The objective of this research is to understand how a set of systems, as defined by the business process, creates value. The three studies contained in this work develop the model of process-based automation. The model states that complementarities among systems are specified by handoffs in the business process. The model also provides theory to explain why entry systems, boundary spanning systems, and back-end control systems provide different impacts on process quality and cost. The first study includes 135 U. S. acute care hospitals. The study finds that hospitals which followed an organizational pattern of process automation have better financial outcomes. The second study looks in more depth at where synergies might be found. It includes 341 California acute care hospitals over 11 years. It finds that increased costs and increase adverse drug events are associated with increased automation discontinuity. Further, the study shows that automation in the front end of the process has a more desirable outcome on cost than automation in the back end of the process. The third study examines the assumption that the systems are actually used. It is a cross-sectional analysis of over 2000 U. S. hospitals. This study finds that system usage is a critical factor in realizing benefits from automating the business process. The model of process-based automation has implications for information technology decision makers, long-term automation planning, and for information systems research. The analyses have additional implications for the healthcare industry.