Telementoring: using the Kinect and Microsoft Azure ...

Int. J. Electronic Finance, Vol. 7, No. 1, 2013

33

Telementoring: using the Kinect and Microsoft Azure to save lives Janet L. Bailey* University of Arkansas at Little Rock, 2801 S. University Ave, Little Rock, AR 72204, USA E-mail: [email protected] *Corresponding author

Bradley K. Jensen Microsoft Corporation, 7000 North State Highway 161, Irving, TX 75039, USA E-mail: [email protected] Abstract: This paper outlines a study and technology that teleports the knowledge and skills of doctors when and where they are needed resulting in a reduction of costs by reducing the number of patients who must be transported from remote areas to cities where specialists are located. Rapid access to specialists’ expertise results in lowered risk of death or permanent damage which requires lifelong treatment and monitoring. The technology presented in this paper has the potential to replace and/or supplement existing telemedicine systems costing in excess of $25,000 with a laptop, a $150 Kinect, an Azure connection, and an Office 365 account. The Kinect allows doctors to control the system without breaking the sterile field via hand gestures and voice commands with a goal of reducing the direct cost of healthcare associated infections to hospitals and patients in the USA currently ranging from $28.4 to $33.8 billion annually. Keywords: telemedicine; Kinect; Microsoft Azure; e-health; e-finance; telementoring; healthcare. Reference to this paper should be made as follows: Bailey, J.L. and Jensen, B.K. (2013) ‘Telementoring: using the Kinect and Microsoft Azure to save lives’, Int. J. Electronic Finance, Vol. 7, No. 1, pp.33–47. Biographical notes: Janet L. Bailey is an Associate Professor of MIS at the University of Arkansas at Little Rock. She is president-elect for Southwest Decision Science Institute, member of Microsoft Enterprise Consortium Board of Directors, UALR Student AITP Advisor, and Microsoft Imagine Cup mentor since 2009 for four National Finalists, two third-place winners, and two World Finalists. Her students have collectively deployed over 500 applications to Azure as well as an Azure proof-of-concept presented to Walmart and Microsoft Senior Executives. Under her leadership her students have made presentations at the US Public Sector CIO Summit and the Microsoft Cloud Futures Conference.

Copyright © 2013 Inderscience Enterprises Ltd.

34

J.L. Bailey and B.K. Jensen Bradley K. Jensen is a Principal Academic Relationship Manager at Microsoft. A 2011 Circle of Excellence Platinum Award winner, he is also a former faculty member and senior executive of Xerox Corporation. He serves as co-chair of the Board of Directors for Texas Business and Education Consortium STEM, co-chair of the Microsoft Enterprise Consortium Board of Directors, and member of numerous MIS, CS, and industry advisory boards. His proven accomplishments are in information security, business intelligence, innovative technologies, project management, strategic alliances, e-commerce, strategic marketing, P&L management, team building, cloud computing, and mobile development.

1

Introduction

What do you do if you find yourself in need of a medical specialist and you are not in a major city in the USA? Although, according to the US Census Bureau, there are approximately 7600 hospitals and roughly another 25,750 health clinics in the USA (Bureau of Labor and Statistics, 2012; US Census Bureau, 2012) how many of these have specialists if you are in a life threatening situation where that would make the difference? “(This a problem that is) rooted in the 1980s and 1990s, when US medical schools put a cap on enrolments, believing that managed healthcare, among other factors, would create a glut of doctors. They were wrong. And now the impact of a national shortage of surgeons and family practice doctors is echoing across the country (Davis, 2008)”. The problems are just as acute if not more so in other parts of the world. In the London area 79% of victims of accidents in rural areas die on the scene, another 11% during transport. Forty-nine percent of casualties require at least two hours to reach adequate hospital care (Pavlopoulos et al., 1998). In Germany, the shortage is so severe that in some cases even general practitioners are retiring without being able to find a successor for their practice (Terschuren et al., 2012). One way to address a shortage or complete lack of specialists in a given area is telementoring. Defined by SAGES as “real-time interactive teaching of techniques by an expert surgeon to a student not at the same site” (SAGES, 2009), telementoring can potentially provide a less experienced physician or medical personnel with guidance from a specialist to help them perform a procedure or make decisions they would not otherwise be capable of (Augestad and Lindsetmo, 2009). The first example of telementoring was performed in 1962 by DeBakey (1995). Technology has come a long way since then but after listening to the concerns of local medical personnel and individuals with family members living in small towns that are inadequately served by specialists, the authors sought answers to the following questions: •

Are current technologies meeting the telementoring needs of the medical community?

