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Main objectives and characteristics of computerized radiological image handling in a radiology department, homogeneously integrated with other information typologies, are discussed. The extension of the present DREAM system to image handling functionalities is in progress. The activities are based on the collaboration between the "Università Cattolica del Sacro Cuore (UCSC), Istituto di Radiologia". Hopital Cantonal Universitaire de Genève-Centre d'Informatique Hospitalier (HCUG) and Gesi aiming at the integration of "Osiris", image handling information system implemented by HCUG with DHE middleware implemented by Gesi and UCSC which represents the functional and information core of the entire information system. The initiative is part of "Synapses" project, partially supported by the European Union DG XIII within the program of information technology applications in health care.

In last years, requirements for health information systems have markedly increased. From essentially sectorial requirements limited to the single operational units, the need has emerged for the interaction and integration of the various components of the health care structure, within the service and over the territory. A major role in this evolutionary process is played by the architectural features of the information system. They must respond to precise requirements of standardization, modularity and openness so as to allow the integration and interaction of different, even if preexisting, applications and of different suppliers. In this article, some fundamental aspects of the architecture of health information systems are discussed based on actual experiences as well as on results of the principal approaches to standardization in Italy and Europe.