This issue has focused on opportunities to improve the quality of laboratory medicine and on the challenges inherent in measuring quality in the laboratory setting. The Physician Quality Reporting Initiative (PQRI) was established by Congress as one means of promoting reporting of quality data. Measures for the initiative are developed through a consensus process; like democracy, the process is far from perfect but is better than all available alternatives. This article describes the evolution of the PQRI program and the methodology involved in measure development. Key points are summarized.