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New rules recently proposed by the US Department of Health and Human Services (HHS) through the Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare and Medicaid Services (CMS) are the most comprehensive and consequential for the future direction of Health IT since the HITECH Act set the basic table stakes of health information technology in 2009.  A growing consensus among industry pundits suggests that the proposed rules will define health information exchange and the Health IT space for the next 5-10 years.