•

If they are not meeting the needs of the community, what do physicians and specialists want or need from a telementoring solution?

Once the initial data was collected, the primary objective was to develop a prototype to address those needs.

Telementoring: using the Kinect and Microsoft Azure to save lives

35

This paper presents background on the shortage of specialists and a synopsis of the current status of telemedicine and telementoring, the methodology and findings of the interviews conducted with medical personnel of all walks, the architecture of the prototype developed, and a discussion of the impact technology can have on costs to patients, insurance companies, and society at large.

2

Background

Healthcare systems worldwide are based on the premise that there will be medical experts available to address the needs of the global population. According to the US Census Bureau, there are approximately 7600 hospitals and roughly another 25,750 health clinics in the USA alone (Bureau of Labor and Statistics, 2012; US Census Bureau, 2012). Despite the fact that healthcare in the USA is among the best in the world, the reality is the number of specialists falls far short of the number needed. During the 25-year period from 1980 to 2005, medical enrolment remained flat while the US population grew by 70 million. Today 34%, or roughly 250,000 doctors, are 55 or older. Medical schools have increased enrolment, however, the majority of graduating doctors are choosing to move to major cities because the rate of pay is higher in metropolitan areas. As a result, the inequities for residents in rural areas who need access to specialists are significant and create a multitude of challenges in the quality of care (Bennett et al., 2008).

2.1 Medical expertise shortage Table 1 which has been calculated using data collected from the Bureau of Labor and Statistics (2012) starkly illustrates just how severe the per capita shortage is. Furthermore as previously mentioned, the problem is not limited to the USA. The dots on the map in Figure 1 represent major concentrations of specialists around the globe. Looking at the map, it becomes painfully obvious the majority of the world’s population does not have adequate access to the expertise they or a loved one might need. This is not to say there are not specialists in other locations but the numbers are few and far between and while there may be one or two specialists in a given area, all important disciplines are not adequately represented. Figure 1

Worldwide shortage of specialists (see online version for colours)

Source: World Health Organization (Figure by Aaron Rothberg)

36 Table 1

J.L. Bailey and B.K. Jensen Specialists per capita

Physician and surgeon breakdown Population of the USA: 307,006,055 Profession category No. available % of total Profession to population ratio Haematologist 8210 7.37 1 : 37,394 Neurologist 12,200 6.30 1 : 25,164 Orthopaedic surgeons 19,922 11.01 1 : 15,410 OB/GYN 19,940 30.92 1 : 15,397 Radiologist 20,000 15.83 1 : 15,350 Surgeons (other) 23,308 9.51 1 : 10,200 Paediatrician general 30,100 6.30 1 : 13,172 Anaesthesiologists 34,820 3.86 1 : 8,817 Internist general physicians 50,070 6.32 1 : 6,132 Family and general physicians 97,820 2.59 1 : 37,139 Source: Bureau of Labor and Statistics Occupational Outlook Handbook 2012–2013

2.2 Telementoring effectiveness and deterrents Telemedicine and telementoring have been shown to be effective yet there are a number of deterrents that have slowed progress being made in the field which include legal implications (Dickens and Cook, 2006), patient privacy and security of patient records (Dinh and Chu, 2006; Granade, 1995; O’Toole et al., 2011; Turner et al., 2003; Whitten et al., 2000), health insurance companies’ reluctance to accept the technology (Turner et al., 2003), shortage of individuals who know how to use the complicated technology (Matusitz and Breen, 2007), and cost of equipment and training (Dinh and Chu, 2006). Research further shows that due to excessive regulatory burdens, inter-hospital networks tend to be non-collegial unless there is a financial incentive to do so. Unfortunately, Medicare will not reimburse a hospital if it transfers a patient prior to admission (O’Toole et al., 2011). Interviews during a 2011 stroke study also revealed a high number of financial impediments including the fact that stroke care tends to be unprofitable for hospitals, the requisite focus on efficient use of resources poses challenges to availability of diagnostic procedures, and the drain of finances and other resources as hospitals are required to continually update protocols to maintain currency with improvements in the science of stroke care slows the incorporation of requisite telemedicine technology (O’Toole et al., 2011). On the flip side, real-time access to specialists via telemedicine has proven to decrease mortality rates, ICU complications, and ICU length of stay (Rosenfeld et al., 2008). It can reduced length of hospital stay related to birth weight (Redina, 1998), result in fewer adverse events during neurosurgery transfers (Goh et al., 1997a, 1997b; Granade, 1995), and improve the convenience of patients undergoing routine procedures such as colonoscopies (Essex, 2009). The ability to treat an acute stroke victim at the site has been shown to result in significant healthcare savings in transportation costs (Shuaib et al., 2010) as well as being much more successful at preventing brain damage thus reducing lifelong treatment and monitoring (Walter et al., 2010).

