In 2008 Intel Corporation’s chief technology officer speculated on the possibility that machines “could even overtake humans in their ability to reason in the not so distant future” (Rattner, 2008) which as we move through 2010 the paucity of  ‘reasoning’ decision support toools should give some concern to those working in health care who desire to move through the muddled complexity of current systems to a point where clinical systems reasoning for the future will become the arbiter of care in clinical information and decision support systems.