Reasons are given for the little clinical successes the first generation of PACS had known. It has become clear that the next generation of PACS should be integrated with the HIS or RIS. The enormous amounts of data to be transported put specific requirements on network management. Distributed data-bases will be essential. Adaptive user interface will facilitate the use by and the communication between several types of professional users. The HIPACS project studied the aspects and concluded that we are moving from a development driven by technology towards a approach based on the embedding of medical information in the systems.