Integrated information and patient record systems are required to support the information management needs of a reformed health care system. These information systems are social systems that use information technology. The implementation of such systems does more than enhance our ability to deliver health care; it also affects practice patterns and professional relations among individuals and groups within the organization. This paper proposes a framework for diagnosing, measuring and analyzing the effectiveness and impacts of these integrated systems. Case studies are used to illustrate how the framework can be used to pose questions and to select measures, research designs and analytical tools to evaluate the effectiveness and impacts of computer-based patient record systems.