Telementoring: using the Kinect and Microsoft Azure to save lives

37

Strokes are responsible for more chronic adult disabilities than any other cause and they are a leading contributor to death and dementia (Rothwell et al., 2005; Van der Worp and Van Gijn, 2007). In the state of Arkansas, strokes dwarf all other causes of death. Thanks to a new telementoring program called AR Saves, 39 hospitals across the state now have access to specialists in the Little Rock area who assist them in diagnosing and treating a stroke victim. The program in place less than 12 months has seen a 40% drop in mortality from strokes at participating hospitals (AR Saves, 2012; KHTV, 2012). The University of Arkansas Medical Sciences (UAMS) also has a telementoring program in place for high-risk pregnancies and maternal health (UAMS, 2012). “Healthcare is evolving faster than ever, and telemedicine is becoming an increasingly important component of the overall healthcare delivery system (Lowery, 2012)”. While UAMS’ current program is quite successful, their goal is to get the technology into every hospital and clinic in the state. However, the sheer cost and cumbersomeness of the equipment has hindered their progress towards this goal.

3

Methodology and data

The methodology was a two part process: Part 1 consisted of structured interviews with doctors, specialists, members of AR Saves, and first responders in addition to performing archival research of telemedicine technologies currently being used. Participants also shared information from their work with the Mayo Clinic in the telemedicine field. Part 2 consisted of JAD communications with the individuals who participated in the structured interviews at regular intervals to provide continual review of and enhancements to the design. The interviews revealed that medical specialists wanted and needed the following capabilities: •

simultaneous sharing, collaboration, and annotation of medical images

•

ability to control which medical data and images are shared

•

voice and video communication with the ability to capture still images from the live video stream

•

ability to have as many concurrent participants as necessary so that specialists from multiple disciplines can participate

•

the capability of controlling the technology without breaking the sterile field or having to rely on someone else to put medical images up for viewing

•

a secure collaborative environment due to the nature of the data

•

a solution affordable and compact enough to place in homes of specialists on call and in hospitals and clinics across the state

•

the ability to use a single system rather than having to combine a video conferencing system with multiple computers and software applications

•

a communication desktop-sharing system specifically designed for the medical community

•

an easy and intuitive interface.

38

J.L. Bailey and B.K. Jensen

Working from the results of the interviews and with the continued input of the medical professionals a telemedicine solution called Collaboration and Annotation of Medical Images (CAMI) was developed. According to the medical participants, there is currently no system of its kind on the market. Rather medical professionals need to utilise multiple disparate solutions in conjunction to achieve a portion of what CAMI provides. They need to use a medical image application, a communications solution that allows for the sharing of the desktop as well as voice communication and video streaming software. The time required by doctors to setup a communication portal using all the disparate components is expensive in both money and time. As an illustration of how much money the lost time on the part of a specialist can cost, an unrelated recent calculation by radiologists at UAMS revealed that a technology implemented for all radiologists in the hospital that saved each of them 20 sec a day translated into $125,000 of annual savings (Harrod, 2011). Furthermore, in critical situations, the patient does not have the luxury of waiting for a series of unrelated components to be brought up collectively. Many current applications provide audio and video communications, such as Live Meeting or Skype, although unlike CAMI, these applications use a consumer driven interface and are not designed specifically for medical purposes. Participants stated current applications that provide desktop collaboration are designed for consumers and leverage typical mouse/keyboard inputs, such as clicking through menu items or using keyboard shortcuts which is time consuming and that in life-threatening situations, minutes and sometimes seconds make the difference between life and death.

