When David Blumenthal, MD, was national health IT coordinator, he focused on 2015, the HITECH Act's original target date for meeting meaningful use criteria. Now that he's back in civilian life, he's taking a longer view of the initiative to create a national health network triggered by the HITECH Act's cash incentives to physicians and hospitals using electronic health record systems. Blumenthal, who keynoted the Massachusetts annual health IT conference last week, quoted President Barack Obama's line that the HITECH Act was a "down payment" on health reform. He likened the fusion of health IT and payment reform processes -- in the spirit of reducing healthcare costs while making quality gains -- to a series of mountains to climb, one peak after another.