A device, system, and method determines a reading environment by synthesizing downstream needs. The method at a workflow server includes receiving a request from a physician device utilized by a referring physician, the request directed to performing an imaging procedure. The method includes determining at least one normalized need from the request, the normalized need corresponding to the referring physician. The method includes generating information to be included in a reading environment based on the at least one normalized need, the information assisting an image interpreter in interpreting the imaging procedure.