In several areas of Auckland, urban development has resulted in flooding and siltation problems that have been both difficult and expensive to manage. This study investigates the fluvial processes of runoff and sediment generation with a pastoral catchment of the Albany Basin and assesses the potential hydrological impacts of urban development with its catchment area. During the study period this catchment was on the fringe of the urban development of Auckland's North Shore. By examining the factors that control runoff and sediment generation within a pastoral catchment, site information that may be useful for controlling runoff and sediment generation within an urbanised Albany Basin is gained. To assess the impacts of urban development, streamflows and suspended sediment yields from catchments representative of three different land uses are compared: pastoral, urban construction and developed urban. Stream channel enlargement indices for a number of nearby catchments with different proportions of urban land cover are also determined and compared. The study shows significant increases in stormflows and suspended sediment yields from catchments that are either fully developed or undergoing construction for urban use. But due to the relatively dry weather experienced during the study period these results are thought to underestimate the impact of urbanising the Albany Basin. The investigation of stream channel enlargement shows that for totally urban catchments stream channel cross-sectional areas may be nearly three times those for pastoral catchments. Methods for controlling the impact of urban development on streamflows, sediment yields and channel enlargement are discussed. It is proposed that by developing techniques where by storm runoff is dispersed and stored within the considerable soil moisture storage capacity of an urban land cover, of the type planned for the Albany Basin, that a considerable reduction in stormflow and sediment generation may be achieved. The study concludes that through careful land use planning and the use of appropriate control structure the impacts of urban development may be reduced to acceptable levels.

This dissertation presents the results of research of physical and biological processes of sedimentation on the shoreface and continental shelf in Pakiri Bay, on the east coast of the Northland Peninsu1a, New Zealand. These environments comprise the subtidal portion of the Pakiri sand body. Sand bodies that are contiguous with unconsolidated sediments of coastal barriers are characteristic of the embayed east coasts of the Auckland and Northland Regions, yet little is known of their geomorphology. Existing models of shoreface and shelf sedimentation afford limited assistance because they were developed in different environments. Factors that distinguish the study area from other coasts include tectonic stability, lack of modern (non-biogenic) sediment inputs, the predominance of currents related to shoaling surface waves, and a sea level stillstand for the last 6,500 years. The model of sedimentation developed is derived from intensive field investigation of the morphology, sedimentology and ecology of the Pakiri Bay shoreface and continental shelf. Investigations of sediment transport entail interpretations of the sediments and sedimentary structures of the seabed, application of existing sediment transport models and the analysis of morphodynamic data. The geomorphology of the Pakiri sediment body is characterized by a regular pattern of morphologic components and associated sediment types. Alongshore variation in these characteristics is generally minor compared with shore normal variation. The shoreface comprises a curvilinear concave surface, that extends offshore from the alongshore bar approximately 1500 m, to water depths of about 22 n. The inner continental shelf comprises an equally curvilinear, mostly convex, surface that slopes seaward to the relatively flat middle continental shelf. Secondary morphological variations result from the presence of large-scale bedforms on the middle continental shelf and landward margin of the inner shelf. The sediments of the shoreface are fine, very well sorted quartz-feldspathic sands of 2 ø mean grain size. The inner shelf sediments grade offshore from a medium sand to very coarse sands and fine gravels (mean grain size 0.0 to 0.5 ø). In contrast the sediments of the mid shelf are very fine sands (mean grain size 2.0 to 2.5 ø), with a mud content of 5 to l0 percent. Carbonate skeletal debris, derived mostly from molluscs, comprises a significant proportion of inner and mid shelf sediments. The concentration of carbonates in the sediments increases offshore from 0 to 5 percent on the shoreface to 30 percent at the base of the inner shelf. The carbonate fraction of the sediments is size graded on the inner shelf and mid shelf in accordance with the grain size characteristics of the non-carbonate fraction. A model of the distribution and abundance of living macrobenthos (mostly of the phyla