Objective. The goal of this paper is to highlight some health care related issues with regard to Information Systems implementations. This case study is connected to the adoption of a Picture Archiving and Communication System (PACS) in Turku University Central Hospital. PACS is an Information System, which handles radiological film images in digital form. Benefits, costs and drawbacks are discussed. Methods. The results are based on a four-year survey consisting of statistical data, cost

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... is, modelling, customer satisfaction inquiries, time and motion studies, observation and staff interviews. Results and discussion. Less than 1 % of the hospital budget was dedicated to the implementation and adoption. PACS was expected to eliminate the use of film-and paper prints, and introduce a new working environment. After four years of adoption one clinical customer unit shifted to filmless activity, namely the Intensive Care Unit (ICU). Availability of imaging requests, imaging studies and radiology reports was improved to 100 % from 87-88 %. A staff member was dedicated to the manual transfer of digital images to the wards. Film acquisition costs were not reduced as anticipated. Personnel tasks will reduce only to the degree to which paper and film prints will be renounced. Also, new tasks will emerge due to PACS. Conclusion. Hospital staff was unprepared for the change. Inexperience regarding informatics, system behaviour, and lack of designated expert personnel slowed down the implementation process. In general there is inexperience regarding digital archiving of medical images, which hinders efficient adoption. Technology providers had not sufficient information or knowledge of clinical requirements. Budgets were not adequate for the build-up of a comprehensive cost-effective system. PACS did not overcome any of those concerns it was expected, but added new concerns.