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The Defense Health Information Technology Symposium, sponsored by the Office of the Assistant Secretary of Defense for Health Affairs, provides critical information management and information technology knowledge, shares innovative ideas, discusses lessons learned and new developments. Most importantly, this symposium provides a unique opportunity for leadership to communicate effectively and proactively the Department of Defense strategy to modernize the electronic health record and streamline the agency’s work with the Department of Veterans Affairs on the electronic health records program. In addition, this symposium conveys the strategic direction for the new Health IT (HIT) Directorate and the concepts of the shared services. It provides HIT leadership and staff with a collaborative environment to discuss and establish the key factors for success when the Defense Health Agency (DHA) moves to one organization and moves from Initial Operating Capability to Full Operating Capability. Due to the standup of the DHA and the focus on business acumen to achieve the needed cost containment for the MHS, new approaches and guidelines are essential to meet this new paradigm.