mollusca) is derived from benthos surveys in Pakiri Bay. Species that are diagnostic of high and low energy environments are characteristic of the shoreface and middle continental shelf respectively. The pattern of carbonate concentration in the sediments of the subtidal sediment body does not correlate with the pattern of modern biogenic production. Highest levels of modern shell production occur across the shoreface, whereas carbonate concentrations are greatest at the base of the inner shelf. Hypotheses are advanced to explain this dichotomy. The geomorphology of the shoreface and inner continental shelf is seen as a response to modern processes of sedimentation. Sediment transport occurs primarily in response to currents related to shoaling waves. Two process regimes are recognized. During typically calm (swe11 wave) conditions the fine sands of the shoreface may be transported landward as a result of an onshore mass transport current. During severe storm events this process may transport bed sediments landward across the inner shelf and middle continental shelf forming the characteristic sediment and morphologic patterns observed. However, during such events this onshore flow is, probably counteracted by return flows that are able to transport eroded foreshore and inshore sediments seaward Key words: Sedimentation, shoreface, continental shelf, wave dominated, carbonated sedimentation, sediment body, facies.

The soil seed bank in Agathis australis (D. Don) Lindl. (kauri) forests of northern New Zealand is quantified, and its potential role in secondary successions examined. Seed bank data from a number of kauri forest sites stratified by successional time and distance from forest edges are summarized using Detrended Correspondence Analysis (ordination) and linear regression models. A number of issues concerning secondary successions and the soil seed bank are discussed. These include: 1. The relationship between the soil seed bank and extant vegetation. 2. The nature of the soil seed bank and successional time. 3. The nature of the soil seed bank and distance from forest edges. 4. The soil seed bank, canopy gaps and gap regeneration strategies. 5. The nature of the soil seed bank and soil properties. 6. The fruiting phenology, seed rain, and soil seed bank dynamics. The forest sites ranged from 50 years to over 1,000 years old, while distance from forest edges ranged from 0.2 km to 3.5 km. Soil seed bank densities under kauri forests were 134 - 5,388 seeds m-2 with a mean density of 1,320±217 seeds m-2 which is similar to estimates reported for temperate and tropical forest sites elsewhere. The spatial distribution of seeds in the seed bank both within and between sites is highly variable. A total of 6,062 seedlings emerged from the seed bank samples. This represented 62 vascular plant species, 26 (42%) native woody, 19 (30%) native weedy, 16 (26) adventive weedy and 1 (2%) native fern. The species composition of the soil seed bank was not closely related to extant vegetation and only 11%ot canopy and 13% of understorey species were represented in the soil seed bank. Thus, 77% of extant vegetation at any given site is floristically different from that of the soil seed bank. Ordination of the data by detrended correspondence analysis (DCA) suggested that extant vegetation (canopy and understorey) and the soil seed bank contain characteristic floras. The species composition of the seed bank is variable between sites. The viable seed pool is larger under young successional forests than under older mature forests. The number of species also declined with distance from forest edges. Adventive and native weedy species were found in seed banks under mature forests and sites of considerable distances from forest edges. However, the density of the weedy species component of the soil seed bank was at least partly determined by distance from forest edges where such species are common. While buried seed is likely to contribute to the early stages of secondary succession, evidence from canopy gaps suggested that the seedling bank (formerly suppressed understorey component) is more important in gap regeneration than the soil seed bank. DCA analysis revealed that seedling bank species composition of canopy gaps and forest sites were quite different from the soil seed banks, indicating that regeneration stemmed from formerly (suppressed) understorey seedlings. Phenology and seed rain study of a mature forest remnant and a regenerating forest community showed that as little as 5% of the seed input to the forest floor enters the soil seed bank and remains viable for more than one year. Evidence is presented to suggest that in a forest community, secondary succession after large-scale or localised disturbance, is achieved more so by suppressed seedlings and recent seed rain than the soil seed bank. The soil seed bank becomes significant in secondary succession when the subsoil is disturbed by the uprooting of trees or the forest floor is exposed by tree-fall (not covered by tree-fall debris).

