Organizations across the country — even globally — are taking a hard look at their imaging ecosystems and determining it is time for change. Most technology and clinical leaders have read, listened to and observed the imaging vendor narrative over the past few years while they focused primarily on deploying the electronic health records (HER). Now most feel comfortable enough — either internally or with the help of consultants — to tackle this next huge patient record initiative. Vendor neutral archives (VNA), viewers, workflow, analytics, integration and exchange are all under review as components of the enterprise imaging effort. The good news for those in this phase of discovery and analysis is that the pioneers are far enough down the path to prove that an enterprise approach can be incredibly successful and that there are organizational, clinical, technical and even financial benefits to adopting this model.