## 2 Background  
### Complexity of Healthcare and Data Management  
U.S. healthcare is a complex system, both from a clinical perspective and from a business perspective [4]. Governmental regulations, insurance policies, billing and payment agreements, and internal entity policies have certainly led to a complex business organization inside every healthcare entity. Adding to this system the uniqueness of every patient, creates an extremely complex clinical process as well. One product of the complex healthcare industry are the large volumes of data captured, much of which have the potential to improve performance on both the business and clinical side if used appropriately. The management of this increasing amount of healthcare data is crucial for having efficient healthcare management and decision making [4; 6]. Therefore, information systems are needed to organize and catalog the massive amounts of information in a way that makes the data easily accessible and highly efficient for anyone using a simple search criteria [4; 5; 6]. The evolution of information technology, particularly related to data analytics, has the potential to reduce some of the complexity of healthcare, however, researchers must be willing to explore that potential to its fullest [6].  
Part of the issue with healthcare information systems is the diversity across entities which creates significant obstacles for successful implementation [8]. Some of those obstacles include system failures, costs, fear regarding information confidentiality, security, and privacy, changes in work processes, and a lack of acceptance by clinicians [8]. For example, clinicians often stress their dislike of such systems, expressing concerns around technical (hardware/software) issues, utility (cannot meet the task needs) issues, and usability (is rejected/not accepted by user) issues. More specifically, many clinicians worry that patients will perceive a poorer quality of care if patient wait times increase due to system issues. In addition, they worry that the quality of their work may decline if the technology interferes with their established routines or negatively impacts their relationships with other healthcare entities [9]. There is no clear consensus on how to address these concerns within the healthcare information system because of the complexities of the issues and the diversity among contexts of use [8]. Implementing health information systems that have the same type of rigorous software development and engineering methods found in other 'critical environments', such as air traffic control or railway signaling, may serve as an important step toward eliminating these obstacles [8].  
Another barrier to healthcare information systems is the cost associated with implementation and maintenance [8]. Many researchers note the difficulty of demonstrating a return on investment for these systems. The fact that information technology is not a low risk capital investment further highlights the other noted risks, including financial costs to the organization, uncertain cost benefit tradeoffs, uncertainty in the presence of confidentiality, security and privacy fears, and concerns regarding the level of balance between security/privacy/confidentiality and having access that is acceptable to consumers [8]. Many clinicians have found paper records more convenient than electronic records, stating that electronic integration has not adequately allowed for efficient use of the data within the systems [9]. It is imperative to identify tools and systems that can overcome these obstacles and earn the trust of clinicians, while also reducing healthcare costs.