This thesis examines the use of remote sensing techniques for the investigation and monitoring of geothermal areas in the Taupo volcanic zone of New Zealand. The research and development of a helicopter-borne video thermal infrared scanner technique and associated computer image processing methods constitutes the major portion of this study. In addition, preliminary results are presented from a related shallow ground temperature study conducted to investigate diurnal, seasonal and meteorological effects on temperatures in active thermal ground and results from a precursory assessment of SPOT-l satellite multispectral imagery obtained over the Waiotapu Geothermal Field for detecting, identifying and mapping characteristic geothermal surface features are also reported. The initial conduct of two video thermal IR scanner test surveys, one using an Inframetrics 525 over portions of the Rotorua Geothermal Field, the other using a FLIR 1000A over portions of the Wairakei-Tauhara Geothermal Field, demonstrated that imagery useful for basic geothermal feature mapping could be obtained in the late summer to early autumn period. Surveying during the hours around dusk was shown to be appropriate. Experimentation established instrument operating settings and defined nominal survey parameters. The real-time video imagery format proved useful as an aid to navigation and as a check on proper instrument set-up and operation- The helicopter platform provided valuable manoeuvrability and control. The results obtained from these two initial surveys aided development of survey design and conduct methodology. The video imagery obtained with both the Inframetrics and FLIR scanners was compatible with New Zealand's PAL standard- Visual TV-VCR inspection of the IR imagery allowed easy identification of a range of natural thermal features. Identification of cultural features aided location of the thermal anomalies. The Inframetrics imagery suffered from serious banding and other minor problems. The FLIR imagery was of a generally higher quality, though it exhibited problems. The fundamental ability to digitize images from the videotapes and apply powerful computer image processing techniques to aid interpretation and analysis was demonstrated. A methodology for pre-processing and enhancing the digitized Inframetrics and FLIR images was developed. Application of these image processing techniques brought out detail unavailable in the grey-level imagery and greatly increased interpretation ability. The demonstrated success of the first two test surveys led to the conduct of the first known large-scale video thermal IR scanner surveys of geothermal fields. Most details of the first of these ate confidential (at the client's request). A complete range of geothermal features was detected and easily recognised and their distribution established thus providing a much more detailed map of the geothermal activity than was previously available. The successful results attained confirmed the survey design and conduct methodology used. The second and largest survey covered the entire Rotorua Geothermal Field (l8 km2). Imagery was obtained with both the Inframetrics and FLIR IR scanners and a visible wavelength video camera. Extensive ground control measurements were made. This comprehensive survey of geothermal activity established a baseline from which change can be monitored The survey identified large scale seepage and submerged thermal input into Lake Rotorua which may be the source of known missing chloride. The first geothermal surface feature changes were identified, thus demonstrating the usefulness of the method for monitoring change. Preliminary image temperature calibration results were obtained and a procedure for constructing visible wavelength-thermal IR composite images was developed. The positive results demonstrated by this survey have led to the helicopter-borne video thermal IR technique being adopted for major geothermal feature mapping and monitoring programmes in New Zealand. Preliminary assessment of the high spatial resolution (20m) SPOT-1 multispectral imagery of the Waiotapu Geothermal Field. showed that the larger geothermal surface features can be detected and identified on a contrast stretched, 3-band colour composite image. A shallow (≤ 1m depth) ground temperature measurement site was established in an area extending from very active to near ambient conditions. Preliminary results show that temperature variations ranging from l-19 °C can occur in the most active ground. These temperature variations exhibit a strong negative correlation with atmospheric prcss111e changes and can introduce large, unexpected inaccuracies in ground temperature measurements.

