Internal IT remains as a critical role to the success of healthcare organizations. Evolving technology and the widening gap of responsibilities place excessive burdens on the IT department. Healthcare IT departments have moved well beyond solving daily technology problems to help shape executive decisions around areas of finance/budgeting, data security, regulatory compliance, and more. This unique development of the IT engineer’s role has brought them up from the proverbial basement to the C-Suite as technology now intersects with all other aspects of business operations. The quick evolution of the IT role has undoubtedly created a winding path for technology professionals to try and adapt their skill-sets to include wider range of organizational responsibilities. Executives find it challenging to know what gaps exist between technology operations and business operations and how to reconcile the two. Addressing these challenges will often require more of a collaborative approach which creates long term stability in the IT department and supports business objectives.