Errors are not always in the performance, sometimes they are in the measurement. Persell et al1 document the limitations of using automated measurements within an electronic health record for quality audits. The authors found that 15% to 81% of apparent quality failures were actually audit failures. When the auditors accessed all of the data within the electronic health record, including narrative information, many apparent quality failures were reclassified as compliant.
Sinsky CA. Beware the Burden of Measurement. Arch Intern Med. 2007;167(9):971-972. doi:10.1001/archinte.167.9.971-b