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Most equine practices treat their imaging system and their practice management software as two separate tools that happen to live in the same clinic. Radiographs come off the DR plate, get exported, and live somewhere. The chart lives in the PMS. The two systems never speak to each other, and the cost of that silence gets paid by whoever is hunting for an image six months later.
This is not how it has to work. PACS and PMS integration is one of those quiet operational changes that does not look like much in a sales demo but reshapes how a clinic functions day to day. This post is about what actually changes, in practical terms, when those two systems are connected. Not the marketing version. The real version, with the workflows, the friction points, and the cases where integration does not matter as much as the brochures claim.
What "integration" actually means
The word "integration" gets used loosely in veterinary software. Three different things often hide behind the same label.
One-way export. Your PACS lets you save images as files and email them or drop them into a folder shared with the PMS. Most modern PACS can do this. It is not integration in any useful sense. It just means the two systems both know how to use the same file system.
Linked records. Your PACS knows the patient ID from your PMS, so when you open a horse's chart you can see a list of their studies. Clicking a study opens the PACS viewer. The image data still lives in the PACS, the chart data lives in the PMS, but a clickable bridge exists between the two. This is what most vendors call "integration" today.
Bidirectional workflow integration. Studies get ordered from inside the PMS, modality worklists are generated automatically, finalised images and reports flow back into the patient chart, and you can review images on the same screen as the SOAP note. This is what people usually mean when they say a clinic feels "integrated." It is rarer than vendors make out.
For most equine practices, the meaningful difference is between the first level and the third. The middle level is fine but does not eliminate the duplicate-record problem.
The duplicate-record problem
Every equine practice with separate imaging and PMS has the same hidden cost: every imaging study creates work in three places.
- The image lives in the PACS.
- The chart entry lives in the PMS.
- The radiology report, if one exists, lives somewhere else again, often in a Word document or a PDF emailed to the referring vet.
When an owner calls six months later asking for "the radiographs from when we did the pre-purchase," someone has to coordinate three systems. The PACS has the images. The PMS shows what was billed but not the report. The report might be in someone's email. The owner wants all of it, and the practice spends fifteen minutes hunting.
Multiply this by every imaging request a busy practice gets, and you have a real recurring tax on staff time. AAHA practice management surveys have repeatedly shown that practices significantly underestimate how much administrative time goes into managing imaging records. The number that gets quoted most often is that veterinary practices miss between 5 and 10 percent of all charges, with some audits finding up to 20 percent leakage. Imaging-related charges are some of the most commonly missed, because the bill gets written before the radiology report comes back and nobody updates it.
What changes when imaging and PMS are properly integrated
Seven specific things, in order of how much they save you per week.
1. Study ordering happens inside the chart
In a properly integrated practice, you order a radiograph the same way you order a vaccine. Open the patient chart, click "order study," choose the modality and the views, the system generates a worklist entry that appears on the radiograph plate automatically. No retyping the horse's name. No duplicate patient IDs floating between systems. No errors when someone misspells "Hidalgo" two different ways in two different places.
The time saving on each individual order is small, maybe 60 seconds. But the elimination of duplicate-entry errors is the bigger win. Wrong patient identifiers are the number-one cause of "lost" imaging studies in practices that run separate systems.
2. The chart updates itself when images come back
The imaging study completes, the report finalises, both the images and the report appear in the patient chart automatically. The vet does not have to open another application to know that the study is done. The receptionist does not have to ask whether anything came back. The owner does not have to wait for the report because it is already attached to the horse's record.
This is the workflow that most ambulatory equine practices find most valuable, because it means the chart is complete by the time the vet writes up the SOAP note. The image and the note can sit side by side on the same screen.
3. Billing for imaging happens automatically
When a study is ordered from inside the chart, the procedure code attaches to the chart immediately. The line item appears on the invoice as soon as the study is ordered, not after someone remembers to manually add it. This is where the missed-charges problem disappears.
