5 PACS Strategy Questions CIOs Should Ask

Imaging is no longer confined to the radiology department. It’s embedded across every stage of the care continuum, from diagnostics and treatment planning to patient monitoring and long-term follow-up. As imaging volumes rise and technology evolves, the Picture Archiving and Communication System (PACS) has become a strategic asset to health system performance.

For healthcare CIOs, the challenge is clear: ensure that PACS is more than a storage system. It must be integrated, scalable, secure, and ready for the demands of modern care delivery. But where should CIOs begin?

At Optimum Healthcare IT, we believe the best PACS strategies start by asking the right questions. Here are five that every CIO should be asking.

1.

Are we leveraging AI and machine learning in imaging?

AI is rapidly transforming medical imaging, from automating triage to identifying subtle findings faster than the human eye. Many PACS vendors now offer native AI tools, while others allow integration with third-party platforms. CIOs must evaluate whether AI is available and how it’s being adopted and governed.

A forward-looking PACS strategy includes a clear roadmap for AI adoption, clinical validation processes, and alignment with enterprise AI governance.

What to consider:

What AI use cases are most relevant to our imaging teams?
How do we validate AI tools’ accuracy, reliability, and safety?
Are our infrastructure and data standards ready for AI scale?

2.

Is our PACS strategy aligned with our enterprise cloud roadmap?

As more organizations shift toward cloud-based EMRs and data platforms, PACS must follow suit. Storing imaging data in on-premises silos creates performance, scalability, and disaster recovery challenges. Cloud-based or hybrid PACS solutions enable more flexibility, faster image sharing, and easier integration with analytics platforms.

CIOs should evaluate whether their current PACS vendor supports cloud-native architecture or requires third-party solutions to bridge the gap. Aligning PACS modernization with your broader cloud journey ensures consistency, cost-effectiveness, and long-term viability.

What to consider:

Are we duplicating infrastructure or paying for unnecessary storage?
Can our PACS vendor support cloud archiving, compute, and remote viewing?
Are imaging systems part of our cloud governance policies?

3.

How well is our PACS Integrated with our EMR and enterprise systems?

Disconnected systems slow down workflows and frustrate clinicians. When PACS is not seamlessly integrated with the EMR, providers waste time toggling between systems, hunting for prior studies, or dealing with inconsistent reporting formats. A well-integrated PACS should enable clinicians to view images directly within the patient record, launch diagnostic viewers without logging into another platform, and automate key workflows like order reconciliation and report distribution.

What to consider:

Do we have single sign-on and in-context viewing for PACS within the EMR?
Are imaging workflows optimized across specialties beyond radiology?
Can PACS data be accessed and used for analytics or research initiatives?

4.

Is our PACS supporting interoperability and external collaboration?

Storage costs are rising, but so are retention requirements. Many organizations hold on to more imaging data than necessary or lack a clear governance strategy to manage it. CIOs must work with compliance, legal, and clinical teams to develop imaging governance policies that balance cost, access, and risk. If implemented strategically, modern PACS systems can support tiered storage, automated retention rules, and integration with enterprise data management strategies.

What to consider:

Are we using image exchange networks or still relying on CDs and VPNs?
Can we send and receive studies with outside partners seamlessly?
Do we have access controls and audit trails in place?

5.

Is our imaging governance and retention strategy sustainable?

Patients move, and so does data. PACS systems must be able to share studies across health systems, providers, and care settings. Interoperability is critical for supporting trauma transfers, second opinions, or multisite care delivery.

CIOs should ensure that their PACS supports standard formats like DICOM, HL7, and FHIR, and that image exchange workflows are efficient, secure, and aligned with national interoperability initiatives.

What to consider:

Are we storing duplicate or unnecessary studies?
Do we have a retention policy for each imaging modality?
Are we monitoring access and usage of historical images?

PACS is no longer a back-office system. It’s a critical component of clinical, operational, and strategic success. By asking the right questions now, CIOs can ensure their imaging systems meet today’s needs and drive tomorrow’s innovation.