A method and system for non-invasive medical image based assessment of coronary artery disease (CAD) for clinical decision support using on-site and off-site processing is disclosed. Medical image data of a patient is received. A processing strategy for assessing CAD of the patient using one of on-site processing, off-site processing, or joint on-site and off-site processing is automatically selected based on clinical requirements for a current clinical scenario. Non-invasive assessment of CAD of the patient is performed based on the medical image data of the patient using one of on-site processing, off-site-processing, or joint on-site and off-site processing according to the selected processing strategy. A final assessment of CAD of the patient is output based on the non-invasive assessment of CAD.