4

Architecture

In response to these concerns, CAMI was developed to utilise the traditional mouse/keyboard solution for remote regions of the world that cannot afford and do not have other forms of input devices. CAMI also works with touch input (tablets, slates, and other mobile devices), full voice navigation support, as well as the Kinect for hands-free control to reduce the risk of Hospital Associated Infections (HAIs). In contrast, current applications can be run on desktops or laptops in hospitals and health clinics, but once a medical professional uses the mouse/keyboard input they have broken the sterile field. The Kinect is especially useful in environments such as an operating room. Hospitals or health clinics around the world can benefit from a reduction in germ laden equipment and maintenance of sanitary surgical environments. In a report for the CDC in 2009, the direct cost of HAIs to hospitals and patients in the USA alone ranges from $28.4 to $33.8 billion annually. There are 1.7 million HAIs annually. 99,000 result in death (Clancy, 2011). Additionally, doctors and patients can both benefit from the fact that by using the Kinect as CAMI’s input device, the doctor can focus on the patient rather than the technology. Non-profit organisations like Doctors without Borders, the World Health Organization, and UNICEF, as well as small private clinics and rural hospitals can benefit from the affordability of the technology. Participants in the research and design of the product at UAMS and AR Saves, both leaders in the field of telemedicine, indicated the affordability of the Kinect coupled with Azure and the way it is used by CAMI have the potential to revolutionise the field of telemedicine.

Telementoring: using the Kinect and Microsoft Azure to save lives

39

It should be noted that this project is still ongoing and that as the development and testing phase has not yet been completed, no patient data has been collected to date.

4.1 CAMI vs. current technologies CAMI is a unique telemedicine solution because it is designed in such a way as to provide medical professionals with a low-cost, intuitive, easy to use, fully integrated solution that allows them to focus on the most important person in the room – the patient. Biometrics has been suggested as a preferred method of security to address the concern of access to a patient’s confidential data by unauthorised personnel (Zaidan and Zaidan, 2011). The Kinect not only provides the capability to incorporate a biometric login but to do so using facial recognition so as to avoid breaking the sterile field. In addition to being able to control the Kinect with hand gestures, CAMI allows the medical professional complete control over the system via voice control for time when their hands may be otherwise occupied such as a surgeon actively working on a patient or a paramedic working to stop bleeding at the scene of an accident. The ability for the surgeon to be able to control which image is displayed without having to direct a human assistant, to be able ask the system to call a specialist for an emergency consultation, and to audibly make annotations on an image or to capture still images from the video to enhance the communication with the remote specialist are all anticipated to be significantly life-saving capabilities. Running on a slate connected to a webcam and Kinect, CAMI is portable and easily taken into the field to be used by paramedics and first responders. When coupled with satellite communication, CAMI could be deployed by military medics operating in war-torn areas. Some medical professionals are currently attempting to use desktop applications that provide collaboration, such as Live Meeting, but while these allow for application and desktop sharing, synchronous control of the desktop is rare with sharing being passed back and forth between participants. Table 2 indicates the differences between the current telemedicine technology currently in use in the state of Arkansas and CAMI.

4.2 CAMI’s interface CAMI’s New User Interface (NUI) is broken up into six sections as shown in Figure 2. The main working area contains all images, video streaming, and video-captured still images. This section of the screen is where any annotations occur. The toolbox, menu, and thumbnail areas are collapsible to maximise screen real-estate. Toolbox buttons have been made larger to accommodate selection via hand control but not so large as to use valuable screen real-estate. The toolbox includes the following capabilities: •

Annotation (Pencil) so doctors can draw, write or otherwise document on a given image.

•

Clear annotation (Eraser) in the event that a doctor does not wish to keep the annotations that have been made. Unless the annotation is cleared, all annotations will be saved in the patient’s file.

40

J.L. Bailey and B.K. Jensen

•

Zoom to allow doctors the capability of enlarging and focusing in on a particular part of a given image.

•

Reset image to allow for a quick reset to the original size of the image.

•

Grid overlay to improve precise understanding of what location one or more of the doctors is referring to during communication.