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For an ambulatory practice doing 10 to 15 imaging studies per week at an average of $180 per study, this is the difference between a $0 leak and a roughly $2,000-per-month leak. Over a year, that is $24,000 in charges that get captured automatically instead of being chased after the fact.
4. Owner sharing is one click
Most equine clients now want to see the radiographs themselves. Some have personal vets they want to forward to. Race owners want to send images to bloodstock agents. Insurance claims need imaging packages. In an integrated system, the practice generates a shareable owner link for the study from inside the chart, and the client gets a viewer they can open on their phone. No emails with 200MB attachments that bounce. No "can you send those again, my system did not download them properly."
5. Field viewing actually works
For ambulatory practitioners, the question of whether you can pull up last spring's radiographs on the side of a paddock matters more than any other PACS feature. Properly integrated mobile PMS and PACS lets you open a horse's chart on your phone, scroll the imaging history, and view radiographs at clinical resolution. Without integration, you are switching apps, logging in to a second system, and probably hoping you have signal.
6. The radiology report is structured
When the PACS and the PMS are connected, finalised reports flow back into the chart as structured data, not as a PDF attachment. That means the radiologist's findings are searchable, can be referenced in a SOAP note, can be filtered by date, and become part of the horse's medical history rather than an island document. Six months later, when you are trying to find every horse you have seen with navicular changes, you can actually run that search.
7. Audit trails are unified
The legal and compliance side of imaging is often overlooked. Insurance disputes, ownership disputes, pre-purchase examinations that turn into court cases. A unified audit trail across imaging and chart, showing who viewed what when, who reported, who signed off, makes the practice's position defensible in a way that two separate systems never quite manage.
Where integration matters less than the brochures suggest
Not every practice gets the same value from PACS-PMS integration. Three honest cases where the upgrade matters less.
Pure clinic-bound practices with high imaging volume already handle the workflow well. A large referral hospital with dedicated radiology staff has already solved the coordination problem with people. The integration adds polish, but the operational gain is smaller because the existing process is not broken in the same way.
Practices that outsource all radiology. If a practice's imaging workflow is mostly "take the image, send to a tele-radiologist, get a report back in 24 hours," then the report flow back into the chart matters less, because there is already a queue process around it.
Practices doing very low imaging volume. A small ambulatory practice doing one or two radiographs a week may not see the time savings add up to enough to justify a software migration. The duplicate-record problem still exists, but at smaller scale.
For the average mid-sized equine practice doing 8 to 25 studies per week across mixed clinic and field work, integration pays for itself within months on missed-charge recovery alone.
What to look for when evaluating
If integration is on the shortlist, these are the questions that actually separate good from marketing-good.
Can you order a study from inside the PMS chart and have a modality worklist appear on the plate automatically? If the answer requires a workaround or a manual step, that is linked records, not workflow integration.
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When the study is finalised, does the chart update without anyone clicking anything? Some "integrated" systems require a manual sync step that someone has to remember to do. That is not integration; that is two systems with a button between them.
Can the vet view full-resolution images on a phone or tablet from inside the patient chart? This is the question that breaks most claims of mobile readiness. A lot of integrated systems work on the desktop but fall apart on mobile.
Is there a real shareable owner link, or does sharing mean exporting and emailing? Owner-facing experience is where most integrations get lazy.
How does the system handle multi-owner records? If a syndicate horse is imaged, can the report and the images flow to the correct owners on the correct invoices? Generic vet PMS usually cannot handle this. Equine-specific systems should.
A note on the StableTrack and Keystone PACS combination
StableTrack and Keystone PACS are built by the same parent company, Asteris, and have been designed from day one to work as a single workflow rather than two products with a connector between them. Orders flow from the chart to the modality worklist. Finalised studies and reports flow back into the patient record. Images view at clinical resolution on iOS, including offline once cached. Multi-owner invoicing works with imaging procedures the same way it works with everything else.
This is not the only equine PMS-PACS combination in the market. ezyVet integrates with several PACS systems including Asteris Keystone. ThoroVet has its own imaging workflow. Cassadol has imaging features built in. The right choice depends on what imaging hardware you already have, how your radiology workflow is structured, and whether mobile field viewing is a real requirement.
