This paper addresses the role of IT Governance in a Hospital Information System (HIS) management. ITIL is introduced as a best practice for supporting HIS development. Since IT Governance is extensive, we focused our study on an ITIL Assessment. The assessment was centred on IT Service Management, and which, according to our findings, is being carried inefficiently in Hospital São Sebastião. Although the literature quotes the many benefits brought by ITIL to the organizations, they all depend on how good the planning and implementing processes are. The implementation process itself is very complex and we focused our study on the assessment step. The ITIL assessment was crucial to identify IT Governance weakness; and it is a way for the organization to become consciousness about IT improvement priorities. The results were used to rethink HIS strategy in order to properly address the next challenges.