•

Capture image from live video feed for documentation purposes or to allow for annotations to be made.

•

Scroll images (Next and Previous are designated by the directional arrows). Note that images do not have to be medical images such as x-rays. They may also be PDFs of admission documents, pictures of an auto accident the patient was involved in, or any other type of document the doctor feels is relevant and should be entered into the system.

Table 2

Current telemedicine technologies vs. CAMI (see online version for colours) Current telemedicine technology

CAMI

Hardware cost No. of connections

$25,000.00 4

Integration capabilities

No patient record/image integration Complex multiple pieces of equipment Little to none

Runs on existing hardware Limited only by the situation instead of the technology Yes

Ease of use Mobility

Single intuitive interface Yes

The Top Left section displays the doctor(s) or hospital connected. The Top Middle section is used to display the patient’s information once it has been loaded. The Top Right section shows visible confirmation of actions and selected tools. Specialists whose availability is indicated by standard Lync indicators appearing on the right. Lync is used because it is a well-established, stable, and familiar platform that allows for unlimited participants. The list of specialists comes from a database of vetted specialists housed on Azure. Only specialists on call and who are granted permission to ‘practice’ remotely at the host hospital appear. Specialists may reside anywhere in the world. Since the doctor who is with the patient initiates the conversation and only specialists the hospital has pre-approved appear in the list of options for connection, legal issues should be in the same realm of a face-to-face consultation with a doctor approved to practice at the facility.

Telementoring: using the Kinect and Microsoft Azure to save lives Figure 2

41

CAMI NUI and unique features (see online version for colours)

Source: Figure by James Taylor

The ribbon across the bottom is used to display the patient’s images that are currently in the system, as well as any saved images that contain annotations. Anyone of the medical personnel connected to the session can annotate and save images to the patient file. To maintain consistency between all connected parties, CAMI uses a web service running on Azure that updates each of the applications connected in near real-time to provide for a smooth manipulation and annotation of images. There is no technical limit to the number of doctors that can be connected. If needed and practical, 100 doctors could simultaneously be participating in the same conference, controlling images, and annotating – all from their own location and all using a Kinect or a myriad of other input devices including a keyboard, mouse, touch and even the Windows Phone. The system is developed so that the Kinect can work in tandem with any or all of these devices. The CAMI user interface has been designed to be as user-friendly and intuitive as possible. The layout supports a clean design to allow for easy navigation and has been tested to provide the optimal colour combination for ease of viewing of medical images. All buttons use commonly recognised symbols that identify the command. Initial testing has shown the interface and intuitive design minimises training time and maximises satisfaction. Voice commands are intuitive with audible and visible confirmations from the CAMI application to verify activity.

4.3 Technical architecture Patient records never leave the host site but are instead accessed by a CAMI database of pointers also housed on the host site. This coupled with the vetting of the specialists, the fact that specialists cannot initiate communication with the host, the biometric login security layer at the host site, and the fact that images are being transmitted via web services over Azure and the security that brings to the table, provides powerful security to protect a patient’s privacy and ensure HIPAA compliance.

42

J.L. Bailey and B.K. Jensen

The process starts when a patient arrives at a local clinic. If the doctor or medical professional who is available to treat them has the requisite expertise, they can use CAMI as a stand-alone system. However, as has already been established, in small towns, rural areas, and even some suburbs of large cities, the necessary expertise is not available. When this situation occurs, the physician present with the patient accesses CAMI and identifies one or more specialists he or she wishes to connect to. A secure connection via SSL is created and Lync conferencing is used to create a video conference. The specialist receives a ‘request’ from CAMI and must accept in order for the connection to take place. The connection can be made via desktop, slate, or even Windows Phone. Once the specialist has accepted the request, a web services connection is made which starts the sharing of the medical images. Full synchronous sharing and control of annotating on the images is available to each party and all annotations are saved for future use but the patient records never leave the premise. The physician or medical professional at the patient’s location may use any input device although the Kinect provides the optimal hands-free environment. Figure 3 provides a visual representation of the CAMI’s architecture. Figure 3

CAMI’s technical architecture (see online version for colours)

