The VA has developed a DICOM interface between clinical specialty modalities and the VistA hospital information system (HIS) for use in acquiring images in dental, endoscopy, ophthalmology, cardiology, and other areas. This is an interface between the general-purpose clinical specialty application on the VistA HIS and corresponding image acquisition instruments that use the DICOM Modality Worklist, Storage, and Structured Reporting specifications of the HIMSS/RSNA Integrating the Healthcare Enterprise Technical Framework (IHE TF). The workflow in the clinical specialties is very diverse and is quite different from that in radiology. Significant design and development work was required on the HIS to port the DICOM modality interface from the relatively well-ordered radiology-centric world where it was developed to the comparatively unstructured environment of the clinical specialties. This required us to develop software that is much more flexible than that used for radiology in order to handle the diversity in the workflow. Fortunately, the DICOM portion of the IHE TF that we implemented to interface the modalities can be used with little or no change.