ACP Releases New Papers on Performance Measures and the Development of a National Health Information Infrastructure

College intends to take the lead in reviewing and disseminating physician peformance data.

The American College of Physicians released two ground-breaking papers today calling for the use of clinical performance measures to improve physician quality and the development of an interoperable national health information infrastructure to support such quality improvements.

"The Use of Performance Measurements to Improve Physician Quality of Care" paper argues such measures have great potential to assess individual physician performance, improve the quality of patient care and reward physicians who meet or exceed high standards of health care delivery.

However, performance measures done in a bureaucratic, arbitrary or punitive manner, ACP warns, could hinder good patient care and cause physician frustration and career dissatisfaction.

The College has announced its intention to take the lead in reviewing and disseminating physician clinical performance measures and developing public policies to support the appropriate use of performance measures

ACP outlines other policy goals as:

Fostering continuous quality improvement of clinical care to meet evidence-based national standards of such care.

Promoting performance measures that are evidence-based, broadly accepted, and clinically-relevant. These measures should assess and focus on those elements of clinical care over which physicians have direct and instrumental control (as opposed to systems constraints). They should be built on statistical methods that provide valid and reliable comparative assessment across populations.


Ensuring that data collection should be feasible, reliable, and practical. Data collection should not violate patient privacy nor add to the paperwork burden experienced by physicians. Should performance measurement data collection impose additional costs on physicians, these costs should be supported by the health system and not the physician.

Encouraging studies, funded by both governmental and non-governmental sources, to develop public reports of physician performance that would provide patients with information to make educated choices about their physicians and other health care professionals. Physicians should have a key role in development and design of such demonstration projects, physician participation should be voluntary, and there must be adequate safeguards of physician and patient privacy.

Using information technologies to facilitate data acquisition for performance measures and to minimize any manual data extraction to support such measurement.

Evaluating the use of incentives, including financial incentives, to reward physicians who meet or exceed performance standards. Any financial incentives related to performance measurement should be directed at positive rather than negative reward.

ACP's paper titled "Enhancing the Quality of Patient Care Through Interoperable Exchange of Electronic Health Care Information" provides a comprehensive review of efforts to date, a description of obstacles to achieving true interoperability and recommendations for maintaining medical quality in the process.

The paper cites numerous studies demonstrating health care information interoperability will bring a higher standard of quality to the U.S. health care system. A 2003 Government Accounting Office (GAO) study found interoperability benefits included "improved quality of care, reduced costs associated with medication errors, more accurate and complete medical documentation, more accurate capture of codes and charges, and improved communication among providers that enabled them to respond more quickly to patients' needs."


The biggest obstacles to achieving this goal include cost and the lack of common medical terminology, coding, and communications software. This problem results from the highly fragmented nature of the U.S. health care system.

Virtually every component of care�drugs, lab results, digital imaging, disease classification, procedures performed, and electronic health records� uses different terminologies. For drugs alone, at least 12 separate systems exist for naming medications, the ingredients, dosage and route of administration.

The ACP identifies a number of key recommendations for achieving interoperability.

The creation of interoperable health care information networks must not become another un-funded regulatory mandate on physician practices.

Federal policy should support voluntary standards setting, rather than federal mandates on specific e-health technologies or products.

Demonstration projects, which contain usability requirements, should be conducted to test the new e-health technologies to ensure the technology is practical and worthwhile in the clinical setting.

Physicians and other caregivers must be given adequate time and financial resources to acquire the necessary technology, training and skills to incorporate interoperable health care information networks.

"These two papers demonstrate the College's strong commitment to improving patient care by using the latest technology and quality measurement methodologies available," said ACP President Munsey Wheby, MD, FACP. "All sectors of the health care system and the U.S. government must get behind these efforts if patients are to reap the benefits of the information age."

The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include more than 115,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illnesses in adults.
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[Note to editors: The full text of "The Use of Performance Measurements to Improve Physician Quality of Care" is available at The full text of "Enhancing the Quality of Patient Care Through Interoperable Exchange of Electronic Health Care Information" is available at]

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