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While American healthcare has been at the confluence of pressures to improve the quality and safety of care, the HITECH and Affordable Care Acts offer a renewed call for the integration of information technology in all aspects of health care delivery. Many clinicians are uncertain about the relationship of these HHS initiatives—to improve quality and promote the adoption, and meaningful use, of health information technology. As we prepare for the second stage of Meaningful Use this discussion will examine our current state, our trajectory, and practical opportunities for clinicians and providers to leverage information technology to improve the quality and efficiency of the care they provide—part of this discussion must include the clear challenges on this path. When viewed in this context, we will better understand the inextricable relationship between the meaningful use of electronic health records, our national healthcare quality agenda, healthcare reform, and the individual capacity of each physician to improve the quality and efficiency of the care delivered through his/her practice.