In this paper the authors review and discuss four different qualitative approaches as they are used to evaluate health information systems: (1) grounded theory, (2) ethnography, (3) verbal protocol analysis/usability engineering and (4) action research. The authors describe the historical origins, current uses, strengths and weakness of the three qualitative methodologies that are frequently used in health informatics and they discuss an emerging approach: action research. More importantly, they identify how each of the approaches can be used across the SDLC to inform planning, analysis, design, implementation and support of health information systems.