The United States continues to lag behind other countries in its adoption of health information technology. A failure to increase adoption will jeopardize the nation’s ability to reduce medical errors, address the rapid growth of healthcare costs, and enact effective healthcare reform. Health information technology (HIT) implementation success factors as perceived by healthcare executives and industry experts are well documented in the literature. Few studies, however, have focused on the perceptions of HIT end users such as physicians and nurses. The purpose of this exploratory case study was to describe the strategies, actions, and other factors that contribute to the successful implementation of HIT as perceived by 29 HIT end users at a 613-bed adult hospital and 7 end users at a 272-bed children's hospital. Interview data, secondary sources, and investigator observations were analyzed in three phases consistent with the core elements of qualitative data analysis and led to the emergence of eight unique themes which suggest factors that allow or inhibit HIT implementation success. These factors include (a) the end users’ understanding of the implementation goals, (b) the appropriateness of the selected HIT system, (c) the usability of the system, (d) the adequacy of the supporting infrastructure, (e) the quality of the end user training, (f) the adequacy of the on-site support, (g) the resulting impact to nursing and physician workflows, and (h) the resulting quality of nursing and physician documentation. Conclusions drawn from the exploration include: (a) communication between the decision-makers and the end users was inadequate; (b) poor usability design, lack of supporting infrastructure, and lack of workflow optimization brought on serious side effects including a decrease in the quality of physician documentation, an emphasis on financially-driven versus care-driven charting, and disruption to provider-patient and physician-nurse relationships; (c) specialized care environments require equally specialized HIT systems if they are to operate optimally; and (d) less end user training prior to implementation in favor of more post-activation on-site support and follow-up training would have represented a more effective use of resources.