Healthcare enterprises often "acquire and install" picture archiving and co
mmunications systems (PACS) without examining many of the care delivery pro
cesses and information flows that will be affected. Many times these unexam
ined factors can delay or be the cause of failure of the PACS project. This
article presents issues that were worked through as part of a PACS clinica
l services assessment and reengineering analysis for several US military me
dical treatment facilities, Copyright (C) 1999 by W.B. Saunders Company.