In several areas of Auckland, urban development has resulted in flooding and siltation problems that have been both difficult and expensive to manage. This study investigates the fluvial processes of runoff and sediment generation with a pastoral catchment of the Albany Basin and assesses the potential hydrological impacts of urban development with its catchment area. During the study period this catchment was on the fringe of the urban development of Auckland's North Shore. By examining the factors that control runoff and sediment generation within a pastoral catchment, site information that may be useful for controlling runoff and sediment generation within an urbanised Albany Basin is gained. To assess the impacts of urban development, streamflows and suspended sediment yields from catchments representative of three different land uses are compared: pastoral, urban construction and developed urban. Stream channel enlargement indices for a number of nearby catchments with different proportions of urban land cover are also determined and compared. The study shows significant increases in stormflows and suspended sediment yields from catchments that are either fully developed or undergoing construction for urban use. But due to the relatively dry weather experienced during the study period these results are thought to underestimate the impact of urbanising the Albany Basin. The investigation of stream channel enlargement shows that for totally urban catchments stream channel cross-sectional areas may be nearly three times those for pastoral catchments. Methods for controlling the impact of urban development on streamflows, sediment yields and channel enlargement are discussed. It is proposed that by developing techniques where by storm runoff is dispersed and stored within the considerable soil moisture storage capacity of an urban land cover, of the type planned for the Albany Basin, that a considerable reduction in stormflow and sediment generation may be achieved. The study concludes that through careful land use planning and the use of appropriate control structure the impacts of urban development may be reduced to acceptable levels.

This dissertation presents the results of research of physical and biological processes of sedimentation on the shoreface and continental shelf in Pakiri Bay, on the east coast of the Northland Peninsu1a, New Zealand. These environments comprise the subtidal portion of the Pakiri sand body. Sand bodies that are contiguous with unconsolidated sediments of coastal barriers are characteristic of the embayed east coasts of the Auckland and Northland Regions, yet little is known of their geomorphology. Existing models of shoreface and shelf sedimentation afford limited assistance because they were developed in different environments. Factors that distinguish the study area from other coasts include tectonic stability, lack of modern (non-biogenic) sediment inputs, the predominance of currents related to shoaling surface waves, and a sea level stillstand for the last 6,500 years. The model of sedimentation developed is derived from intensive field investigation of the morphology, sedimentology and ecology of the Pakiri Bay shoreface and continental shelf. Investigations of sediment transport entail interpretations of the sediments and sedimentary structures of the seabed, application of existing sediment transport models and the analysis of morphodynamic data. The geomorphology of the Pakiri sediment body is characterized by a regular pattern of morphologic components and associated sediment types. Alongshore variation in these characteristics is generally minor compared with shore normal variation. The shoreface comprises a curvilinear concave surface, that extends offshore from the alongshore bar approximately 1500 m, to water depths of about 22 n. The inner continental shelf comprises an equally curvilinear, mostly convex, surface that slopes seaward to the relatively flat middle continental shelf. Secondary morphological variations result from the presence of large-scale bedforms on the middle continental shelf and landward margin of the inner shelf. The sediments of the shoreface are fine, very well sorted quartz-feldspathic sands of 2 ø mean grain size. The inner shelf sediments grade offshore from a medium sand to very coarse sands and fine gravels (mean grain size 0.0 to 0.5 ø). In contrast the sediments of the mid shelf are very fine sands (mean grain size 2.0 to 2.5 ø), with a mud content of 5 to l0 percent. Carbonate skeletal debris, derived mostly from molluscs, comprises a significant proportion of inner and mid shelf sediments. The concentration of carbonates in the sediments increases offshore from 0 to 5 percent on the shoreface to 30 percent at the base of the inner shelf. The carbonate fraction of the sediments is size graded on the inner shelf and mid shelf in accordance with the grain size characteristics of the non-carbonate fraction. A model of the distribution and abundance of living macrobenthos (mostly of the phyla mollusca) is derived from benthos surveys in Pakiri Bay. Species that are diagnostic of high and low energy environments are characteristic of the shoreface and middle continental shelf respectively. The pattern of carbonate concentration in the sediments of the subtidal sediment body does not correlate with the pattern of modern biogenic production. Highest levels of modern shell production occur across the shoreface, whereas carbonate concentrations are greatest at the base of the inner shelf. Hypotheses are advanced to explain this dichotomy. The geomorphology of the shoreface and inner continental shelf is seen as a response to modern processes of sedimentation. Sediment transport occurs primarily in response to currents related to shoaling waves. Two process regimes are recognized. During typically calm (swe11 wave) conditions the fine sands of the shoreface may be transported landward as a result of an onshore mass transport current. During severe storm events this process may transport bed sediments landward across the inner shelf and middle continental shelf forming the characteristic sediment and morphologic patterns observed. However, during such events this onshore flow is, probably counteracted by return flows that are able to transport eroded foreshore and inshore sediments seaward Key words: Sedimentation, shoreface, continental shelf, wave dominated, carbonated sedimentation, sediment body, facies.

