As the adoption of AI systems within the clinical setup grows, limitations in bandwidth could create communication bottlenecks when streaming imaging data, leading to delays in patient diagnosis and treatment. As such, healthcare providers and AI vendors will require greater computational infrastructure, therefore dramatically increasing costs. To that end, we developed intelligent streaming, a state-of-the-art framework to enable accelerated, cost-effective, bandwidth-optimized, and computationally efficient AI inference for clinical decision making at scale. For classification, intelligent streaming reduced the data transmission by 99.01% and decoding time by 98.58%, while increasing throughput by 27.43x. For segmentation, our framework reduced data transmission by 90.32%, decoding time by 90.26%, while increasing throughput by 4.20x. Our work demonstrates that intelligent streaming results in faster turnaround times, and reduced overall cost of data and transmission, without negatively impacting clinical decision making using AI systems.