A picture archiving and communication system (PACS) supported by a multimedia medical image database, is being integrated with all other components of a hospital information system (HIS), resulting in a second generation distributed PACS architecture test bed. The research is in the stage of preprototyping. The first systems are being tested in the laboratories and prepared for integration into the clinical environment. Initial efforts have been focussed on addressing integration issues. Integration of PACS into a hospital environment is a prerequisite for clinically useful systems, and involves the integration of all departmental systems, as well as the adoption of standards and coordination with CEN TC251.