The National Programme for IT in the UK National Health Service has been described as “the biggest IT project in the world”. The literature suggests that IT projects don’t scale well so it is perhaps no surprise that all has not gone well. This paper looks at a health information system that has been a success. The Patient Pathway Management (PPM) system developed by Leeds Teaching Hospital Trust holds the records of 669,000 patients. In contrast to the National Programme it was a bottom-up, user led development that evolved over an extended period at a fraction of the cost. Our study looked at the characteristics of success from the perspective of 268 users of PPM and links these to the development approach. It is hoped that an understanding of what success looks like will inform the inevitable debate about whether the UK’s National Programme has been value for money.