Background An efficient registration system for all these types of Taiwan medical institutions will enable outpatients to register online and inform them of the best time to go to the hospital and when their turn for medical treatment is. Hence, understanding the outpatients’/users’ actual needs is important for hospital managers to design a user-friendly registration system. Purpose This study, based on means-end chain (MEC) theory and the Kano model, aims to: 1) understand user preferences toward using a hospital online registration system by constructing the Kano–MEC hierarchical value map, and 2) deduce and formulate effective system planning and promotion strategies. Methodology/approach Mixed methods research was employed to collect data. A total of 16 hospital registration websites were examined and 34 in-depth interviews were conducted. All the interview transcripts were analyzed, and 16 attribute, 13 consequence, and 4 value variables were obtained for a final questionnaire design. A total of 376 valid samples were collected from a questionnaire survey to construct a Kano–MEC hierarchical value map. Results The Kano–MEC hierarchical value map depicts hospital online registration users’ innermost thoughts and cognitive structure with regard to their attribute/consequence/value preferences and their attribute performance, as categorized by Kano’s quality classifications. Conclusions The Kano–MEC map showed that “right-clicking the registration by department tab,” “modifying or canceling one’s appointment,” “downloading doctor’s schedule,” “doctor introduction,” “right-clicking the registration by doctor’s name,” and “instant messaging” are classified as Kano’s one-dimensional attributes that can improve users’ satisfaction and reduce their dissatisfaction by increasing quality fulfillment. Practice Implications Evidently, managers should focus on “right-clicking the registration by department tab,” “modifying or canceling one’s appointment,” “downloading doctor’s schedule,” “doctor introduction,” “right-clicking the registration by doctor’s name,” and “instant messaging” to formulate their system planning for enhancing the functions of their online registration system and increasing user satisfaction.