The tight integration of the Hospital Information System/Radiology Information System (HIS/RIS) and the Picture Archive Communication System (PACS) has become a priority in modern healthcare delivery systems. Traditional paper-based systems are being replaced by gateway style interface engines. Gateways provide a tightly integrated link between the HIS/RIS and the PACS, increasing productivity by automating many mundane clerical tasks associated with paperbased systems. A centralize'd gateway, however, represents a processing bottleneck and single point of failure. A self-monitoring distributed gateway architecture that replicates essential services increases the fault tolerance and the overall availability of the gateway, while providing reduced, consistent transaction times. A possible distributed architecture is proposed as a means to realize the advantages of a distributed architecture.