There is an emerging sense of "knowing" that American health care is in dire straits. Two premises underlying this belief are driving change: that the system is too expensive and too dangerous. The proof of the first premise is generally proffered by observations that there are too many uninsured Americans, and most of the remainder are increasingly burdened by inexorable increases in the cost of care. Proof of the second seems to derive from reports of medical ineffectiveness and error, such as the report of the Institute of Medicine. In apparent response comes expanded interest in "performance measures" and appraisal. To effect improvement in performance, 2 significant trends are emerging: renewed interest in technology, particularly the electronic medical record (EMR), and accountability among medical providers (witness the calls from Congress for . . . [Full Text of this Article]