Enhanced techniques for the extraction and use of metadata from medical images are disclosed herein. Based on the information in the metadata, specific processing may be performed within an image order management system, radiology information system (RIS), or like system. A radiology read order may be created, pre-populated, and transmitted via a processing system (e.g., a teleradiology image order management system) based on the metadata within the radiology image. For example, this metadata may exist within the header of a DICOM-formatted image data file or a DICOM communication protocol transmission. The processing system may then provide the pre-populated read order back to the source of the medical images for verification and submission. Other processing actions may also occur based on information extracted from the image metadata, such as custom workflows and handling based on an originating facility, or transferring the images to a particular radiologist or location.