01

Whitepaper

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Revolutionizing
the way
patient information
is transferred.
Medicom is a software solution intended for use by radiology and other
medical practices to transfer imaging studies across the internet. Med-
icom’s peer-to-peer design avoids the costs and risks associated with
cloud storage and has the following design features:

· Fastest image transfer protocol possible,
limited only by internet speed

· Robust transfer methodology guarantees

that images will be transferred without loss

· Intuitive user interface, simplifying workflow

for techs and film library staff

· Highest level of security available in image

transfer, backed with a complete audit trail

Medicom can be accessed on any computer with an internet connection

using the Google Chrome browser. Users with a PACS may choose to
install Medicom’s desktop application on their PACS workstation allowing
Medicom to send and receive directly from PACS. Medicom requires no
additional hardware.

In this White Paper, we describe technical details to assist IT, PACS man-
agers and other sophisticated users in the evaluation and implementation
of Medicom.

If you require further information, please contact us at 1-919-230-8868.

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 Contents
04 I. Data Transfer and Security

a. Data Transfer Protocol

b Database Storage and Account Information
c. Browser Security
d. HIPAA and HITECH Compliance
e. Business Associate Agreement (BAA)
f. Security Summary

07 II. Accounts, Licenses and Privileges

a. Account Types
b. Licenses
c. Administrator and Standard User Privileges

08 III. Account Setup

a. Institution/Organization
b. Sites
c. Users

09 IV. User Interface - Web Portal

a. Dashboard
b. User Settings
c. Passwords
d. Site Selection
e. Sending
f. Contacts
g. Receiving
h. Site History
i. Audit Trail
j. Site Settings
k. Billing
l. Help

12 V. User Interface - Desktop Application

a. Settings
b. Incoming
c. Outgoing
d. Autorouting and Rules
e. CD/DVD Importing

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 04
I. Data Transfer and Security
A. Data Transfer Protocol
Medicom’s transfer protocol is accessible in two ways:
1. Through Medicom’s website (accessed through
Google Chrome), or 2. via Medicom’s desktop appli-
cation, which functions as it’s own DICOM node under
the DICOM Standard. With either the website or the
desktop app, Medicom’s transfer protocol simplifies
image sharing through a hardware free, user-friendly
interface. Medicom’s proprietary networking protocol
connects users in real time via peer-to-peer connec-
tions, eliminating cloud storage.
Medicom’s proprietary transfer protocol involves
multiple steps: signaling, peer discovery, connection
negotiations, media stream encryption and decryption
before and after delivery, and persistent sending.
1 Signaling
Medicom initiates a peer-to-peer connection through
Medicom’s signaling server. When a sender initiates
a transfer, Medicom first ensures that the target peer
is reachable and willing to establish a connection.
Medicom has the ability to connect peers across
distinct and disparate networks and behind one or
more layers of NAT, both symmetric and asymmetric.
Medicom uses proprietary STUN messaging in order to
traverse NAT.
The target peer is notified of the connection offer
through Medicom, which can be configured to
manually or automatically accept the offer. Once the
target peer accepts a connection offer, the Medicom
server routes the response back to the user who
initiated the exchange. If the target user is not online
to accept the transfer, the peer waits for the other
user to come online.
2 Peer Discovery
Once users agree to establish a connection, Medicom
exchanges the information about the data stream.
Medicom uses Session Description Protocol (SDP)
to describe the properties of the media about to be
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exchanged. Once this description is generated, the
revised offer is sent to the target user via the signaling
channel.
3 Connection Negotiation
After the users agree to exchange the file stream,
Medicom identifies potential routing paths and checks
for connectivity. Medicom uses built-in Interactive
Connectivity Establishment (ICE) to perform the
necessary routing and connectivity checks. As soon
as Medicom implements a shared signaling channel, a
peer connection is established.
Unlike most peer-to-peer connections, Medicom’s
protocol does not require the use of UDP or the
opening of ports; this is possible because Medicom’s
proprietary version of STUN communicates over
common TCP ports. Medicom can therefore traverse
any firewall. This proves to be an advantage to our
customers as it maximizes their security systems
since they do not have to open vulnerable ports to use
Medicom.
Once Medicom establishes a peer connection, the
Medicom server disconnects before the files transfer.
Medicom creates an untraceable connection that
lasts the duration of the file transfer, preventing
vulnerability that leads to man-in-the-middle attacks.
No data is ever stored in the memory of any server or
data buffering system.
4 Media stream encryption and decryption
Medicom’s security features ensure privacy and
protection of data. For the Web Portal and the Desktop
Application, encryption is native and no plugins or
downloads are necessary, protecting the user from
potential malware packages or plugins.
Medicom encrypts the media stream using the 2048
Bit Datagram Transport Layer Security (DTLS) method.
DTLS is a standardized protocol and is designed to
medicom.us
 05 Data Transfer and Security

