Quality management standards such as the recently revised ISO 9001 (ISO, 2015) are widely used for organizational improvement and process management at hospitals (Rodrí- guez-Cerrillo, Fernández-Diaz, Iñurrieta-Romero, & Poza-Montoro, 2012; Shaw et al., 2014). Additionally, there are several accreditation programs designed for healthcare that require self-evaluation, regulatory compliance, and information transparency (Angst, Agarwal, Gao, Khuntia, & McCullough, 2014). Notable examples are the Agencia de Calidad Sanitaria de Andalucía (ACSA) accreditation, the Australian Council on Healthcare Standards, or the Haute Autorité de Santé, and Accreditation Canada (Almuedo-Paz, Núñez-Garcia, ReyesAlcázar, & Torres-Olivera, 2012). But to reach comprehensive organizational quality (Stylianou & Kumar, 2000), hospitals must look beyond their healthcare processes and into the fit with their information systems (IS). Pressure mounts for (1) timely IT solutions in support of the quality efforts; (2) IT support in the redesign and improvement of healthcare processes; and (3) the adoption of quality policies in the HIS development lifecycle. IS development takes place in regulated contexts that may differ in knowledge expertise, organizational structure, project, team, and individual behavior (Curtis, Krasner, & Iscoe, 1988; Kautz, Madsen, & Nørbjerg, 2007). Directives that shape the hospital regulatory space (Hancher & Moran, 1989) may be enforced, for example, in the case of legal requirements; or they may be voluntary, for instance, in the case of the adoption of quality standards, codes of conduct, and best practice guides. Compliance with those regulations, both in design and operation of IS involves dealing with a high number of variables. Such complexity makes IS development methodologies even more relevant nowadays, with the potential to be adapted into specific situations (Avison & Fitzgerald, 2003), namely the highly regulated environments of hospitals. There are design-time and run-time synergies in the development of IS and quality management systems (QMSs) (Barata & Cunha, 2015). In fact, Ray Paul’s definition (2007, p. 195) that “the IS what emerges from the usage and adaptation of the IT and the formal and informal processes by all of its users” would fit perfectly in modern quality models that are process oriented, require the involvement of all their users, and greater than ever IT support. pport. Our paper addresses a problem that intertwines IS and quality, namely how to assess hospital information systems (HIS) compliance with quality standards and evaluate the contrasting opinions of healthcare professionals about quality in hospital practice. Our proposal is to evaluate the HIS users’ opinions about compliance with a questionnaire tool. Then, we focus on the design-reality gaps (Heeks, 2006) that may occur in the perceived compliance of hospital managers and service staff. Heeks (2006) suggests that identifying gaps between HIS design conceptions and “the realities of the hospital use context” must address different dimensions such as IT, processes, management systems and structure, or information and it “can be used to address the problem of HIS failure [and success], both as a post hoc evaluative tool and as a pre hoc risk assessment and mitigation tool” (p. 125). According to Heeks (2006, p. 135) “the process of successfully introducing an HIS can be seen as a set of reciprocating changes to both design and reality that eventually reach some kind of workable closure between the two”