The soil seed bank in Agathis australis (D. Don) Lindl. (kauri) forests of northern New Zealand is quantified, and its potential role in secondary successions examined. Seed bank data from a number of kauri forest sites stratified by successional time and distance from forest edges are summarized using Detrended Correspondence Analysis (ordination) and linear regression models. A number of issues concerning secondary successions and the soil seed bank are discussed. These include: 1. The relationship between the soil seed bank and extant vegetation. 2. The nature of the soil seed bank and successional time. 3. The nature of the soil seed bank and distance from forest edges. 4. The soil seed bank, canopy gaps and gap regeneration strategies. 5. The nature of the soil seed bank and soil properties. 6. The fruiting phenology, seed rain, and soil seed bank dynamics. The forest sites ranged from 50 years to over 1,000 years old, while distance from forest edges ranged from 0.2 km to 3.5 km. Soil seed bank densities under kauri forests were 134 - 5,388 seeds m-2 with a mean density of 1,320±217 seeds m-2 which is similar to estimates reported for temperate and tropical forest sites elsewhere. The spatial distribution of seeds in the seed bank both within and between sites is highly variable. A total of 6,062 seedlings emerged from the seed bank samples. This represented 62 vascular plant species, 26 (42%) native woody, 19 (30%) native weedy, 16 (26) adventive weedy and 1 (2%) native fern. The species composition of the soil seed bank was not closely related to extant vegetation and only 11%ot canopy and 13% of understorey species were represented in the soil seed bank. Thus, 77% of extant vegetation at any given site is floristically different from that of the soil seed bank. Ordination of the data by detrended correspondence analysis (DCA) suggested that extant vegetation (canopy and understorey) and the soil seed bank contain characteristic floras. The species composition of the seed bank is variable between sites. The viable seed pool is larger under young successional forests than under older mature forests. The number of species also declined with distance from forest edges. Adventive and native weedy species were found in seed banks under mature forests and sites of considerable distances from forest edges. However, the density of the weedy species component of the soil seed bank was at least partly determined by distance from forest edges where such species are common. While buried seed is likely to contribute to the early stages of secondary succession, evidence from canopy gaps suggested that the seedling bank (formerly suppressed understorey component) is more important in gap regeneration than the soil seed bank. DCA analysis revealed that seedling bank species composition of canopy gaps and forest sites were quite different from the soil seed banks, indicating that regeneration stemmed from formerly (suppressed) understorey seedlings. Phenology and seed rain study of a mature forest remnant and a regenerating forest community showed that as little as 5% of the seed input to the forest floor enters the soil seed bank and remains viable for more than one year. Evidence is presented to suggest that in a forest community, secondary succession after large-scale or localised disturbance, is achieved more so by suppressed seedlings and recent seed rain than the soil seed bank. The soil seed bank becomes significant in secondary succession when the subsoil is disturbed by the uprooting of trees or the forest floor is exposed by tree-fall (not covered by tree-fall debris).