prevent eavesdropping and tampering. The method
was modeled on Transport Layer Security (TLS)
protocol which offers full encryption with asymmetric
cryptography methods, data confidentiality, and
message authentication. It is consistently used in
browsers, email, and VoIP platforms for encryption.
Each peer uses their own self signed certificate based
on 2048 RSA keys to exchange the private symmetric
2048 Bit DTLS key for each file transfer. This ensures
data can be secured over any SSL based connection
on the web. Medicom provides end to end encryption
between peers.
5 Persistent Sending
Medicom is the first hardware free system with failsafe
data delivery checkpoints. Medicom’s proprietary
algorithm monitors the internet connection and
validates that every bite of data is transferred. This
feature gives Medicom the capability of handling
interruptions in internet connectivity, as well as
computer and server restarts. For example, if a study
begins transferring and the internet stops working,
or if a user has to restart their computer or server,
when the user comes back online, the study will
resume transferring where it left off, until the study is
delivered. This is especially useful when transferring
from an unreliable internet connection, for example
from mobile radiology units to central archives, as
interruptions in cellular and satellite internet services
do not cause transfer failures.
As noted in the link above, our communication server
systems managed by Amazon Web Services (AWS)
are designed and managed in alignment with security
best practices, including: SOC1/SSAE 16/ISAE 3402
(formerly SAS 70), SOC 2, SOC 3, FISMA, DIACAP, and
FedRAMP, DOD CSM Levels 1-5, PCI DSS Level 1, ISO
27001, ITAR, FIPS 140-2 ,MTCS Level 3.
Audit Trails are encrypted with a separate user gener-
ated 2048 Block Chain Cypher. The Medicom Server
does not store or have a record of the account hold-
er’s encryption key for the Audit Trail. Consequently,
the Audit Trail is secure, compliant with HIPAA and
HITECH standards, and encrypted with two-factor
authentication.
All image data transfers occur through the peer-
to-peer connection after the connection has been
released from the Medicom Server; therefore, image
data is never saved or stored on the Medicom Server.
C. HTTPS Security
Medicom uses the HTTPS communications protocol
for secure communication over computer networks
to protect page authenticity throughout the Medicom
site, to secure accounts and to keep user communi-
cations, identity, and web browsing private. HTTPS
encrypts all the data it sends and receives to prevent
interception.

HTTPS is the worldwide standard for web pages that

B. Database Storage: Account collect and transfer credit card information and other
Information sensitive data.

The Medicom Server stores two types of information

in its database: Account Information and Audit Trails.
To keep account information secure, Medicom uses
2048-bit block chains to encrypt data stored on Med-
icom’s server. Our database of accounts utilizes state-
of-the-art electronic surveillance and multi-factor
access control systems. Our data centers are staffed
24x7 and are managed by Amazon Web Services.
Please view their security whitepaper for additional
information (http://d0.awsstatic.com/whitepapers/
compliance/AWS_HIPAA_Compliance_Whitepaper.
pdf).

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06 Data Transfer and Security

D. HIPAA and HITECH Compliance

Medicom is not designated as a covered entity under
HIPAA and HITECH rules (45 CFR 160.103). Never-
theless, we recognize that our account holders must
be fully HIPAA and HITECH compliant. Medicom’s
data transfer protocol exceeds HIPAA and HITECH
requirements for ePHI, allowing users to be compliant
with applicable rules (45 CFR 160.302-.318)

E. Business Associate Agreement (BAA)

Per the Omnibus Final Rule Conduit Exception (45 CFR
160.103 a.i), Medicom does not require a BAA as Med-
icom does not regularly access ePHI. All Audit Trails
are secured by the user’s key, which is unavailable to
Medicom. All image transfers pass through peer-to-
peer connections between users after Medicom has
released the connection.

