If the admin computers aren't connected to the internet, how do patients interact with the administrative staff, for things like appointments, referrals, etc.?

If the admin computers aren't connected to the internet, how do patients interact with the administrative staff, for things like appointments, referrals, etc.? If the x-ray processing isn't connected to the internet, how do the x-rays & the radiologist's evaluation end up in the patient's record, or in a place where the patient can download their imaging results?