Florida’s seagrasses are ecologically important marine environments which have suffered major degradation caused by increasing anthropogenic pressures. A 2011 seagrass die-off event caused by an algal bloom in the Florida Indian River Lagoon (IRL) was particularly severe with a majority of seagrass lost in areas such as the Banana River. An understanding of how this coastal marine environment changed is an important step toward better managing resources for conservation. Modern tools and methods provide new opportunities to study these changes at the landscape scale, a scale that informs on the larger more comprehensive state of a system. Classified satellite imagery and spatial landscape metrics were used to quantify changes in IRL Banana River seagrass landscape patterns following the die-off event. Thirty-six landscape metrics in four categories (Area-Edge, Shape, Core Area and Aggregation) were used to discern the spatial complexities of habitat changes over space and time in the IRL study area. Seagrass loss from 2011 to 2013 based on image classifications was as high as 91% in the Banana River study areas. Landscape metrics indicate that following the seagrass die-off in the IRL, meadows became more fragmented, patches became more isolated, and the amount and spatial complexity of meadow edge was reduced. For the most part, these landscape structural changes in the IRL increased with more severe amounts of seagrass loss. The metrics were evaluated and scored for their effectiveness in detecting seagrass landscape changes and their ability to provide consistent detection with variable resolution imagery. The top metrics in order of highest evaluation score were Total Edge, Splitting Index, Total Core Area, Effective Mesh Size, Landscape Shape Index, Edge Density, Perimeter-Area Ratio Distribution, Average Core Area, Disjunct Core Area Distribution Mean and Patch Shape Index. Area-edge and aggregation type metrics were identified as the best metrics for evaluating landscape changes under different degrees of seagrass loss in the IRL. Landscape metrics applied to classified images have the ability to provide quantitative and informative techniques for monitoring seagrass health.

The tropical hardwood forests of south Florida persist as well-drained patches of broadleaf forest separated by brackish water swamp, marsh, or pineland. In this dissertation, a functional trait approach was used to understand the structure and dynamics of these communities and their responses to abiotic and biotic variation. Twenty-seven permanent plots (20 x 20 m2) were established across the south Florida landscape, representing four sub-regions: Everglades marsh, Long Pine Key, Upper Keys, and Lower Keys. Community weighted mean trait values for four of six selected traits showed significant inter-sub-regional variation. Out of them, three traits (specific leaf area, tree height, and leaf phosphorus) increased significantly from dry and low productivity Florida Keys in the south to the moist and productive areas on the south Florida mainland, while wood density showed the opposite pattern. Trait variance ratios (T-statistic metrics) was used to explore internal filtering (processes that operate within a community) and external filtering (processes that operate at larger scale than that of the individual population or community) on community structure. Both external and internal filtering in the functional composition of south Florida hardwood hammock forest were important for local communities differing in freshwater accessibility, or that occupy different positions along strong edaphic or climatic gradients. To understand the underlying mechanisms that drive species assembly during forest succession in Florida dry sub-tropical forest, 13 leaf, stem, reproductive, and architectural traits of resident tree species across the successional gradient were measured. Tests of null models showed that younger communities are shaped by environmentally driven processes, while mature communities are shaped by competitively driven processes. The overall trait similarities among species present in North Key Largo tropical dry forest suggest that tree species are specialists on the local environment, and their ability to survive and grow in a stressful environment may be more important than competition for resources at larger scale. Moreover, tree species in these forests may exhibit specialization or trait plasticity in coping with drought by changes in their stomatal morphology or activity, allowing for a balance between gas exchange and water loss in a periodically stressful environment. A significant negative correlation between stomatal density and size, and a positive correlation between leaf δ13C and stomatal density were observed across habitat gradient for one of the dominant hardwood hammock species (Bursera simaruba). Small and densely distributed stomates in tandem seems to represent a strategy that allows hammock species to conserve water under physiological drought. Furthermore, findings from this work also showed both intra- and inter-specific trait variation at regional and local scales influence community assembly patterns in hardwood hammock communities in South Florida.

