ISI Group, LLC
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ISI Imaging software integrates directly with an instance of VistA (Veterans Health Information Systems and Technology Architecture). It can be integrated with either the FOIA/open source version of VistA, or with RPMS (Resource and Patient Management System).

VistA is an enterprise-wide EHR (electronic health record) management system. Initially developed by the Department of Veterans Affairs (VA). VistA is used throughout the VA medical enterprise.  Open source and commercially supported versions of VistA are being used  in an increasing number of non-VA hospitals.  For more about VistA in general, see

When it is implemented with an instance of VistA, ISI Imaging interfaces directly with VistA’s central database to tightly integrate text-based medical data with the medical images. Unlike other PACS, which are independent systems interfacing with VistA, ISI Imaging works completely within VistA. From the clinician’s perspective, medical images managed by ISI Imaging are seamlessly appended to VistA’s text-based medical data. 

The images themselves are stored on Windows-compatible file servers and are automatically moved between online and nearline storage as needed.