BMJ Qual Saf 22:155-162 doi:10.1136/bmjqs-2012-001170
  • Research and reporting methodology

Method for developing national quality indicators based on manual data extraction from medical records

Open Access
  1. Etienne Minvielle1
  1. 1Inserm U988, Institut Gustave Roussy, Villejuif Cedex, France
  2. 2Department of Medicine, University of Washington, Washington, DC, USA
  3. 3Department of Management, University of Montreal, Montreal, Canada
  1. Correspondence to Dr Etienne Minvielle, Inserm U988, Institut Gustave Roussy, 38, rue Camille Desmoulins, Villejuif Cedex 94805, France; Etienne.MINVIELLE{at}
  • Received 14 May 2012
  • Revised 31 August 2012
  • Accepted 7 September 2012
  • Published Online First 26 September 2012


Developing quality indicators (QI) for national purposes (eg, public disclosure, paying-for-performance) highlights the need to find accessible and reliable data sources for collecting standardised data. The most accurate and reliable data source for collecting clinical and organisational information still remains the medical record. Data collection from electronic medical records (EMR) would be far less burdensome than from paper medical records (PMR). However, the development of EMRs is costly and has suffered from low rates of adoption and barriers of usability even in developed countries. Currently, methods for producing national QIs based on the medical record rely on manual extraction from PMRs.

We propose and illustrate such a method. These QIs display feasibility, reliability and discriminative power, and can be used to compare hospitals. They have been implemented nationwide in France since 2006. The method used to develop these QIs could be adapted for use in large-scale programmes of hospital regulation in other, including developing, countries.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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