Through the Health Information Technology for Economic and Clinical Health (HITECH) Act, the federal government is making up to $27 billion available in incentive payments, followed by penalties, over 10 years for eligible professionals and hospitals. HITECH is extended by the sections of the Patient Protection and Affordable Care Act (PPACA) that deal with payment reform. Of particular importance are those sections that discuss accountable care organizations and the different ways that Medicare will pay for care. These changes may be more significant to the industry and to healthcare information technology (HIT) than the "meaningful use" regulation itself. In some ways, meaningful use becomes the tactical plan for achieving the strategic plan outlined by PPACA. The HIT market will evolve to include exchanging data, orchestrating the coordination of care across settings, and finally guiding caregivers with contextual knowledge at the point of care.