Source: Figure by James Taylor

4.4 Microsoft Azure plays a major role According to a Wall Street Journal article published in April 2010, there are an estimated 954,000 doctors in the USA (Sataline and Wang, 2010). However, as the complexity of medicine has increased it has become impossible for any one person to know everything about even one subject much less multiple ones. Therefore, it is critical to provide a connection between doctors so they can pool their knowledge and skill sets. Azure plays a major role in this process. Doctors and specialists join the system, being pre-vetted and having accounts setup in SQL Azure. Using the Lync feature of Office 365, CAMI allows the doctor with the

Telementoring: using the Kinect and Microsoft Azure to save lives

43

patient to search the database for a particular doctor or all doctors with a particular specialisation. Only those doctors who are available and approved by the hospital appear. Early evaluation by an AR Saves technician is that CAMI shows extreme promise for replacing their current complex system and that with the incorporation of a larger database of doctors (i.e., a national database), time could be reduced even further than it currently is (Hogbin, 2012). Although the data being stored on Azure does not fall under HIPAA guidelines, it is critical that the data on specialists who can be contacted be kept secure. Azure is the perfect environment for this because it is an industry-recognised secure platform that has achieved FISMA, ISO 27000, and SAS 70 Type II certifications. In addition to keeping the database of doctors who may be contacted for assistance on Azure, video conferencing logs can be stored on Azure in Blob format at the client’s discretion as protection against possible future lawsuits. Of course, such logs could contain damming information if the doctor was actually at fault.

5

Discussion

As previously mentioned, there are several impediments to the advancement of telemedicine. The capabilities in CAMI have the potential to address several of them. Legal implications which occur due to interstate licensing and institutional credentialing of physicians are still somewhat of a concern. However, by allowing the hospital to identify which doctors have ‘practicing rights’, the way is paved for access to more physicians whether they be in state or out, while still ensuring control by the hospital of who is contacted. It has been suggested that the quality of healthcare can be improved by the creation of social media platform between patient and doctor (DeVries, 2012). CAMI creates a social network of sorts between doctors. Physicians are much more likely to contact a specialist they know and trust. CAMI provides the mechanism to do so. Privacy and security of patient records is addressed through biometric logins, SSL connections, and security inherent in Lync and Azure, in addition to the fact that the patient records never leave the hospital or clinic where the patient is located. Recorded sessions can protect against lawsuits which can result in significant savings if the recording proves the innocence of the doctor and/or medical facility. The general lack of people who know how to use complicated technology can be reduced by providing doctors with a system they helped design, one that utilises frequently used Microsoft communication technologies such as Lync, and common, recognisable icons. The cost of the equipment also represents a significant savings over current configurations which run in excess of $25,000 per installation as CAMI runs on existing equipment connected to a Kinect and a webcam. Even the Kinect is optional. While the quality of the video provided by an inexpensive webcam is not as high as a more expensive unit, a pathologist on the Italian Island of Lampedusa who urgently needed to confirm the diagnosis of malaria armed only with the camera on her smartphone proved that inexpensive cameras can significantly “increase opportunities and quality diagnostics while lowering costs and considerably increasing connectivity between most isolated laboratories and distant reference centres (Bellina and Missoni, 2009)”. We expect CAMI to be no different.

44

6

J.L. Bailey and B.K. Jensen

Implications and conclusions

CAMI is not anticipated to be a panacea to the telemedicine environment but it is a powerful tool that can be affordable in virtually any community that has existing technology and communication infrastructure. The system has been tested on fast and slow bandwidths without failure. Redundancy is built into the communications. Video does not depend on the audio. The ability to share and communicate via images does not depend on audio and/or video. Bringing Azure and the Kinect into the arsenal of telemedicine makes the future very exciting. The current technology and capabilities are just the tip of the iceberg. Imagine doctors being able to volunteer a few hours or a day of their time to assist Doctors Without Borders. Imagine medical schools in the USA being able to train doctors in remote regions of the world using inexpensive Kinect technology. Imagine a future where the world no longer has medical haves and have not’s. The future is indeed very bright. Quite simply, to address the growing healthcare needs of the world’s population, a telemedicine solution that allows doctors or other medical personnel to speak with an expert, share the images, and show a live video stream of the patient is needed. In order for the technology to be available to as much of the world as possible, it needs to have the following characteristics: •

be small, easily portable, and inexpensive enough to transport with doctors working in or travelling to remote villages and towns and to put in the homes of specialists who can then be on call without being in a hospital

•

allow the medical personnel to control the system without having to touch a keyboard, mouse, or touch screen once they start working with the patient.

