For physicians

Onboarding the Measura protocol

Most programs of this kind fail on workflow rather than on clinical rationale. The first ninety days are about making the measurements reproducible before making them numerous.

Phase one: define the population and the rule

• Agree the selection criteria and write them down. Selection criteria.
• Convert them into a standing order set that staff can apply without interrupting a clinician. Standing orders.
• Settle scope-of-practice and supervision questions locally, in writing, before anyone is tested.
• Decide which discrete values will be captured in the record, and never change the list. EMR integration.

Phase two: train the technique, not the equipment

Equipment training takes an afternoon. Technique training is what determines whether the measurements are comparable, and it is worth deliberately over-investing in.

1. Fix the patient positioning, the rest period and the room conditions, and write them into a one-page protocol that sits in the testing room.
2. Have each tester perform the full battery on the other testers, repeatedly, until repeat measurements on the same person on the same day agree.
3. Practice coaching the challenge maneuvers. A poorly coached maneuver looks like an abnormal result and is the most common source of a false finding.
4. Build the habit of recording the conditions of measurement alongside the numbers. Staffing and workflow.

Phase three: run a small cohort deliberately slowly

Test perhaps twenty patients before scaling. The purpose is not the clinical yield; it is to find the workflow failures — the preparation instruction nobody gives, the report that reaches the chart three days late, the field somebody forgot to populate.

Review every one of those twenty reports as a group, with the tester present. It is the fastest way to correct technique, and it establishes from the start that the interpretation and the measurement are one process.

Phase four: close the loop

• Set repeat intervals from findings rather than from the calendar.
• Audit the gap between patients who met the criteria and patients who were actually assessed. That gap is the real measure of whether the standing order is working.
• Feed the discrete values into whatever quality reporting the practice already does. Quality reporting.
• Re-review technique quarterly. Drift is silent and it invalidates trends retroactively.

The three things that most often go wrong

For patients: the same subject written for the person having the assessment is at what to expect at an appointment.

Common questions

Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, medical director of Measura. Last reviewed August 20, 2026.