Health IT systems tools are valuable, but they run up against a deeply rooted medical culture that doesn't pay all that much attention to costs. This culture begins to take hold during medical school. As soon as medical students begin their clinical training, they're encouraged to consider all the diagnostic possibilities when caring for patients, say Lisa Rosenbaum, MD, and Daniela Lamas, MD, editorial fellows at the New England Journal of Medicine. Many physicians would argue that ignoring these more remote diagnoses means putting costs ahead of patients' welfare, and that's simply unethical. Bills would be significantly lower if physicians stopped ordering unnecessary procedures. And there's now solid evidence to show that some routine diagnostic and screening tests really are a waste of money.