• There are important new local and regional opportunities for collecting real-time data and using it to make inferences for use in real-time decision making.
  • Health care delivery organizations create streams of clinical, quality, operational, and administrative data that could interface with electronic health records to enable just-in-time research and learning and could serve as a valuable resource for designing metrics.

Implementing metrics requires a robust data, technical, and social infrastructure. Three workshop speakers explored common themes around the infrastructure needs for advancing measurement (Hillestad et al., 2005). In particular, their presentations focused on the challenges and opportunities for making measurement a routine component of health and health care systems. Kevin Larsen, medical director of meaningful use in the Office of the National Coordinator for Health Information Technology (ONC), discussed the next generation of the digital infrastructure and the opportunities it can afford. Christopher Queram, president and chief executive officer of the Wisconsin Collaborative for Healthcare Quality, described one example of building and using a data collection infrastructure. T. Bruce Ferguson, Jr., inaugural chairman of the Department of Cardiovascular Sciences at East Carolina University, provided a practitioner’s perspective on using metrics within the confines of a real-world health care organization.


Kevin Larsen explained that the goal of ONC is to improve the performance of the overall health and health care system, not simply to expand the use of digital tools. Operationalizing this goal means providing tools that providers, organizations, and public health systems can use to drive improvement. At their best, such tools can identify gaps in a patient’s care, allowing providers to make changes to address those specific gaps and to reform care processes in order to improve outcomes for future patients. To further this vision, ONC, the Centers for Medicare & Medicaid Services (CMS), and other federal partners have developed a strategy that focuses on real-time measurement, as opposed to retrospective measurement, and that emphasizes local ownership, benchmarking, links to decision support, and patient engagement tools. Larsen emphasized that ONC’s initiatives are

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