During the Health IT presentation, I was struck by the discussion to hold EMR systems accountable for patient outcomes. Furthermore, I had trouble with the acceptance of a provider’s tendency to not double check an order when an EMR is present. At first, this seemed like an unacceptable reliance on technology in lieu of addressing the underlying issue of medical decision making. It was not until our second to last presentation, with the example of fighter aircrafts being managed by 18-22 year olds, that I understood the rationale behind this. They are able to optimize their delivery system despite the operator. I realized that when we view “the system” as an accountable aspect of patient care, this includes sub-optimal support systems such as the EMR. By not providing the optimal support system, we are undermining the delivery of optimal care.