There have been two pivotal contests between Congress and two presidents over the nation's investment in health information technology (IT) and whether it will improve the quality and efficiency of care. The first, between President George W. Bush and the 109th Congress, resulted in a strong declaration of presidential support for health IT and galvanized the health IT community for aggressive activism. The second was set in motion when the 111th Congress used the stimulus legislation to drive potentially disruptive changes in health IT spending and policy. We again face the question of whether presidential leadership will keep health IT on course as a driver of health reform.