Around the world, hospitals are faced with both budget and regulatory pressures, forcing them to re-examine the way clinical practice is carried out. Proposed technologies that provide workflow enhancements include Picture Archiving and Communications Systems (PACS); however, is PACS really effective in improving hospital workflow and the flow onto patient care, and how should this be evaluated? An acknowledged and successful approach for organizational evaluation is the Balanced Scorecard (BSC), providing the fundamental features for assessing organizations from various perspectives. In this research, the impact of PACS on the workflow of a large public hospital in Melbourne, Australia, is examined using an adapted version of the BSC. Empirically, this model was applied as an evaluation instrument through a series of in-depth interviews with PACS users. Results show that PACS did improve hospital workflow considerably and that the organizational alignment of PACS in hospitals is an important critical success factor.