Historically, a request for sharing of imaging health information would require data to be burned to a CD/DVD and couriered to an outside facility, with unknown delay in care delivery. Now, the requests can be processed and transmitted 24 hours a day, 365 days a year to referring facilities, or uploaded into the local system. The key player in this facilitation is the Picture Archiving and Communication System team in Diagnostic Imaging at the IWK. They oversee the imaging informatics aspect of health records for Radiology, Ophthalmology, Dentistry, Ambulatory Gynecology, Laparoscopic Gynecology, Fetal Assessment Clinic and Cardiology. These images are stored in a centralized provincial database with built-in redundancy and catastrophic failure mechanisms in place. Enterprise solutions exist, but they are expensive and not currently available to Nova Scotia. In the meantime, the conventional PACS system is being used to manage and store non-conventional images. Facilitated by the in-house development of an image request database, a notification is generated and the images can then be sent electronically. Building on existing Secure File Transfer Protocol service of the Nova Scotia Health Authority, the IWK PACS applications specialists have facilitated timely, reliable imaging health information-sharing across Canada, the United States, Europe and as far away as Australia. The Nova Scotia PACS system is directly linked, meaning images aren’t required to be packaged, but can directly transmit to Prince Edward Island, New Brunswick, and Newfoundland. This direct Atlantic interconnectivity across provinces is very unique around the world, and something the IWK uses every single day.