Michael R. Udwin, MD, FACOG, Medical Director, Analytic Consulting and Research Services, Truven Health Analytics, formerly the Healthcare Business of Thomson Reuters. Why do we continue to drive off the road despite guard rails? Order sets and clinical pathways promised to be the solution to physician practice variability. Yet, quality and utilization continue to represent challenges to hospitals and health systems. Dr. Udwin discusses approaches to addressing opportunities in the new world of collaborative medicine, and covers the background on directed care, strategies to reduce physician variability and what the future may hold.