Integration of systems with the relevant pieces of information is necessary, and in hospitals is generally done with HL-7 messages (see Chap. 7). Referring physicians increasingly expect to view images and to see reports with rich information. HL-7 does not address these demands well. Similarly, many EHRs are not able to address these needs. Because medical imaging has been a major component of increases in total health care costs, there has been much attention paid to assuring that only necessary examinations are performed. To help assure this, decision-support systems to guide proper ordering have been developed that have been shown to have an impact on utilization of imaging studies (Sistrometal. 2009 ). Such systems have been shown to decrease the total number of examinations performed, and in particular to decrease the number of examinations that appear to be unnecessary. In addition to alerting the user to a potentially improper order, educational materials are often provided to help the ordering physician understand when and what imaging examinations might be appropriate for the given indication. In addition, such systems can provide management reports to improve the understanding of ordering practices.