During my remarks, I borrowed an analogy from Laura Adams of the Rhode Island Quality Institute , to the effect that wondering how we are going to achieve more efficiency in health care is like wondering why we don't have buttered toast. Some people say the key is to plug the toaster in; others say we need to go to the store and buy the bread; others say the key is putting the bread into the toaster and pressing the lever down; and others say the most important step is the final one, applying the butter. (For those of you who like to eat healthy, imagine wheat toast and a high-protein spread instead.) Health IT is like plugging in the toaster -- necessary but not sufficient by itself to produce the buttered toast. Obtaining some combination of higher quality and lower cost from health care will also require changing the way we use information and the incentives facing providers, among other steps. In other words, health care contains massive opportunities for efficiency improvements, and health IT can facilitate some of the steps that will be crucial to improving efficiency, but capturing those opportunities will generally require more than just expanded health IT. For more on health IT, see here and here .