F. Security Summary
At Medicom our first priority is security.

Medicom accomplishes an unparalleled level of se-

curity by eliminating central servers and cloud stor-
age. Instead Medicom uses a hardware free, highly
encrypted one time peer-to-peer connection to send
each individual imaging study.

By using RSA security tokens for all server process-

es and state-of-the-art end-to-end user encryption,
Medicom can ensure that all database and account
information is protected and transfers are fully HIPAA,
HITECH, and OMNIBUS compliant.

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07
II. Accounts, Licenses and Privileges
A. Account Types
Medicom has two account types: Full Accounts and
Free Accounts. A Full Account gives the user access
to all the features of Medicom outlined in this White
Paper. Free Account users have access to all the same
features with one exception: they are unable to initiate
new connections. This system is similar to the way
VPNs work in that only one partner in a VPN connec-
tion pays the cost of the direct line between the two
facilities.
With a Full Account, the user can transfer files (both
sending and receiving) with any other type of Medicom
user including facilities that have Full Accounts or Free
Accounts as well as facilities/individuals that have no
account (by sending a link to their email address).
Free Account Holders can transfer files exclusively
with organizations that have Full Accounts but only
after they have been invited by a Full Account holder
to share files.
This design allows Full Account holders to transfer
files with all other entities. A Full Account holder that
frequently sends studies to another site, would often
ask that site to sign up for a free account to facilitate
transfers. Where transfers occur infrequently or on
a one time basis and the receiver does not have a
Medicom account, the Full Account holder would likely
send to the receiver’s email address (when sending a
study, Medicom prompts for the name of the receiver.
If the receiver has no account, their email address can
be entered instead. Medicom then sends the receiv-
er an email containing a link to download the study.)
Sending to a non-account holder via email link by
Medicom is called Medicom Direct.
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B. Licenses
Medicom account holders, whether they are Full or
Free accounts may use Medicom’s Web Portal via
Google Chrome on an unlimited number of computers.
The Medicom Desktop Application can be installed on
an unlimited number of computers by both Full and
Free Account Holders. Account holders may have an
unlimited number of users on each account. Account
holders can transfer an unlimited number of imaging
studies.
C. Administrator and Standard User
Privileges
Medicom users are designated as either standard
users or site administrators.
Standard users have access to the image exchange
dashboard and a list of the site contacts which they
will use to send and receive images. They also have
access to the site transfer history which gives a
record of the last 30 days of transfers.
Site Administrators have all the functionality of
standard users and in addition, they have access to
Medicom’s Admin Controls, including which includes
their site’s settings, profile and audit trail. Site admin-
istrators can add or delete other standard users or
site administrators from a site.
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08

III. Account Setup

Medicom accounts are created on the Medicom Web Portal at https://medicom.us/siteregister.

To open a Medicom account, new users will need to provide their name, email address, institution/organization,
and site (See below for definitions of institution/organization and site). Medicom also requires the phone number,
fax number, city, and state of your site. Users will choose a password that meets Medicom requirements.

After a new account has been created, the user must activate the account by responding to an activation link sent
via email.

The first user of a site is, by default, the site administrator. On this user’s first login, they are prompted to invite
other members of their site and create an Audit Trail password. Additional members that are invited to join the site
will need to confirm their email and create a password to join the Medicom network.

A. Institution/Organization
Medicom uses Institution/Organization to identify the
parent organization to which an account belongs. The
Institution/Organization could be a company, hospital,
university, medical practice or another type of institu-
tion providing medical care. Since many Institutions/
Organizations have multiple divisions and facilities,
some Institutions/Organizations may have multiple
‘sites’ as described below.
For example: a large radiology group called “Statewide
Radiology” may have multiple divisions, offices, and
archives, but each site would come under their Insti-
tution/Organization name, “Statewide Radiology.”
C. Users
Users include standard users who will be sending and
receiving studies as well as administrators who may
also be viewing the audit trail, determining account
settings and profile, and adding or deleting other
users. Users can be members of multiple sites within
an instituition/organization. This allows individuals
who work at multiple sites within an institution/or-
ganization to have a single Medicom username and
password.

