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This study adds to the growing body of literature through case studies reporting benefits and costs/burdens in eight sites with advanced health information technology (HIT) systems. While all eight of the case study sites noted that they would "never go back" to paper-based systems for administration and clinical service delivery, no site had conducted a rigorous cost-benefit analysis of their HIT systems. Thus, the case studies necessarily focused on the costs and benefits reported by system users and managers. Respondents cited numerous examples of system benefits and rated their magnitude, as well as identified the types of increased costs and burdens resulting from HIT implementation. [124 PDF pages]