U. S. health care delivery and administration systems have undergone transformations that create an evolving demand for health information technology (health IT) infrastructure. The successes of both U.S. Health Care reform and the use of the Internet for Health Information Technology rely on consumer/patient “trust” that information will remain private and secure and recognizing the interdependence of policy choices. Each decision is a balance between ease of use, privacy and security concerns of consumers/patients, practicality, costs and political will. Currently, U.S. stakeholders ranging from the federal government to private companies are working collaboratively to structure this balance. The U.S. opportunities and challenges of implementing a complete health IT picture in our current Health Reform and legal environment provides experiences for other countries to consider as health IT continues to develop internationally.