As the trend toward consolidation of hospitals continues, problems with merging radiology practices multiply. With no standardization of patient identifiers, increased demand for access to reports and medical records, and in some cases, too few radiologists to cover rural areas, the job of creating a unified system for electronic radiology practice becomes an important, frustrating, and time-consuming proposition. After acquiring several rural facilities and a community hospital, researchers and developers at Shands Medical System, Inc, centered at the University of Florida have worked integrate the various systems and create a unified system for image and report dissemination. Digital imaging equipment was installed at each institution and dedicated network lines were installed between rural locations. Since each hospital assigned medical record numbers, an institutional code was added to identify locations of patients and to assure unique identifiers. As radiology information systems (RIS) and hospital information systems (HIS) were implemented, they were interfaced to the PACS and voice recognition systems. A web-server provided wide access to clinical images and an interface to the voice recognition system provided reports when the HIS was not available or had not yet been installed.