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Despite huge growth in hospital technology systems, there remains a dearth of literature examining health care administrator's perceptions of the efficacy of interoperable EHR systems. A qualitative research methodology was used in this multiple-case study to investigate the application of diffusion of innovations theory and the technology acceptance model (TAM) by the Chief Information Officer (CIO)/Health Information Technology (HIT) Manager toward the implementation of an interoperable electronic health record system (EHR) and user adoption of the new technology. This study included evaluation of factors that enabled the CIO to determine user behavioral intentions toward using a new computer technology for patient medical data sharing with other health care organizations. The study was conducted at three hospitals in southeastern Florida. The researcher conducted structured interviews with a representative from each hospital. The collected data were used to explore CIOs' decision-making processes and the unique challenges concerning the adoption of an interoperable EHR system and ensuring user adoption. The results elucidated the health information manager's electronic health records adoption process with respect to perceived usefulness, perceived ease-of-use, and behavior intention of users. It also showed that perceived ease-of-use, perceived usefulness, self-efficacy, training and behavioral intention to use the adopted interoperable EHR were factors pertinent toward technology change and user acceptance. By understanding the factors mentioned in this study, CIOs or HIT managers may successfully alter the manner in which EHR implementation is planned and implemented. Lastly, this study may serve as a guiding tool for CIOs or HIT managers who plan future adoption of electronic health record systems. Recommendations for future studies include more studies in the areas of change management as well as technology acceptance model, as they apply to health information management and adoption of interoperable electronic health record systems. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]