ASCO and its members, whether we recognize it or not, are in the quality business. Our members, because society has an expectation of a high standard of care from physicians; our Society, because we are charged with helping establish the standards by which our members' claims to quality care are judged.

ASCO has devoted increasing attention to the issue of quality. Recently we created a Quality Department, led by Dr. Deborah Kamin, within the organization. This group can be thought of as a tripod, with the three legs composed of QOPI, Guidelines, and EHR. We allocate staff to each of these and have recently finished a Board of Directors meeting devoted to their integration, and to our future in this arena.

Quality is hard. We differentiate between "qualitative" and "quantitative" in common speech, but in the health sciences we have learned that quality has to be defined and quantitated. As a society this has meant that we create practice guidelines, and then measure them in practice through our Quality Oncology Practice Initiative, or QOPI.

QOPI has gradually picked up steam and is increasingly used by practices interested in quality improvement. But QOPI, like our Guidelines, has several issues that we continue to wrestle with. Some of these are practical ones: the QOPI process is retrospective rather than real-time, it requires real commitment and resources from ASCO volunteers, it is not as streamlined or user-friendly as we would like, and it is not as useful to our members as it could be. Some are, for lack of a better word, philosophical problems. Not everything that is important is measurable, and not everything that is measurable is important. How do we make sure that what we measure matters, and that the measuring leads to reduced cancer morbidity and mortality?

There is still an enormous amount of work to do in this area. We would like, at the end of the day, to have performance measures such as QOPI to be seamlessly integrated and essentially invisible, perhaps extracted from an electronic health record. We would like every patient's experience to inform the care of other patients through health services research. We would love our standards and QOPI to form part of real-time decision support for physicians caring for cancer patients.

To do all of these things today is not a simple task. But we can dream, and we can plan, and we can and should take first steps toward the integration of guidelines and performance measures in an electronic medical record environment. The Board believes that ASCO can play an important role in this enterprise: far better that we develop and apply standards to ourselves than having them imposed from outside. We hope to finalize our strategic approach to the quality area in the near future.