Implementing an information technology system can impact more than just quality of care and patient outcomes. The purpose of this 4-year, observational research project is to examine changes in organizational culture, quality improvement (QI) maturity, and quality of care following adoption of a single, electronic health record (EHR) system within an integrated healthcare network. The primary outcome measure, the Culture and Quality Questionnaire (CQQ), assesses the perceived culture of an organization and the degree of CQI maturity in seven quality management areas. Baseline surveys were distributed prior to conversion to the EHR. Subsequent data collection occurred at 12 months post "go live" and will occur at 24 and 36 months after the first hospital "go live". Secondary data were abstracted from routinely collected patient satisfaction measures and standard quality indicators. Contrary to expectation, our findings from the Baseline and 12-month follow-up data suggest that employees perceived the organizational culture as becoming more, rather than less, hierarchical. We also hypothesized that quality indicators would show improvement due to enhanced information flow and ease of information retrieval. This hypothesis was not supported by 1-year results. However, follow-up data from years two and three may provide different results.