Obtaining providers' 'buy-in' and establishing effective means of information exchange will be critical to HITECH's success.

In enacting the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act, Congress set ambitious goals for the nation to integrate information technology into health care delivery. The provisions called for the electronic exchange of health information and the adoption and meaningful use of health information technology in health care practices and hospitals. We examined the marketplace and regulatory forces that influence HITECH's success and identify outstanding challenges, some beyond the provisions' control. To reach HITECH's goals, providers and patients must be persuaded of the value of health information exchange and support its implementation. Privacy concerns and remaining technical challenges must also be overcome. Achieving HITECH's goals will require well-aligned incentives, both visionary and practical pursuit of exchange infrastructure, and realistic assumptions about how quickly such wholesale change can be accomplished. The use of metrics to show adoption proceeding at a reasonable pace, increased flow of data across parties, and evidence that care is improving, at least in areas with robust systems, will be essential to persuade stakeholders that the initiative is progressing well and warrants continued investment.