The document outlines requirements for an 8-page paper that analyzes 3-5 major healthcare reform initiatives and their implications on designing 21st century healthcare information systems. It requires the paper to evaluate challenges of each trend and how to overcome them, assess each initiative's impact on leadership, strategic planning, and ERP systems. The paper should also review relevant legislation, how CIOs can assess initiatives, and predict global HMIS adoption trends over 5 years. References and support for all opinions are required.