Medical image exchangewithout the per-image fees.
Share DICOM images and clinical data directly between organizations, end-to-end encrypted, with no centralized cloud and no transaction fees. A modern alternative to PowerShare, Ambra Health, and lifeIMAGE.
Three ways a study leaves the building.
Medical image exchange is how a CT, MRI, or X-ray gets from the facility that acquired it to the clinician who needs it next: a referral, a transfer, a second opinion, a teleradiology read. Today that happens one of three ways.
On a disc
- How it moves
- Burned to CD or DVD, handed to the patient or couriered, then imported by hand at the other end.
- Delay
- Days.
- Where the copy lives
- In the patient’s bag, then on whichever workstation imported it.
- What it costs
- $15 to $25 per disc in institutional cost (ACR), plus courier and staff time.
Through a cloud network
- How it moves
- A gateway uploads the study to the vendor’s cloud; the recipient pulls it down from there.
- Delay
- Minutes to hours, once both sites are on the same network.
- Where the copy lives
- On the vendor’s servers, for as long as their retention policy says.
- What it costs
- Per image, per study, or per transaction, on a quote. PowerShare, Ambra, and lifeIMAGE all work this way.
Direct, site to site
- How it moves
- The two sites open an end-to-end encrypted link and the study lands in the partner’s PACS.
- Delay
- Minutes.
- Where the copy lives
- Only at the two sites. No cloud copy, and OpenShare never sees the pixels.
- What it costs
- $500 per server per month with 2.5 GB included, then $0.25 per GB. A routine CT is about eight cents.
Centralized cloud exchange has a cost problem.
Services like PowerShare and Ambra Health route every medical image through centralized cloud infrastructure. That architecture creates real costs, and real risks.
Per-image fees add up
Per-transaction pricing means costs scale linearly with volume. High-throughput imaging centers face significant recurring charges that compound over time.
Your data in their cloud
Every image routes through cloud PACS infrastructure. Your PHI sits on someone else’s servers, subject to their security posture, their retention policies, their compliance guarantees.
Vendor lock-in
Deep EHR integrations and network effects create switching costs. Once embedded, changing vendors means renegotiating workflows across your entire organization.
CDs still cost a fortune
Even with cloud exchange services, many organizations still burn CDs for image sharing, at $15–25 per disc in institutional cost per the ACR, plus courier and handling that add up quickly at high-volume sites.
How direct exchange is different.
OpenShare Exchange establishes direct, encrypted connections between healthcare organizations. No cloud middleman. No per-image fees.
Signaling only
OpenShare handles connection setup (signaling). It never sees, stores, or processes your medical images or clinical data.
Direct WebRTC connections
Data travels directly between organizations via WebRTC. When a direct connection is blocked (strict NAT or firewall), an encrypted TURN relay takes over, still end-to-end encrypted.
Billed by the gigabyte, never the study
No per-image, per-study, or per-transaction fees. Membership is $500 per server, per month, with 2.5 GB included and a published $0.25 per GB after. A routine CT is about eight cents.
No vendor-cloud copy
Studies travel straight to your exchange partner. No copy is ever parked on a vendor’s cloud, and OpenShare never sees the pixels. You keep full control of where your PHI lives.
What a study actually costs.
Ambra’s standard contract defines “a billing event” as “a Study being uploaded” (2019 SaaS agreement), and lifeIMAGE’s founder described the model as “$1 per exam” (2011). OpenShare meters bandwidth instead, at a published $0.25 per GB beyond the 2.5 GB monthly allowance. Per study, that looks like this.
| Modality | Typical transfer size | OpenShare bandwidth cost |
|---|---|---|
| X-ray (CR/DR) | ~20 MB | about half a cent |
| Ultrasound | ~100 MB | about 3 cents |
| MRI | ~200 MB | about 5 cents |
| CT (routine) | ~300 MB | about 8 cents |
| Digital breast tomosynthesis | ~450 MB, up to 3 GB | about 11 cents, up to ~75 cents |
| CT angiography | ~800 MB | about 20 cents |
Raw transfer sizes; lossless DICOM compression typically halves them. A site moving 1,000 routine CTs a month uses roughly 300 GB, about $74 of overage on top of the $500 membership. Heavier modalities cost more per study, and the meter reads gigabytes either way, at a rate anyone can check.
Feature-by-feature comparison.