What is unique about the StableTrack and Keystone combination is the depth of the integration on mobile, the equine-specific data model that runs across both systems, and the fact that you can trial it on real practice data for 30 days without committing to either platform.
How the integration works
How does StableTrack connect to Keystone imaging?
StableTrack connects to Keystone Omni across four points in the imaging workflow: ordering a study from the horse's chart, returning the report to the chart, opening the viewer from the chart, and attaching imaging to discharge summaries automatically. Together they remove the system-to-system shuffle most equine practices deal with today.
Can I order imaging directly from the horse's chart?
Yes. From any horse's profile in StableTrack, you select the study type, modality, and clinician. The order is pushed to the Keystone Omni RIS and appears on the DICOM Modality Worklist, so the technician at the plate or ultrasound machine selects the patient from a list instead of retyping the details. The accession number stays consistent from order to report.
Do reports come back into the chart automatically?
Yes. When the radiologist finalizes a report in Keystone Omni, the signed PDF and a representative thumbnail return to the horse's StableTrack chart within minutes of sign-off. The chart shows the study date, the radiologist of record, and a link to the full image set. Nothing is re-uploaded by hand.
Can I view the actual images from inside StableTrack?
Yes. Clinicians launch the Keystone Omni viewer directly from the horse's profile with the correct study already loaded. Comparing a new study against previous ones on the same horse takes a click rather than a search.
What happens to imaging at discharge?
StableTrack assembles the discharge summary by pulling in every imaging study from the admission window. Thumbnails appear inline and the full report PDFs are attached, so owners and referring vets receive the complete record without anyone manually collating files.
Setup and cost
Do I need to be an existing Keystone customer to use this?
The integration connects StableTrack to Keystone Omni, so a practice runs both. Existing Keystone customers can add StableTrack, and StableTrack customers can add Keystone imaging.
Is there an extra cost for the integration?
The integration carries no additional license cost for practices running both StableTrack and Keystone Omni.
What modalities does it support?
The workflow covers DICOM-compliant modalities including digital radiography and ultrasound, which are the studies equine practices order most.
How long does it take to set up?
Setup is handled as part of StableTrack onboarding, with the imaging connection configured alongside the rest of the practice's workflow.
Frequently asked questions
Do I need to replace my PACS to get integration with StableTrack?
Not necessarily. StableTrack integrates most fully with Keystone PACS because they share the same backend, but it can also integrate with most modern DICOM-capable PACS systems through standard protocols. The depth of integration is higher with Keystone, but that does not mean other PACS are unusable.
Can I view radiographs from my phone in the field?
Yes, on iOS. Images are accessible from inside the patient chart in the mobile app at clinical resolution. Once an image has been viewed it caches on the device, so it remains available offline. Studies you have not viewed yet require signal to load.
What about ultrasound, endoscopy, and other modalities beyond radiography?
Any DICOM-compatible modality can route through the same integration. Ultrasound studies, endoscopy still images and video, portable CT, and any other DICOM-producing device flow into the chart the same way radiographs do.
How long does the integration take to set up?
For a practice already using Keystone PACS, StableTrack integration is configured during onboarding, typically within the first week. For practices on a different PACS, the timeline depends on how DICOM-compatible the existing system is. Most modern equine PACS work without custom integration work.
Does the imaging integration cost extra?
No. StableTrack pricing is flat at $199 per month for unlimited users. Imaging integration is included. Keystone PACS is priced separately.
Can the integration handle multi-owner billing for imaging procedures?
Yes. When an imaging study is ordered for a horse with multiple owners on file, the procedure cost is split across owners according to the ownership percentages stored in the chart. Each owner receives their share on a separate invoice.
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See the integrated workflow yourself
The fastest way to understand what PACS and PMS integration actually changes is to run a real imaging study through both systems. StableTrack offers a 30-day trial with no credit card required. If your practice already uses Keystone PACS, the integration is configured during the first week.