There is a growing need to exchange and share imaging studies with outside entities. Hospitals that have foregone the traditional merger and acquisition route to become affiliates, for example, have a need to share both individual patient and population health data, though their modalities for exchange and viewing may be very different. Patient transfers between facilities, specialty and professional consultations and even telehealth opportunities have created a new way of thinking about the delivery of images between two related, yet independent points of care.