OpenShare Exchange
vs PowerShare.
PowerShare is Nuance’s cloud image-exchange network, now part of Microsoft: studies upload to the vendor cloud, recipients pull them down, and the meter counts images. OpenShare Exchange links the two sites directly, end-to-end encrypted, PHI on-premise, billed by the gigabyte. Here is how each one works and what it costs.
Side by side.
Both move DICOM studies between healthcare organizations. One routes them through a vendor cloud, the other connects the two sites directly.
Direct exchange
OpenShare Exchange uses WebRTC to establish direct encrypted connections between organizations. The OpenShare server handles signaling only, it never sees, stores, or touches your images or clinical data. WebRTC DTLS encryption protects the data channel end-to-end.
- PHI stays on-premise
- End-to-end encrypted (WebRTC DTLS)
- No per-image fees, flat per-server pricing
- Partners connect free, one membership covers the connection
Centralized cloud exchange
A cloud image-exchange network from Nuance (a Microsoft company since 2022). Your PACS sends studies through a gateway to the PowerShare cloud, and recipients retrieve them from there, with per-image or per-transaction pricing.
- ~80% of US hospitals connected (Nuance claim)
- Best in KLAS 2026 for image exchange
- Deep Epic EHR native integration
- 2.5M studies exchanged/month (Nuance claim)
Feature-by-feature comparison.
OpenShare Exchange vs PowerShare. Honest, attributed, and hedged where pricing is estimated.
| Capability | OpenShare Exchange | PowerShare (Nuance/Microsoft) |
|---|---|---|
| Architecture | Direct (WebRTC) | Centralized cloud (Microsoft) |
| Data routing | Direct between organizations | Through Microsoft/Nuance cloud |
| PHI storage | On-premise only | Vendor cloud |
| Pricing modelPowerShare pricing not publicly disclosed; sold as packages, billed per image or per transaction | $500/server/mo flat + $0.25/GB after 2.5 GB | Per-image / per-transaction (est.) |
| End-to-end encryptionPowerShare uses TLS in-transit; data accessible on vendor cloud. OpenShare is end-to-end encrypted (WebRTC DTLS). | ✓ | ✗ |
| DICOM support | ✓ | ✓ |
| HL7 / FHIR exchange | Full (via OIE engine) | Limited, imaging focus |
| Open source engine | ✓ | ✗ |
| Network scale | Growing (new network) | ~80% US hospitals (Nuance claim) |
| Epic EHR integration | Via OIE (HL7/FHIR) | Deep native embedding |
| KLAS recognition | Not yet rated | Best in KLAS 2026 |
| Vendor | Saga IT / open source | Nuance (Microsoft) |
| Free tier | ✓ | ✗ |
An honest comparison.
We’re direct about where each product leads.
- No per-image or per-transaction fees, flat per-server pricing
- No copy on a vendor cloud, studies go straight to your partner
- End-to-end encryption (WebRTC DTLS), not just in-transit TLS
- HL7 v2, FHIR, DICOM, X12, full healthcare data stack, not just imaging
- Open-source engine (OIE, MPL 2.0) with no engine licensing fees
- Free to start, no credit card required
- Established network: Nuance claims ~80% of US hospitals connected
- Best in KLAS 2026 for medical image exchange, independently recognized clinical benchmark
- Deep native Epic EHR embedding: physicians access shared images in one click from Epic
- 2.5 million studies exchanged per month (Nuance claim), 2+ billion images/year
- Backed by Microsoft, enterprise-scale infrastructure and compliance
- Decades of production use at major US health systems
Bottom line: If your organization is already embedded in PowerShare’s network and relies on Epic integration, switching carries real workflow risk. OpenShare Exchange is the stronger choice for organizations that want predictable, volume-independent costs and full data sovereignty, especially if you’re exchanging data with a known set of partner organizations rather than an open network.
Frequently asked questions.
What is the PowerShare network?
Nuance PowerShare is a cloud-based medical image exchange network, part of Microsoft since 2022. A gateway on your network sends studies from your PACS to the PowerShare cloud, and connected facilities, clinicians inside Epic, and invited patients retrieve them from there. Nuance says about 80% of US hospitals are connected and that the network has shared more than 3 billion images.
Is OpenShare a PowerShare alternative?
Yes, for organizations that want direct, on-premise medical image exchange without per-image fees. OpenShare Exchange transfers DICOM images and clinical data directly between organizations, end-to-end encrypted, no centralized cloud, flat per-server pricing. PowerShare (Nuance/Microsoft) routes all exchanges through its cloud and charges per image or per transaction. PowerShare leads in network scale and Epic integration; OpenShare leads in cost predictability and data sovereignty.
How much does PowerShare cost?
PowerShare does not publicly disclose its pricing. It operates on a per-image or per-transaction model. OpenShare publishes its rate: a flat $500 per-server/month membership with 2.5 GB of transfer included, then $0.25 per GB, so cost tracks gigabytes, never image counts.
How do I get a PowerShare account?
Provider organizations subscribe through Nuance (now Microsoft) and connect a gateway to their PACS; Nuance then configures sending channels to the facilities you exchange with. Patients do not sign up on their own: the facility holding the images sends an invitation email from PowerShare, and the free patient account lets them view, download, and share their own studies.
Does PowerShare work with Epic EHR?
Yes. PowerShare (a Nuance/Microsoft product) has deep Epic EHR integration, enabling physicians to access shared images directly within the Epic workflow with a single click. This is one of PowerShare’s primary competitive advantages. OpenShare integrates with Epic via the OIE integration engine using standard HL7 and FHIR interfaces, but does not have the same level of native Epic embedding.
Who owns PowerShare?
PowerShare is a product of Nuance Communications, which was acquired by Microsoft for approximately $19.7 billion in March 2022. PowerShare is positioned as part of Microsoft’s healthcare cloud portfolio.
What is the difference between direct and centralized image exchange?
Centralized image exchange (like PowerShare) routes every image through a vendor’s cloud: your PACS sends images to the vendor’s cloud, and the recipient retrieves them from there. Direct exchange (like OpenShare) establishes an encrypted connection between two organizations, data travels straight between them, the vendor never sees or stores your images. This eliminates per-image cloud storage and retrieval costs and keeps PHI fully on-premise.
