Health systems around the world face the issue of financial and workforce sustainability. Mobile health technologies – those devices which connect health professionals, patients, payers and the many other contributors who make up the health system offer some solutions – not just as ‘add ons’ but as enablers of real system change. This paper presents a vision for what the health system of the future could be like and emphasises the opportunities for real patient participation in clinical decision-making if the professions can engage the technologies and patients/community in a meaningful way. Predicting the future is never easy but many of the technologies are here now – but how we will use them to make the system more patient friendly, more productive and sustainable is still for discussion. This paper should start that conversation.