The realization of Health Information Systems (HIS) requires rigorous evaluation that addresses technology, human and organization issues. Our review indicates that current evaluation methods evaluate different aspects of HIS and they can be improved upon. A new evaluation framework, human, organization and technology-fit (HOT-fit) was developed after having conducted a critical appraisal of the findings of existing HIS evaluation studies. HOT-fit builds on previous models of IS evaluation--in particular, the IS Success Model and the IT-Organization Fit Model. This paper introduces the new framework for HIS evaluation that incorporates comprehensive dimensions and measures of HIS and provides a technological, human and organizational fit. Literature review on HIS and IS evaluation studies and pilot testing of developed framework. The framework was used to evaluate a Fundus Imaging System (FIS) of a primary care organization in the UK. The case study was conducted through observation, interview and document analysis. The main findings show that having the right user attitude and skills base together with good leadership, IT-friendly environment and good communication can have positive influence on the system adoption. Comprehensive, specific evaluation factors, dimensions and measures in the new framework (HOT-fit) are applicable in HIS evaluation. The use of such a framework is argued to be useful not only for comprehensive evaluation of the particular FIS system under investigation, but potentially also for any Health Information System in general.