Aligning social structures and technology capabilities is a significant challenge to information technology-related organizational change. It is particularly challenging in institutionalized settings such as hospitals. We report an interpretive field study of computerized physician order entry (CPOE) at an acute-care hospital, in which we investigated how institutionally triggered and technology-triggered change interacted in complementary processes to engender alignment. Social structure changes included increased interdependency among clinical departments, multidisciplinary cooperation across clinical disciplines, and standardization in clinical decision-making. Organization members also enacted institutionalized interaction patterns with physicians by deferring to their preferences for CPOE use. The cumulative influence of change triggers nonetheless facilitated the hospital’s realization of clinical goals. We drew on Barley’s (1990) role- and network-based model for technology and structure alignment. Nonetheless, we extended this micro-level analytic approach to account for the influence of change in the macro-institutional environment. Our analysis clarified the extent of structure change attributable to the CPOE technology and highlighted institutional forces that promoted yet inhibited change. The case also highlighted the importance of role networks on the trajectory and outcomes of organizational change processes.