OpenShare Exchange vs PowerShare (Nuance/Microsoft) and Ambra Health / lifeIMAGE (Intelerad).
| Capability | OpenShare Exchange | PowerShare / Ambra / lifeIMAGE |
|---|---|---|
| Billing meter | $500/server/mo flat + $0.25/GB after 2.5 GB, published | Per-image / per-transaction (est.), quote-only |
| Architecture | Direct (WebRTC) | Centralized cloud (Microsoft/Intelerad) |
| Data routing | Direct between organizations | Through vendor cloud infrastructure |
| PHI storage | On-premise only | Vendor cloud |
| End-to-end encryptionCentralized cloud services use TLS in-transit; data is accessible on vendor servers | ✓ | ✗ |
| DICOM support | ✓ | ✓ |
| HL7 / FHIR support | Full (via OIE engine) | Limited, imaging-focused |
| Open source engine | ✓ | ✗ |
| Network scale | Growing (new network) | 80%+ US hospitals / 13,000+ facilities (vendor claims) |
| Epic EHR integration | Via OIE integration engine | Deep native embedding (PowerShare) |
| Vendor lock-inNetwork effects and EHR embedding create high switching costs | ✗ | ✓ |
An honest comparison.
We believe in direct, truthful comparisons. Here’s where each option leads.
Where OpenShare Exchange leads6
- No per-image or per-transaction fees, flat per-server pricing
- Data stays on-premise: PHI never routed through vendor cloud
- End-to-end encryption (WebRTC DTLS), not just in-transit TLS
- HL7 v2, FHIR, DICOM, X12, all data types, not just images
- Open-source engine (OIE, MPL 2.0), no engine license fees
- Partners connect free, one membership covers the connection
Where PowerShare / Ambra / lifeIMAGE lead4
- Established networks: PowerShare claims ~80% of US hospitals; lifeIMAGE claims 13,000+ facilities
- Deep Epic EHR embedding (PowerShare): single-click image access for physicians
- Decades of production history at major health systems
- Consolidated under Intelerad: Ambra + lifeIMAGE collectively claim 80+ billion images managed
The key insight: Large established networks shouldn’t require giving up control of your data or paying per image. OpenShare connects organizations directly, your data stays yours, the pricing stays flat, and the platform never touches your PHI. For organizations prioritizing cost predictability and data sovereignty over network breadth, OpenShare Exchange is worth evaluating.
Beyond images, a complete integration platform.
PowerShare and Ambra handle medical images. OpenShare + OIE handles all healthcare data.
PowerShare, Ambra, and lifeIMAGE are purpose-built for medical image exchange, DICOM studies, radiology reports, and imaging workflows.
OIE + OpenShare processes all healthcare data formats, provides browser-based administration, secure remote access, and direct exchange, one platform for all integration and exchange needs.
Frequently asked questions.
What is medical image exchange?
Medical image exchange is how a CT, MRI, X-ray, or ultrasound study gets from the facility that acquired it to the clinician who needs it next: a referral, a transfer, a second opinion, or a teleradiology read. Studies leave the building one of three ways: on a disc, through a hosted cloud network such as PowerShare, Ambra, or lifeIMAGE, or over a direct, encrypted site-to-site connection such as OpenShare Exchange. The three differ in delay, in where a copy of the study ends up, and in what the sender is billed for.
How does OpenShare compare to PowerShare?
PowerShare (Nuance/Microsoft) routes all medical images through centralized cloud infrastructure with per-image or per-transaction fees. OpenShare uses direct WebRTC connections to exchange data directly between organizations, end-to-end encrypted, no centralized cloud, flat per-server pricing. PowerShare has broad US hospital penetration and deep Epic integration. OpenShare is a growing network that gives organizations full control over their data and eliminates per-image fees.
Does OpenShare replace PowerShare?
OpenShare can replace PowerShare for direct medical image and data exchange between organizations. However, PowerShare’s value includes its large established network (~80% of US hospitals, per Nuance/Microsoft) and deep Epic EHR integration. OpenShare is ideal for organizations that want to eliminate per-image fees, keep data on-premise, and exchange data directly with known partners.
What is direct medical image exchange?
Direct medical image exchange transfers DICOM images and clinical data directly between healthcare organizations without routing through a centralized cloud. OpenShare uses WebRTC for direct connections with TURN relay fallback, both paths are end-to-end encrypted. The OpenShare server handles signaling only and never sees or stores the actual data.
How much does PowerShare cost?
PowerShare pricing is not publicly disclosed. It uses a per-image or per-transaction pricing model. OpenShare publishes its rate: a flat $500 per-server/month membership with 2.5 GB of transfer included, then $0.25 per GB, never a per-image fee at any volume.
What is Ambra Health / lifeIMAGE?
Ambra Health is a cloud-based medical image management platform (cloud PACS + VNA + image exchange). lifeIMAGE is a vendor-agnostic image and evidence exchange network that claims to connect 13,000+ facilities and 160,000+ US providers. Both were acquired by Intelerad (Ambra in October 2021, lifeIMAGE in September 2022) and are now part of the Intelerad platform.
