In concurrence with the introduction of the internet, widely networked computers, and the collection of large amounts of digital data, the medical profession as a whole has become more self-aware and self-critical. It is increasingly apparent that suboptimal decisions are made at times and, on other occasions, are fatally flawed. Most clinical decisions rest largely on what is referred to as the art of medicine: that is, decision-making that is based on inconsistent and incomplete provider knowledge; variable skills, training, and experience; and last but not the least, an array of biases. Unsurprisingly, the result is an unacceptable degree of care variation that is not explained by patient factors or the clinical context. Every minute, a medical decision is being made somewhere that could be more informed, more objective, more precise, and more safe. How does medicine move on to adapt to an era of big data and a need to make consistent, data driven, evidence and value-based clinical decisions?