With today's increased focus on the cost effective delivery of health care, we are seeing great emphasis placed on the systems approach to cost containment. One area in which this approach has direct application is the collection, storage, retrieval and display of diagnostic information (both images and text). The evolution of relevant technologies has now advanced sufficiently to consider their applications in image storage, communication and display. This paper will discuss the state of technology and other considerations that must be examined in the design of an integrated Multi-Modality Imaging and Communications System (MMICS). Specifically, we will explore the information requirements, both image and text, the data storage and retrieval issues, the communications networking requirements, the image display issues and the need for an interface into the Hospital Information System (HIS). Another recent trend in medical imaging is a trend towards shared resourses. A group of hospitals and/or clinics come together to share a CT or MR facility. Or a group of hospitals, each of which has a CT with which to take data, share certain specialists who may be located at different member institutions. This resource sharing creates the need to connect hospital MMICS's together and perhaps also allow other users, such as referring physicians or clinics located outside of the hospital, to have access to parts of the system.