Fourth, we must develop more sophisticated measures that can be programmed into flexible, electronic, clinical decision-support rules. These could take the form of more restrictive eligibility criteria, such as the patient subgroups described for the VTE prophylaxis measure. Corresponding point-of-care alerts or reminders designed to improve performance would only be triggered for patients in the same high-risk subgroups identified in the measure specifications. For some measures, more sophisticated multivariable risk rules can be applied, such as for identifying patients at high risk for cardiovascular events (for example, the Framingham risk score) who should be offered statin therapy. Several risk prediction methods have been proposed for VTE prophylaxis, but none has been endorsed for widespread use at this time. Further research is needed to refine and validate these VTE risk prediction rules, including assessment of the feasibility of implementing them into electronic health record systems.