The Agency for Healthcare Research and Quality was established in 1989 in response to an Institute of Medicine report that pointed out ?escalating healthcare costs, wide variations in medical practice patterns, and evidence that some health services are of little or no value?. More than 25 years later, there has been surprisingly little progress in these three areas. The interest in applying machine learning to clinical practice is increasing yet the practical application of these techniques has been less than desirable. There is a persistent gap between the clinicians required to understand the context of the data and the engineers who are critical to extracting useable information from the increasing amount of healthcare data that is being generated.