B. Sites
Medicom designates a Site as the location where Med-
icom is being used to transfer images. In Medicom,
accounts are assigned to Sites. In the simplest case,
a radiology practice that has only one location, the
site is the same as the organization. A larger radiology
practice with multiple locations could set up a Med-
icom Site for each of their locations. However, large
radiology practices that have multiple locations but
a shared archive may choose to have only one Medi-
com account at a single site such as a centralized film
library, where all imaging studies could be sent and re-
ceived. Please feel free to contact Medicom to discuss
the optimal number of accounts/sites to best match a
specific implementation.

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09
IV. User Interface - Web Portal
A. Dashboard
The Dashboard is equivalent to a user’s homepage.
From the Dashboard, users do the work of sending
and receiving studies as described in sections E and
G below. In addition, users can monitor the progress
of studies in transit and cancel transfers if necessary.
The Dashboard also provides links to access all other
user features described in this section.
B. User Settings
Users have the ability to update their profile informa-
tion and notification settings at any time.
Settings: editable user settings include:
• First name
• Last name
• Phone number
• Email
• Password
Notifications: Medicom offers notifications to keep
users informed of image files that have been delivered
or received at all times. Users may opt to receive a
notification upon receiving an incoming file transfer
to decrease wasted time at their desk or upon their
file being delivered to give them a reassurance that
their transfer was successful. Notifications may be
set to none, email, text, desktop, or any combination
of these. Sounds may also be configured to play on
incoming files to notify the user that their attention is
needed.
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C. Passwords
For security reasons, users must re-enter their current
password to update it. First and last name will be the
user’s identifier across the website in the History, Au-
dit Trail, and Dashboard. A user’s phone number will
not be available for other users to see but, if enabled,
will be used to send text notifications. The email of the
account will be used for the login procedure and for
email notifications.
D. Site Selection
When a user who works at more than one site within
an Institution/Organization logs into their Medicom
account, they are given the ability, in the top right
hand corner, to log into the site that they are work-
ing at on a specific day. This way, traveling techs or
medical records staff are always sending and receiving
studies on the behalf of the site where they are cur-
rently working.
E. Sending
Sending studies through the Medicom Web Portal
takes place on the user’s Dashboard. Users can select
studies to send by dragging and dropping them onto
the Dashboard or click the Send File button above
the Incoming and Outgoing sections. Users are then
asked to record the patient’s name, date of birth, type
of study, date of study, and any notes pertaining to
the study. From the sending module users can add or
remove files as needed before selecting recipients.
Users then select recipients from their favorites list,
by searching the global site list in the search bar, or
by typing the email address of the intended recipient.
Before finalizing the send a review page informs users
ofthe studies they have chosen as well as the intended
recipients. The sent studies will appear in the Outgo-
ing section of the Dashboard as “queued” until they
have been downloaded.
Note: Studies to be sent using Medicom’s Web Portal
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010
must be zipped before they are sent. In a typical
workflow, the user begins by exporting the study from
PACS to the downloads folder. In the downloads fold-
er the study is then zipped by right clicking on it and
selecting ‘compress’ on a Mac or ‘send to’ and then
‘compressed folder (zipped)’ on a Windows computer.
When selecting the study to be sent in Medicom, the
user can then navigate to the downloads folder and
select the zipped file.
The Medicom Desktop Application automates the
sending of files by receiving the study in DICOM format
from PACS or other sources, extracting the metadata
to identify the study, and then zipping the study.
F. Contacts
Medicom’s Contact feature allows sites to keep a
searchable and compact list of sites with whom they
transfer studies. The Contacts section displays the
organization, site name, and location of each contact
a site has added. Users may select to organize the
list of sites either by name or location. Contacts are
added to the list automatically whenever two sites
successfully complete a transfer between them for the
first time.Contacts may also be added manually by
searching for a site via the search bar. Once added as
a contact, sites used most often may be selected as
favorites to decrease the time spent searching for a
site. When sending a file, favorite sites appear above
the search bar for ease of selection.
G. Receiving
Receiving a study begins with a notification that
another site has posted a study for transfer. The
notification appears on Medicom’s Dashboard in the
Incoming section. Incoming studies are identified by
the patient’s name, the type of study, and the name of
the facility sending the study. To receive an incoming
study, users must click the download arrow beside the
study they intend to download. Once the study has