In short, the solution is a collaborative medical system using a Kinect attached to a Windows device. For the ultimate portability, a Windows slate is suggested. The financial impact on individuals and facilities alike can be significant in a number of ways: •

inappropriate triage transport from one hospital to another for diagnostic purposes is expensive (Breen and Matusitz, 2010; Walcott et al., 2011) for both individuals and insurance companies

•

costs required to care for a person with permanent disabilities due to delayed treatment are significantly higher

•

more affordable equipment and training will lead to opportunities for greater telementoring coverage which will save time, money and lives

•

specialist mentoring helps produce more accurate diagnoses and treatment thus improving quality of life and reducing the risk of lawsuits

•

pure logic says that lives saved also result in more productive members of society.

CAMI has the potential to save costs and increase productivity in addition to reducing the negative impact of emergency situations on families and individuals. Saving lives is not a game filled with fun-packed action and the amazing graphics the Kinect is capable of but thanks to the other extraordinary capabilities of the Kinect coupled with its affordability and the functionality of CAMI, people all around the world,

Telementoring: using the Kinect and Microsoft Azure to save lives

45

in the near future, will be able to enjoy having fun with their loved ones rather than mourn their loss.

Acknowledgments The CAMI project presented in this paper was developed by a team of four MIS students: Stephen Burks, Daniel Harrod, Aaron Rothberg, and James Taylor. The project took Third Place in the 2012 US National Imagine Cup Finals and was selected as the student-developed technology for presentation at the 2012 US Public Sector CIO Summit in Seattle.

References AR Saves (2012) AR Saves Annual Report 2011, Little Rock, AR. Augestad, K. and Lindsetmo, R. (2009) ‘Overcoming distance: video-conferencing as a clinical and educational tool among surgeons’, World Journal of Surgery, Vol. 33, pp.1356–1365. Bellina, L. and Missoni, E. (2009) ‘Mobile cell-phones (M-phones) in telemicroscopy: increasing connectivity of isolated laboratories’, Diagnostic Pathology, Vol. 4, http:// www.diagnosticpathology.org/content/4/1/19 Bennett, K., Olatosi, B. and Probst, J. (2008) Health Disparities: A Rural – Urban Chartbook, Rural Health Research & Policy Centers, http://rhr.sph.sc.edu/report/(7-3)%20Health% 20Disparities%20A%20Rural%20Urban%20Chartbook%20-%20Distribution%20Copy.pdf Breen, G. and Matusitz, J. (2010) ‘An evolutionary examination of telemedicine: a health and computer-mediated communication perspective’, Social Work in Public Health, Vol. 25, pp.59–71. Bureau of Labor and Statistics (2012) Occupational Outlook Handbook, www.bls.gov/ooh/ Clancy, C. (2011) Preventing Healthcare-Associated Infections: Initiating Promising Solutions and Expanding Proven Ones, Agency for Healthcare Research and Quality, http://www.ahrq.gov/ news/commentaries/comhais.htm Davis, R. (2008) ‘Shortage of surgeons pinches US hospitals’, USA Today, http://www.usa today.com/news/health/2008-02-26-doctor-shortage_N.htm DeBakey, M.E. (1995) ‘Telemedicine has now come of age’, Telemed Journal, Vol. 1, pp.3, 4. DeVries, P. (2012) ‘Electronic social media in the healthcare industry’, International Journal of Electronic Finance, Vol. 6, pp.49–61. Dickens, B.M. and Cook, R.J. (2006) ‘Legal and ethical issues in telemedicine and robotics’, International Journal of Gynecology & Obstetrics, Vol. 94, pp.73–78. Dinh, M. and Chu, M. (2006) ‘Evolution of health information management and information technology in emergency medicine’, Emergency Medicine Australasia, Vol. 18, pp.289–294. Essex, D. (2009) ‘Did someone say virtual colonoscopy’, Communications of the ACM, Vol. 52, pp.16–18. Goh, K.Y., Lam, C.K. and Poon, W.S. (1997a) ‘The impact of teleradiology on the inter-hospital transfer of neurological patients’, British Journal of Neurosurgery, Vol. 11, pp.52–56. Goh, K.Y., Tsang, K.Y. and Poon, W.S. (1997b) ‘Does teleradiology improve interhospital management of head-injury?’, Canadian Journal of Neurological Sciences, Vol. 24, pp.235–239.

