BACKGROUND Electronic health records (EHRs), in combination with health information exchange, are being promoted in the United States as a strategy for improving quality of care. No single metric set exists for measuring the effectiveness of these interventions. A set of quality metrics was sought that could be retrieved electronically and would be sensitive to the changes in quality that EHRs with health information exchange may contribute to ambulatory care. METHODS A literature search identified quality metric sets for ambulatory care. Two rounds of quantitative rating of individual metrics were conducted. Metrics were developed de novo to capture additional expected effects of EHRs with health information exchange. A 36-member national expert panel validated the rating process and final metric set. RESULTS Seventeen metric sets containing 1,064 individual metrics were identified; 510 metrics met inclusion criteria. Two rounds of rating narrowed these to 59 metrics and then to 18. The final 18 consisted of metrics for asthma, cardiovascular disease, congestive heart failure, diabetes, medication and allergy documentation, mental health, osteoporosis, and prevention. Fourteen metrics were developed de novo to address test ordering, medication management, referrals, follow-up after discharge, and revisits. DISCUSSION The novel set of 32 metrics is proposed as suitable for electronic reporting to capture the potential quality effects of EHRs with health information exchange. This metric set may have broad utility as health information technology becomes increasingly common with funding from the federal stimulus package and other sources. This work may also stimulate discussion on improving how data are entered and extracted from clinically rich, electronic sources, with the goal of more accurately measuring and improving care.