been downloaded it cannot be downloaded a second
time unless reposted by the sending site. The study
information and a transfer receipt will be visible under
the Incoming section for reference until the user
clears the record from the Incoming section or logs
out of Medicom.
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User Interface - Web Portal
Note: Imaging studies received will be held as a zipped
file in the Chrome browser. The zipped file will need to
be saved from the browser to the workstation. The file
appears at the bottom of the Chrome browser and can
easily be saved to the workstation’s download folder
by clicking on the file and selecting save to download
folder. Once in the download folder, the file can be un-
zipped and then will be ready for viewing or uploading
to PACS.
The Medicom Desktop Application automates the pro-
cess of receiving files by downloading, unzipping and
uploading the file to your PACS or viewer.
H. Site History
All users of a site may view the site’s history by
selecting ‘History’ from the menu on the left side of
Medicom’s Dashboard. History is separated into two
sections: Sent and Received. The History of a site con-
tains a list of each transfer that has occurred in the
previous 30 days and provides multiple details about
each transfer.
Information stored about each transfer:
• the filename and extension
• the user who performed the transfer
• the name of the organization and site that
participated in the transfer
• the date of the transfer
• the current status of the transfer
The History may be organized by any of the above
categories or searched via the search bar.
Detailed patient information is available about each
transfer in Medicom’s comprehensive Audit Trail which
is available only to site administrators.
I. Audit Trail
The Audit Trail, accessible from the Dashboard’s left
menu under Admin Controls, contains detailed infor-
mation, including patient information, about every file
transfer that has occurred at a site. To be compliant
with HIPAA and HITECH regulations, the Audit Trail re-
quires its own additional password. Upon site creation,
the site administrator will be prompted to create the
Audit Trail password which ensures the security of
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011
e-PHI. To achieve enhanced security, this password, is
not stored on Medicom’s server. Therefore, a lost Audit
Trail password is unrecoverable and as such should
be safeguarded by a site’s administrator. This is done
in an effort to prevent the theft of patient information
in the unlikely event of a security infiltration. With
the Audit Trail password, in the unlikely event of a
Medicom server breach, Audit Trail information would
remain fully encrypted and undecipherable with no
access to the cipher key.
Additional transfer information available in the Audit
Trail includes:
• Patient’s Full name
• Patient’s date of birth
• Date of study
• Type of study
• Name of the Institution/Organization and site
involved in the transfer
• Name of the User involved in the transfer
• Date of the transfer
• File name and extension
The information in the Audit Trail can be exported into
either a basic or comma separated value excel docu-
ment for ease of use and for Site Administrator’s re-
cords. As with the History, all information is separated
into either sent or received, and is searchable within
the Audit Trail.
J. Site Settings
Site Profile - Within the site settings, Site Administra-
tors may edit the site’s profile, the users of the site,
and the site’s billing information.
Editable site profile information includes:
• Organization
• Site name
• Location
• Phone number
• Fax number
Members - A site’s members may be organized by
name or permissions, searched for, added, or removed
within site settings. Current members of the site may
also be given administrative privileges if so desired.
Administrative privileges may be removed from a
member’s profile if necessary.
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User Interface - Web Portal
Billing - Within the billing information section, Admin-
istrators can add a payment method, edit their current
one, or remove it all together. Other information is
displayed such as the last four digits of the current
card being used for payment as well as when the next
payment is due for the site.
K. Billing
Site Administrators of Full Accounts are responsible
for paying for their site. Under site settings in admin
controls, the site administrator can access the billing
page, where they can choose a payment method for
their site with either a bank account or a credit card.
International transactions are processed and ACH
payments require account confirmation. Medicom bills
$500/month for a Medicom Site/Account.
I. Help
Medicom offers extensive guides for using both
our Web and Desktop application.
In the Web Portal, to view FAQs, click on the username
in the upper right hand corner.
For information on signing up for an account:
https://medicom.us/sitecreation
For information on using the Web portal:
https://medicom.us/webguide
To download the Desktop Application:
https://medicom.us/desktopDownload
(Note: this link contains configuration instructions,
but you must be logged in to access it).
For information on using the Desktop Application:
https://medicom.us/desktopguide
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012

IV. User Interface - Desktop Application

Medicom’s Desktop Application differs from the Web Portal in that the Desktop Application automates the sending
and receiving of imaging studies by interacting directly with a PACS or other DICOM node as described below.

