Malpractice records review glossary
Short version: the terms a physician reviewer or a hospital risk team meets in a malpractice record review, in plain words. Where a term has a legal meaning that varies by state, the definition here is the working sense. The statute or the contract decides the rest.
Limits: Prices, turnarounds and claims come from each provider's own pages or the cited survey and statute, read 2026-11-14. We bought no review from anyone listed and cannot vouch for the quality of any reviewer, and nothing here is legal advice on who may testify in your state.
Terms about the opinion
- Standard of care
- What a reasonable physician in the same specialty would have done in the same circumstances, judged on what was known at the time of the care, not on what the outcome later showed. State law and expert testimony define it case by case, and clinical guidelines are evidence of it, not the definition.
- Deviation
- A decision or an omission that falls short of the standard. Whether a deviation caused harm is a separate question, answered separately, and the 2 answers can point in different directions.
- Causation
- The link between a deviation and the harm. In most states the plaintiff has to show the deviation was more likely than not a cause of the injury, which is not the same question as whether the care was poor.
- Outcome bias
- The tendency to judge care as worse once the reviewer knows the patient was harmed. In Caplan, Posner and Cheney (JAMA, 1991), ratings of appropriate care fell by 31 percentage points when the same cases were presented with a permanent injury instead of a temporary 1.
- Implicit review
- A judgment made by a reviewer who reads the whole record and applies professional judgment, rather than scoring fixed criteria. Structured instruments improve agreement between reviewers, but Hayward and Hofer (JAMA, 2001) still found interrater reliability of 0.34 for 2 reviewers using 1.
Terms about who reviews and what starts it
- Affidavit or certificate of merit
- A sworn statement filed with a malpractice complaint in states that require 1, saying a qualified reviewer has reviewed the records and found a reasonable basis for the claim. The reviewer signs it, so the review has to be done before filing, on the record as it stands.
- Medical review panel
- A statutory panel that reviews a claim before it can go to court, in states that use 1. Indiana empanels 3 provider panelists and an attorney chair, and the panel issues a written opinion on standard of care and causation.
- External peer review
- A review of a clinician's care by a physician outside the organization, used when no staff member can review without a conflict. It feeds the medical staff process, so the notice, hearing and privilege rules around that process apply to it.
- OPPE and FPPE
- Ongoing professional practice evaluation, the routine review of a practitioner's performance, and focused professional practice evaluation, the targeted review after a concern or a new privilege. 42 CFR 482.22 requires the medical staff bylaws to cover both.
- HCQIA
- The Health Care Quality Improvement Act of 1986, which gives limited immunity from damages for peer review actions that meet its conditions: a reasonable belief the action served quality health care, a reasonable effort to obtain the facts, and adequate notice and hearing procedures. The conditions are in 42 USC 11112.
- LNC (legal nurse consultant)
- A nurse who reviews records for attorneys or risk teams: chronology, missing records, nursing standard questions. An LNC is not a substitute for a physician opinion where state law requires a same-specialty physician.
Terms about the record
- Page citation
- The page, Bates number or page range a finding comes from, written so a reader can open that exact page. A finding without a page citation cannot be checked, and a reviewer whose findings cannot be checked is weaker in deposition.
- Chronology
- A date-ordered table of the clinical events in a record set, 1 row per event, each row citing its page. It records what the file says and holds no opinion.
- Late entry
- A note or addendum written after the encounter it describes. The interval between the encounter and the entry is often 1 of the questions in a standard-of-care review, which is why the audit trail matters.
- Audit trail
- The EHR's own log of who opened, changed or signed a record, and when. It is the evidence that separates a late entry from a note that was edited after the fact.
- Deduplication
- Finding pages that repeat and setting the extra copies aside so each event appears once. Duplicates are common when 2 parties produce the same records. A careful process logs what it set aside and deletes nothing.
- PHI (protected health information)
- Health data that identifies a patient and is covered by HIPAA. Any vendor that handles it for you should sign a business associate agreement before the first upload.
Terms about the engagement
- Retainer
- An advance payment a reviewer asks for before starting, drawn down against hourly charges. SEAK's 2024 survey of experts puts the median retainer at $3,000 among those who require 1.
- Retention agreement
- The written contract that sets the rate, the scope, the retainer, who owns the work product and whether the reviewer will testify. 64% of experts in the SEAK 2024 survey require 1.
- BAA (business associate agreement)
- The HIPAA contract a vendor signs before it handles PHI on a covered entity's behalf. Ask for it before the upload, not after the review starts.
Definitions are ours, written from the statutes and studies linked above and read on 2026-11-14. The methodology page says how we capture and check facts.