The topic for this paper is the conditions for change in large and complex organisations, where information and communication technologies (ICT) are introduced to enable more efficient forms of communication and collaboration. Our research aim was to study the factors that shaped and constrained ICT-related organisational change, and in this paper we report from a process of introducing a digital patient record system into a hospital. The findings from the case study indicate that space for change and learning is significantly shaped by the existing institutionalised practises and information infrastructure, as well as by regulations, both formal laws and locally defined rules and procedures. The significance of these aspects has been neglected in most studies of organisational change and learning, and should be given more attention.