Background An effective health system is dependent on the people, processes, and technology required to support its successful use. Technology, including essential health information technology (HIT) components, is not enough to successfully support quality patient care delivery. Without a strong support structure, HIT tools and data alone will fail to meet the desired goal of quality patient care that achieves health equity. Multiple factors, including governance processes, policies, and standards, are critical for the development, implementation, and consistent and effective use of clinical HIT systems and the resulting data. A comprehensive model that provided support for a holistic assessment of the HIT ecosystem could not be identified. The Facility HIT Ecosystem Capability Maturity Model (ECMM) was designed in response to this need. Objectives This project was designed to create and propose a comprehensive framework for self-assessment and support of a maturation pathway for a facility's comprehensive HIT ecosystem, including governance processes, policies, and standards. Methods Iterative methods based on agile and human-centered design practices were used to create and validate the framework and its contents. Results The ECMM and toolkit support a health care facility's clinical or technical leadership, including chief medical officers, chief information officers, and chief medical/health/nursing informatics officers, in identifying and assessing policies, processes, and capabilities surrounding HIT. This framework supports iterative evaluation and step-ladder style progression and goal setting to achieve desired capabilities, both at the local level and at the level of supporting organizations. Reviewer feedback was used to provide iterative tool improvement and refinement. Conclusion The proposed HIT maturity model toolkit showed potential as a tool to help empower health care facilities and their leadership to advance their HIT ecosystem.