At the annual AMDIS Physician Symposium last month, the annual gathering of CMIOs and other medical informaticist executives, sponsored by the Association of Medical Directors of Information Systems (AMDIS), held in Ojai, Calif, reactions to the Thursday, June 28 ruling by the Supreme Court on the Affordable Care Act (ACA) were varied. For the most part, industry leaders were pleased with the result, even if some didn’t think any ruling from the court would have had an impact on what they generally all consider to be the inevitable work of “internal healthcare reform”- pushing the healthcare system towards improved patient safety and care quality, clinician effectiveness, efficiency, and cost-effectiveness, while leveraging healthcare IT to move the industry forward.