The future sustainability of health systems will depend on how well governments are able to anticipate and respond to efficiency and quality of care challenges. Bold action is required, as well as willingness to test innovative care delivery approaches. The greatest promise for transformational change is in applications that encourage new, ubiquitous, participatory preventive and personalised smart models of care. A whole new world of possibilities in using mobiles and the Internet to address healthcare challenges has opened up. The potential of mobile devices, services and applications to support self-management, behavioural modification and "participatory healthcare" is greater than ever before. A key hurdle is, however, the big data challenge, dealing with the exponentially accelerating accumulation of patient data - all of which must be mined, stored securely and accurately, and converted to meaningful information at the point of care. In order to fully exploit the new smart approaches to care, acceptance, privacy and usability issues will also have to be carefully considered.