Informatics and information technology (IT) leaders in healthcare organizations (HCOs) face increasing pressure to justify the substantial resources needed to manage electronic health record (EHR) systems. Demonstrating the value of EHR systems is difficult because there is no standard method for calculating EHR return on investment (ROI), nor is it known whether some EHR system operating models (organizational structures) are more beneficial than others. An expanded understanding of EHR operating models would enable EHR leaders to improve resource allocation decisions and to better demonstrate systems value. This study aimed to describe operating models U.S. HCOs use to manage their EHR systems and to identify characteristics of those models that may impact EHR systems management.