Over the last 50 years US health care has been characterized by major advances in knowledge base and technology development, resulting in improved life span and lower mortality rates. However, the combination of an aging population with chronic diseases, the explosion of clinically relevant information, and expensive imaging and technology has led to a crisis in solvency, with 15% of the GDP now being spent on health care. For individual clinicians, the complexity and cost of innovative therapies is now so great that newer information technology -based systems are urgently needed to help them assess efficacy, cost, and outcome of these technologies and therapeutics. This seminar will discuss the impending health care crisis within the framework of both the overall health care system and the quotidian challenges of clinicians practicing in intensive care units- where the most expensive care and the most mortal outcomes occur in clinical practice.