The vision of a seamless care environment enabled through the use of health information technology opens the door to exciting possibilities. The first is the creation of a patient-centric Electronic Health Record that would contain all health-related data about a patient from all sources. That EHR would contribute to highest quality, safe, efficient, and low cost care. That same data would be used for multiple purposes, and, by integrating all requirements at the beginning, would meet all those multiple needs. Key to obtaining seamless care is the creation of a global master registry of data elements with attributes that would provide not only interoperability throughout seamless health care but also permit the coupling of knowledge with data. To accomplish this lofty vision will require making critical decisions, staying to the course, eliminating siloed approaches, and adopting universal, cooperative solutions to the use of HIT.