In the United States, the health care sector is 20 years behind in the use of information technology to improve the process of health care delivery as compared to other sectors. Patients have to deliver their data over and over again to every health professional they see. Most health care facilities act as data repositories with limited capabilities of data analysis or data exchange. A remaining challenge is, how do we encourage the use of IT in the health care sector that will improve care coordination, save lives, make patients more involved in decision-making, and save money for the American people? According to Healthy People 2020, several challenges such as making health IT more usable, helping users to adapt to the new uses of health IT, and monitoring the impact of health IT on health care quality, safety, and efficiency, will require multidisciplinary models, new data systems, and abundant research. In this dissertation, I developed and used systems engineering methods to understand the role of new health IT in improving the coordination, safety, and efficiency of health care delivery. It is well known that care coordination issues may result in preventable hospital readmissions. In this dissertation, I identified the status of the care coordination and hospital readmission issues in the United States, and the potential areas where systems engineering would make significant contributions (see Appendix B). This literature review introduced me to a second study (see Appendix C), in which I identified specific patient cohorts, within chronically ill patients, that are at a higher risk of being readmitted within 30 days. Important to note is that the largest volume of preventable hospital readmissions occurs among chronically ill patients. This study was a retrospective data analysis of a representative patient cohort from Tampa, Florida, based on multivariate logistic regression and Cox proportional hazards models. After finishing these two studies, I directed my research efforts to understand and generate evidence on the role of new health IT (i.e., health information exchange, HIE) in improving care coordination, and thereby reducing the chances of a patient to be unnecessarily readmitted to the hospital. HIE is the electronic exchange of patient data among different stakeholders in the health care industry. The exchange of patient data is achieved, for example, by connecting electronic medical records systems between unaffiliated health care providers. It is expected that HIE will allow physicians, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically, and thereby improving the speed, quality, safety and cost of patient care. The federal government, through the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, is actively stimulating health care providers to engage in HIE, so that they can freely exchange patient information. Although these networks of information exchange are the promise of a less fragmented and more efficient health care system, there are only a few functional and financially sustainable HIEs across the United States. Current evidence suggests four barriers for HIE: •Usability and interface issues of HIE systems •Privacy and security concerns of patient data •Lack of sustainable business models for HIE organizations •Loss of strategic advantage of "owning" patient information by joining HIE to freely share data To contribute in reducing usability and interface issues of HIE systems, I performed a user needs assessment for the internal medicine department of Tampa General Hospital in Tampa, Florida. I used qualitative research tools (see Appendix D) and machine learning techniques (see Appendix E) to answer the following fundamental questions: How do clinicians integrate patient information allocated in outside health care facilities? What are the types of information needed the most for efficient and effective medical decision-making? Additionally, I built a strategic gaming model (see Appendix F) to analyze the strategic role of "owning" patient information that health care providers lose by joining an HIE. Using bilevel mathematical programs, I mimic the hospital decision of joining HIE and the patient decision of switching from one hospital to another one. The fundamental questions I tried to answer were: What is the role of competition in the decision of whether or not hospitals will engage in HIE? Our mathematical framework can also be used by policy makers to answer the following question: What are the optimal levels of monetary incentives that will spur HIE engagement in a specific region? Answering these fundamental questions will support both the development of user-friendly HIE systems and the creation of more effective health IT policy to promote and generate HIE engagement. Through the development of these five studies, I demonstrated how systems engineering tools can be used by policy makers and health care providers to make health IT more useful, and to monitor and support the impact of health IT on health care quality, safety, and efficiency.