For many years, quality and safety improvements through health IT (HIT), and the clinical decision support (CDS) systems that help facilitate them, were regarded as healthcare curiosities. In 2008 and 2009, that has changed significantly. Several waves of policy statements, national and state programs, and financial incentives from the Centers for Medicare and Medicaid Services (CMS) and private payers have brought quality and safety improvement through HIT ever more directly into the "must-consider" list for nearly all healthcare providers. In the next two years, the efforts of government, industry, and academic efforts are likely to focus more on how CDS is working to achieve its promised results. A greater realization of the value of different types of CDS in different situations; better recording of actual experience; forums to exchange practical lessons learned; and, the creation of sharable human-readable and machine-readable CDS formats, will go a long way toward helping CDS users learn from each other.