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Background-Health information technology (HIT) has been an emerging solution to reducing some gaps in care. Several nations have implemented expensive, large-scale, HIT projects; most have struggled with poor uptake, interoperability, and low sharing and reuse of data. Lack of understanding of complex" multilevel tensions" was a common reason for failure.

Objective-This study aims to understand how organizational context and interfaces affect the collection, management, and use of data for care improvement (CI).

Methods-The case study consisted of 33 hour-long semi-structured interviews with 38 informants from 27 organizations from 2 states. Primary data collected using snowball sampling in 2007-08 and elicited information on the use of data for improving quality of colorectal cancer care. Data were supplemented using publicly available organizational information. Data analysis included coding to …