Using electronic medical records to measure and improve performance.

Clinical performance measurement and public reporting are taking center stage nationwide, linked to transparency initiatives and incentive systems that reward physicians for meeting endorsed quality standards. While electronic medical records (EMRs) are increasingly available to measure and improve quality of care, performance measurement continues to be dominated by the use of insurance claims. Limitations to claims-based measurement include challenges in assigning attribution of care to specific physicians, inefficient and incomplete sampling methods, and the coarseness of measures frequently available to insurers. Practice improvement using claims-based approaches is further limited by the inability to provide timely and specific feedback to physicians and their patients. Finally, in claims-based approaches, care is not measured for the 47 million uninsured patients in the United States. In the current presentation I describe how these limitations are being addressed using EMRs, highlighting the design and selected preliminary results of a large trial to improve the care of patients with diabetes.