For over 30 years, ambulatory care environments have been a major force in patient care delivery. Today’s drivers of new technology, less invasive procedures, the Affordable Care Act, and consumer demands, are transforming these environments right out of the box. We are seeing new delivery model of specialized clinics in strip malls and even wellness campus providing a full spectrum of outpatient care and the Veteran Affairs developing the Medical Home and Telemedicine. And it is all happening with lightning speed. Outpatient surgeries have increased by two thirds since 2006. Nearly 75% of elective surgeries are performed as outpatient procedures, and it is not stopping there.