Evaluating quality of care through peer review is a challenge for physicians. Rural physicians have the added burden of close personal relationships and conflicts of interest. The Rural Physician Peer Review Model© presents an innovative solution to these problems that involves utilizing simple information technology to share HIPAA-compliant information, a systems approach to review, principles of patient safety/quality of care, and continuing education. The process involves network hospitals submitting patient cases to the central staff, deidentifying patient information, e-transmitting the cases, meeting by teleconference, and report writing by the physician moderator. Over 3 years, 934 patient cases have been reviewed in 209 teleconferences. Participating physicians report high levels of satisfaction with the objectivity of the reviews and new learning. Written evaluations of the teleconferences document that this impartial process promotes the inclusion of quality improvement and patient safety in peer review. Anecdotal evidence indicates increased use of system improvements.