The more complex health system will want Heartbeat enterprise.  Heartbeat Enterprise was designed to continuously test every DICOM node in the enterprise imaging ecosystem AS WELL AS the integration between each system.  Imagine checking every system and every integration between a modality, router, PACS, VNA, EMR Viewer and the DR archive. Again the moment a problem is detected (before a physician is impacted and a ticket is opened) IT is notified not only that there is an issue but precisely which system or integration is having the issue.  In this way, all resources can be dedicated to fixing the problem instead of trying to find it