46

J.L. Bailey and B.K. Jensen

Granade, P. (1995) ‘Malpractice issues in the practice of telemedicine’, Telemedicine Journal, Vol. 1, pp.87–89. Harrod, D. (2011) Project Developer, University of Arkansas Medical Sciences, Interview by Janet Bailey. Hogbin, R. (2012) UAMS Center for Distance Health Technician, Interview by Janet Bailey. KHTV (2012) Strike Out Stroke at Dickey Stephens, http://littlerock.todaysthv.com/ news/news/93998-strike-out-stroke-dickey-stephens Lowery, C. (2012) UAMS Wins National Telemedicine Award, http://cdh.uams.edu/news/? sid=34&nid=9099&id=11504 Matusitz, J. and Breen, G.M. (2007) ‘Telemedicine: its effects on health communication’, Health Communication, Vol. 21, pp.73–83. O’Toole Jr., L., Slade, C., Brewer, G. and Gase, L. (2011) ‘Barriers and facilitators to implementing primary stroke center policy in the United States: results from 4 case study states’, American Journal of Public Health, Vol. 101, pp.561–566. Pavlopoulos, S., Berler, A., Kyriacou, E. and Koutsouris, D. (1998) ‘Design and development of a multimedia database for emergency telemedicine’, Technology and Health Care, Vol. 6, pp.101–110. Redina, M.C. (1998) ‘The effect of telemedicine on neonatal intensive care unit length of stay in very low birthweight infants’, Proceedings of the 1998 AMIA Annual Fall Symposium. AMIA, 10–11 November, Orlando, FL, pp.111–115. Rosenfeld, B.A., Dorman, T., Breslow, M.J., Pronovost, P., Jenckes, M., Zhang, N., Anderson, G. and Rubin, H. (2008) ‘Intensive care unit telemedicine: alternative paradigm for providing continuous intensivist care’, Critical Care Medicine, Vol. 28, pp.3924–3931. Rothwell, P.M., Coull, A.J., Silver, L.E., Fairhead, J.F., Giles, M.F., Lovelock, C.E., Redgrave, J.N.E., Bull, L.M., Welch, S.J.V., Cuthbertson, F.C., Binney, L.E., Gutnikov, S.A., Anslow, P., Banning, A.P., Mant, D. and Mehta, Z. (2005) ‘Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories’, Lancet, Vol. 366, pp.1773–1783. Sataline, S. and Wang, S. (2010) Medical Schools Can’t Keep Up, http://www.usatoday.com/ news/health/2008-02-26-doctor-shortage_N.htm Shuaib, A., Khan, K., Whittaker, T., Amlani, S. and Crumley, P. (2010) ‘Introduction of portable computed tomography scanners, in the treatment of acute stroke patients via telemedicine in remote communities’, International Journal of Stroke, Vol. 5, No. 2, pp.62–66. Terschuren, C., Mensing, M. and Mekel, O. (2012) ‘Is telemonitoring an option against shortage of physicians in rural regions?’, Attitude Towards Telemedical Devices in the North Rhine-Westphalian Health Survey, BMC Health Services Research, Germany. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) (2009) Guidelines for the Surgical Practice of Telemedicine; Practice/Clinical Guidelines, http://www.sages.org/ publication/id/21 Turner, J.W., Thomas, R.J. and Reinsch, R.L. (2003) ‘Telemedicine: expanding healthcare into virtual environments’, in Thompson, T.L., Dorsey, A.M., Miller, K.I. and Parrott, R. (Eds.): Handbook of Health Communication, Taylor & Francis, Florence, Kentucky, pp.515–535. UAMS (2012) http://angels.uams.edu/?id=8929&sid=55 (Accessed 14 June 2012). US Census Bureau (2012) Hospitals Summary Characteristics, http://www.census.gov/compendia/ statab/2012/tables/12s0172.pdf Van der Worp, H.B. and Van Gijn, J. (2007) ‘Acute ischemic stroke’, New England Journal of Medicine, Vol. 357, pp.572–579. Walcott, B., