The coming years could be a watershed period for children and health care as the nation implements the most significant federal health care legislation in 50 years: the Accountable Care Act (ACA). A year earlier, the American Recovery and Reinvestment Act (ARRA) set up a framework and road map for the eventual universal adoption of health information technology in its Health Information Technology for Economic and Clinical Health (HITECH) provisions, and the Children’s Health Insurance Program Reauthorization Act (CHIPRA) legislation articulated a new and compelling vision for quality measurement in child health services.