Abraham Gutman: Pretty soon, I realized that that’s not how medicine works. It’s not arbitrage. This whole notion that people have that most radiology images are leaving the United States and going to India to be read, is absolutely wrong. In the United States, you are required to have three things in order to be able to do a final diagnosis. The final diagnosis is what you need to have in order to be reimbursed by Medicare or insurance companies. The three things are the following. You need to have board certification in the United States. You can have this if you’re a foreign doctor. You need to have a license in the State where the images were taken. That’s also manageable. But, you also have to be on US soil to do the reading.
Sramana Mitra: That rules out all this off-shore business.
Abrahama Gutman: Images are not going to India. That’s a myth. I started to sell this. I went to Brigham and Women’s Hospital, which is one of the two big Harvard hospitals here in Boston. I went to them and said, “I have this network. You should put your images on to my network.” They said, “Okay, but you’re not going to be doing arbitrage. We’re reading for a bunch of other hospitals in Massachusetts. We’re using these VPN and they are impossible to deal with.” Immediately, the hospital began to use our network. I had my first customer. Now we’re talking 2007. Then, I got a phone call out of the blue from a doctor at Brigham saying, “I understand you are moving images for our radiology department. Can you move images in support of clinical trials?” I said, “What is a clinical trial?”
Sramana Mitra: If it’s digital, it’s no big deal.
Abrahama Gutman: He said, “We need to move these phenomenally large images. You shouldn’t worry about what a clinical trial is. Can you move these images for us?” I said, “Yes.” The price points were completely different—significantly better. Within three months, we were deployed at the top 15 hospitals in the United States.
Sramana Mitra: For moving clinical trial data?
Abraham Gutman: For that specific clinical trial. We went from being in Brigham to being at the Cleveland Clinic, Mayo Clinic, Hopkins, NYU, and Cedars-Sinai.
Sramana Mitra: That’s really cool.
Abraham Gutman: My business had two chapters. Each one had only one page. One page said hope and the other said luck. At that point, moving these images on our network required us to have hardware deployed on both ends of the transaction. We started to look into clinical trials, which sounded interesting. Fast forward a few months and we realized that clinical trials are, in fact, interesting but that you cannot deploy hardware particularly on the sending side because global clinical trials are temporary, two- to four-year projects. If you begin shipping hardware everywhere and then collecting that hardware, the business proposition just doesn’t work.