A.A.T. Bui et al institution via a display workstation, and multiple individuals could simultaneous view the same study. Preliminary work also highlighted the need to integrate PACS with other aspects of the healthcare environment and for common data standards to be adopted. Development of the latter was spearheaded by a joint commission of the ACR in conjunction with the National Electrical Manufacturer's Association(NEMA later leading to establishment of the now well-known DICOM(Digital Imaging and Communication in Medicine) standard. While some academic research in PACS is still being performed today, arguably much of this work has transitioned to industry and information technology (IT) suppor Teleradiology: Standardizing Data and Communications In 1994, DICOM version 3.0 was released, setting the stage for digital imaging and PAcS to be embraced across a broader section of the healthcare arena. At the same time, MR and CT scanners were becoming widespread tools for clinical diagnosis ecognizing early on the potential for data networks to transmit imaging studies between sites, and partly in response to a shortage of(subspecialist) radiologists to provide interpretation, the next major step came with teleradiology applications. [18 describes the genesis of teleradiology and its later growth in the mid-1990s. Key tech- nical developments during this era include the exploration of distributed healthcare information systems through standardized data formats and communication protocols methods to efficiently compress/transmit imaging data, and analysis of the ensuing workflow(e.g, within a hospital and between local/remote sites). Legal policies and egulations were also enacted to support teleradiology. From a clinical viewpoint, the power of teleradiology brought about consolidation of expertise irrespective of (physi cal) geographic constraints. These forays provided proof positive for the feasibility of telemedicine, and helped create the backbone infrastructure for today s imaging-based multi-site clinical trials. Although DICOM provided the beginnings of standardization, there was a continued need to extend and enhance the standard given the rapid changes in medical imaging. Moreover, researchers began to appreciate the need to normalize the meaning and content of data fields as information was being transmitted between sites[15]. Newer endeavors in this area continue to emerge given changes in underly ing networking technology and ideas in distributed architectures. For instance, more recent work has applied grid computing concepts to image processing and repositories Integrating Patient Data Alongside teleradiology, medical informatics efforts started to gain further pro- minence, launching a(renewed) push towards EMRs. It became quickly evident that while many facets of the patient record could be combined into a single application, incorporating imaging remained a difficultly because of its specialized viewing requirements(both because of the skill needed to interpret the image, and because of ts multimedia format). Conversely, PACS vendors encountered similar problems radiologists using imaging workstations needed better access to the Emr in order to provide proper assessment. Hence in this next major phase of development, processes that were originally conceived of as radiology-centric were opened up to the breadth of healthcare activities, sparking a cross-over with informatics. For example, the Integrating the Healthcare Enterprise(IHE) initiative was spawned in 1998 througl HIMSS and RSNA (Healthcare Information and Management Systems Society, Radio- logical Society of North America), looking to demonstrate data flow between HL7 and DICOM systems. Additionally, drawing from informatics, researchers began to tackle the problems of integration with respect to content standardization: the onset of10 A.A.T. Bui et al. institution via a display workstation, and multiple individuals could simultaneously view the same study. Preliminary work also highlighted the need to integrate PACS with other aspects of the healthcare environment and for common data standards to be adopted. Development of the latter was spearheaded by a joint commission of the ACR in conjunction with the National Electrical Manufacturer’s Association (NEMA), later leading to establishment of the now well-known DICOM (Digital Imaging and Communication in Medicine) standard. While some academic research in PACS is still being performed today, arguably much of this work has transitioned to industry and information technology (IT) support. Teleradiology: Standardizing Data and Communications In 1994, DICOM version 3.0 was released, setting the stage for digital imaging and PACS to be embraced across a broader section of the healthcare arena. At the same time, MR and CT scanners were becoming widespread tools for clinical diagnosis. Recognizing early on the potential for data networks to transmit imaging studies between sites, and partly in response to a shortage of (subspecialist) radiologists to provide interpretation, the next major step came with teleradiology applications. [18] describes the genesis of teleradiology and its later growth in the mid-1990s. Key tech￾nical developments during this era include the exploration of distributed healthcare information systems through standardized data formats and communication protocols, methods to efficiently compress/transmit imaging data, and analysis of the ensuing workflow (e.g., within a hospital and between local/remote sites). Legal policies and regulations were also enacted to support teleradiology. From a clinical viewpoint, the power of teleradiology brought about consolidation of expertise irrespective of (physi￾cal) geographic constraints. These forays provided proof positive for the feasibility of telemedicine, and helped create the backbone infrastructure for today’s imaging-based multi-site clinical trials. Although DICOM provided the beginnings of standardization, there was a continued need to extend and enhance the standard given the rapid changes in medical imaging. Moreover, researchers began to appreciate the need to normalize the meaning and content of data fields as information was being transmitted between sites [15]. Newer endeavors in this area continue to emerge given changes in underly￾ing networking technology and ideas in distributed architectures. For instance, more recent work has applied grid computing concepts to image processing and repositories. Integrating Patient Data Alongside teleradiology, medical informatics efforts started to gain further pro￾minence, launching a (renewed) push towards EMRs. It became quickly evident that while many facets of the patient record could be combined into a single application, incorporating imaging remained a difficultly because of its specialized viewing requirements (both because of the skill needed to interpret the image, and because of its multimedia format). Conversely, PACS vendors encountered similar problems: radiologists using imaging workstations needed better access to the EMR in order to provide proper assessment. Hence in this next major phase of development, processes that were originally conceived of as radiology-centric were opened up to the breadth of healthcare activities, sparking a cross-over with informatics. For example, the Integrating the Healthcare Enterprise (IHE) initiative was spawned in 1998 through HIMSS and RSNA (Healthcare Information and Management Systems Society, Radio￾logical Society of North America), looking to demonstrate data flow between HL7 and DICOM systems. Additionally, drawing from informatics, researchers began to tackle the problems of integration with respect to content standardization: the onset of