I probably should have expanded on that a bit. In many cases the individual departments don't even communicate purchase intent to IT.

So things like "optional" integration modules go unpurchased. Contract terms don't address basic integration needs, etc.

Or, a specialized department has a software bake off, finds 3 solutions of equal value to them, and picks one at random. Not knowing it's the one least likely to fit in the larger picture.

Or, crossover software that serves more than one department is purchased by only one, with no discussion.

Basically, for whatever reason, healthcare is just more territorial and segregated than most other companies I've worked in.