To download and install the Desktop Application, click on the username in the upper right hand corner of the web
portal window and select ‘Install Medicom’. The installation is self-guiding. Medicom’s Desktop Application runs in
the background and can be viewed by clicking on the Medicom icon, a capital ‘M’ in the system tray.

A. Settings
The settings menu, accessible from the Medicom
Desktop Application by clicking on the gear icon in the
upper right hand corner, gives users access to their
account, preferences, configuration, and auto-routing
features. Inside the Account tabs users have ability
to change sites and logout. Under the Preferences
tab, users can adjust settings that control application
startup, auto-downloading of files, autoupdating, and
alternate download locations for files that cannot be
stored in PACS. Within the Configuration tab users can
set up DICOM nodes within Medicom to receive from
and send to the site’s PACS, archives or alternative
DICOM nodes. After DICOM nodes are configured they
can then be employed in the processes of Autorouting
as described in Section D.
B. Incoming
Incoming files appear under the incoming tab and are
listed with the patient name, the type of study, and the
name of the facility sending the study. An incoming
study can either be accepted manually, or if config-
ured for auto-downloading will be accepted automat-
ically only if the study has been sent from a site on
the contact list. Once a file transfer is complete, the
incoming study line items remains for reference until
cleared by the user. Once the study is accepted, it will
be received and transferred to the designated DICOM
node such as a viewer, PACS or archive.
C. Outgoing
When users send studies from their Archive to the
Medicom Application, a sending Module pops up with
data identifying the study populated from the study’s
Metadata. The Medicom window prompts the user for
the name of the site to receive the study. The user can
then select a site from their favorites list, contact list,
search the Medicom’s global site list in the search bar,
or type the email address of the intended recipient for
a Medicom Direct send. Once the user confirms the
recipient, the study moves into the outgoing section,
where it stays in a “queued” state until it is download-
ed by the recipient.
D. Autorouting and Rules
The Desktop Application offers a feature called Au-
torouting which allows outgoing files to be automat-
ically sent to a configured Medicom site much like a
VPN. When Autorouting is active, the file is sent to
Medicom’s listening DICOM node, where metadata is
extracted. User defined rules review the metadata
and act accordingly to send the study to a predefined
recipient or to multiple recipients. For example, a user
may choose to send all studies to a specific facility
when the referring physician metadata object is the
name of a Physician at that specific facility.
In addition, the Medicom rules allow you to automate
the organization of incoming studies as they arrive at
your facility. A user can specify to direct studies from
certain facilities or with specific metadata values, to
specific DICOM Nodes. For example, many archiving
installations contain hubs and spokes, images arriving
from certain facilities or for specific physicians, can
be sent to the intended archive, automating a process
that techs or film library staff often manage manually.

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013 User Interface - Desktop Application

E. CD/DVD Importing
The Medicom Desktop Application has the ability to
import studies or DICOM images from a variety of
sources, including CDs or DVDs, and send them direct-
ly to an archive, PACS, or to another Medicom site. The
Desktop Application will begin actively checking for
studies once the import button (a CD icon in the upper
left corner of the Medicom Desktop Application) is
clicked. The Disk Import feature will only search devic-
es and drives that are under 20 gigabytes in size. Once
accessible drives are found, each will display in the
Disk Import window and can be imported individually.
After an accessible drive is selected to be imported,
the Medicom Desktop Application will traverse the file
system and locate all DICOM files; studies are recog-
nized via the DICOM header information in accordance
with the DICOM standards. The Desktop Application
will ask the user to specify which files on the disk to
send, and then prompt the user to select a recipient,
unless the autoroute feature is turned on and directs
the studies to the intended recipient.

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