In February 2004, a physician working in the intensive care unit of a Toronto hospital wondered how to implement a strategy whereby an entire health care team could work towards better and consistent patient care based on best evidence. Doctors’ orders varied from one physician to another, and oftentimes the health care team had little insight into what worked best, what the best evidence was and how they could be sure their patients were receiving the best care possible. He wondered if it would be possible to adopt the airline industry’s “order sets” — step-by-step, evidence-based checklists that could be used by clinicians to order treatments for patients. He recognized that there were problems in implementing such a program, especially the lack of a standardized information technology strategy across the provincial health care system and physicians’ fear of losing their autonomy in making care decisions. Physicians already had access to clinical practice guidelines, which were designed to assist them to make informed, evidence-based decisions by removing the burden of tailored research and intervention design, but many found these to be too long, sometimes outdated and not integrated with the clinical process. How could these guidelines be integrated with physician orders to create a standardized process to ensure that every patient had access to the best care possible?