One of the least publicly discussed aims of recent health care reform legislation in the United States is to vastly improve the utility of electronic health records (EHRs) for clinical practice and research. If successfully implemented, EHRs will become platforms for the bidirectional flow of information from patients and providers to researchers and policy-makers, thus creating a nationwide learning health system. Significant steps toward improving EHRs so that greater value can be extracted from them were made with two pieces of legislation, the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of the broader American Recovery and Reinvestment Act of 2009, and the Patient Protection and Affordable Care Act (PPACA) of 2010. These laws, and setting up a learning health system, will have a profound impact on the clinical and research communities within pulmonary, critical care, and sleep medicine. In this editorial, we will review the benefits of using enhanced EHRs to create “smart” health systems, discuss the ways in which health reform supports the development of sophisticated EHRs, and outline how these changes will impact the practice of pulmonary, critical care, and sleep medicine.