Even the most robust technology itself cannot improve healthcare outcomes, as Vanderbilt University Medical center discovered on its way to lowering ventilator-associated pneumonia rates – saving money. During the last decade, Vanderbilt University Medical Center built into its operations the attention to clinical quality that now figures prominently in health reform, using a level of digital documentation and decision support that anyone seeking meaningful use of health IT would love to have. The problem: All that effort was falling flat where it really counted. "We had all of the technology anybody's talking about," said William Stead, the Nashville-based medical center's chief strategy and information officer. "We could show that the percentage of the time we did what we wanted to do with decision support went from, say, 10-30% up to 40-60% – major improvement. But even so, our performance on summative quality measures such as observed to expected mortality were average or actually below average."