In this paper, we propose an approach to balance the legitimate and yet conflicting perspectives between standardization and reconfiguration embedded within hospital information systems (HIS) design activities. We report on an action research study of the customization process of an electronic triage and tracking system that was reconfigured to be used in eight Canadian emergency departments. We argue that during HIS design activities, it is essential for both practitioners and system designers to articulate and identify which aspects can be standardized without constraining important local flexibility and which aspects require local reconfiguration to function in a particular work context. To identify these differences, we suggest an analytical distinction between boundary factors and contextual contingencies, which can be used in a design and reconfiguration process. We argue that the process of designing shared electronic templates should be perceived as a common design process, where multiple stakeholders articulate, identify, and negotiate boundary factors and contextual contingencies. Boundary factors are then represented within the shared electronic system, whereas contextual contingencies form the basis for constructing localized versions of the shared application. All local versions include both boundary factors and the reconfigured contextual contingencies.