1. Image Sharing Hamid Tabatabaie Founder & CEO

2. Why Image Sharing $120B annually spent $30B in unnecessary and / or repeat exams Lack of access to prior imaging delays patient care Patients can be unnecessarily exposed to excess radiation and Errors Aging population needs more imaging and the problem will get worse

3. Image Sharing Usage 150 K Imaging Cases per month 20% growth every 60 days 9.7 K Active Users per month 20% growth every 60 days

4. Image Sharing Use Cases Radiology Centric - – Teleradiology – Distributed reading – Access to priors Clinician / Image intensivists Centric - – ED / Trauma / Stroke – Outpatient or follow up visits – Referrals, Sub-specialty consults, e-Referral, Telemedicine – Transfers, Transplants, Surgery,…more Consumer Centric - – 2nd opinion – Sharing with providers – Acting as a care taker

5. General approaches Network Aware (Napster)Ad Hoc (iTunes) – Simple workflow – Secure – Share-Access-Download – Possible to use standards – DIRECT – BLUE BUTTON – Image enable HIE – Image enable EMR – Use a combination of – Centralized model ex. VNA – Federated Model ex. XDS-I – Can use better Standards

6. What’s Missing? Technology can be better But it works ! HIEs are not image enabled Current Standards not ideal DICOM not an Internet friendly protocol or file format XDS was not intended for images, and its incomplete Ideals for a New set of Standards Payload needs to move efficiently Web method for visualization Reduced redundancy Searchable Built-in Security Inclusive

7. Who Pays for it? Cost To do it well, there will be $1-2 per exam fully loaded cost Includes “managed-services” Reimbursement with Built-in incentives for compliance Image service providers who publish shareable results Imaging Service Provider pays for sharing But, the extra reimbursement should cover their cost Payment model < $0.20 for registering each exam < $2.00 for unlimited viewing <$0.50 for downloading, if necessary