At most medical centers film-based radiology requires that single or multiple copies of patient exams and reports be distributed for results communication. A successful picture archiving and communication system (PACS) should provide a means to improve upon this inefficient paradigm, with universal access to imagery and exam results on demand at the user's convenience. Enterprise and community-wide experience with universal PACS access is reviewed. Referring physicians were surveyed about their experience with PACS, with regard to acceptance, productivity, frequency of usage, and impact on patient care. Web audit trails were used to assess physician usage. Film printing logs were reviewed. The filmless paradigm was highly regarded and frequently used by nearly all users. Significant productivity benefits were gleaned by all of the referring physicians. Patient quality of care benefitted from more efficient communication of results. Very small quantities of film were used for printing of exams, typically for patient copies.