Incident reporting remains a cornerstone of patient safety efforts, despite its documented shortcomings. This qualitative study of patient safety experts delineates multiple challenges of current reporting systems, including weaknesses related to triage and analysis of reports, clinician engagement, visible and timely follow-up action, funding and institutional support, and functionality of current health information technology platforms used for reporting. Based on these results, the authors suggest that health systems must invest additional resources in order to attain more benefit from incident reporting systems. A recent AHRQ WebM&M perspective discusses voluntary reporting and other methods for measuring patient safety.