As health sciences advance, individuals increasingly specialize in fields of study with refined and limited focus making it is difficult to solve very large and complex problems. This qualitative study evaluated the process of integration review. This case study with multiple units of analysis describes information system key integration concerns, an integration process, and closure factors. Content analysis of twenty-two "System Change Requests," five focused interviews, and two program office documents addressed the following: (a) What concerns emerge when multidisciplinary communities discuss changes to an information system used by all the health care communities? (b) What is the process for integration of a change across professional communities? (c) What are the triggers for closure of the integration review? The theoretical foundation for this study was derived from Systems Theory. The case selected was the final version in the life cycle of the Composite Health Care System-a complex worldwide health care information system used by the U. S. military. Of proposed modifications to this system, those selected for this study met the following criteria: (a) will be implemented, (b) have comparable documentation, (c) discuss integration, and (d) reflect interactions among people. Since the organization was geographically distributed, electronic mail was used for integration review. Following review analysis, a qualitative survey was created. A pilot study refined the survey, and Institutional Review Board approval was obtained. Potential interviewees were identified by their participation in the selected reviews. Following content analysis of the interviews, program office documentation was obtained and analyzed for integration processes. Content analysis yielded ten categories of concern: scheduling/prioritization, extending user support, clarification, managing and reducing error, including stakeholders, user community impact, accountability, financial consideration, technology, and benefit. The integration process achieved a common understanding of what must be done to enhance user support without detracting from existing support. Triggers for review closure included time, stakeholder participation and issue resolution. This study confirmed that integration review by health care professionals solves complex problems spanning diverse areas of expertise. This study also revealed the need for a way to move "universal" recommendations for change out of a legacy system.