contact Claudia Frisch or 416-967-2600 ext 586.