To accelerate the use of health information technology (IT), Congress passed and President Obama signed into law the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of the American Recovery and Reinvestment Act of 2009. The HITECH Act authorized the Centers for Medicare & Medicaid Services (CMS) to provide financial incentives to eligible hospitals, Critical Access Hospitals (CAHs), and eligible professionals to adopt and meaningfully use certified electronic health record (EHR) technology to improve patient care.1 The HITECH Act also authorized the Office of the National Coordinator for Health Information Technology (ONC) to establish and administer programs to guide physicians, hospitals, and other key entities as they adopt and meaningfully use certified EHR technology as established in subsequent federal regulations. Section 13113(a) of the American Recovery and Reinvestment Act of 2009 under Title XIII of Division A, part of the HITECH Act requires a book to be submitted to Congress no later than two years after the enactment of the law, and annually thereafter. The Secretary of Health and Human Services submitted the first book on January 17, 2012. This book is the annual update to the previous submission. This book provides: (1) updates on the adoption of health IT; (2) efforts of CMS and ONC to facilitate nationwide adoption and exchange of electronic health information; and, (3) identification and discussion of barriers to the adoption and exchange of electronic clinical data and how ONC's programs are addressing those barriers.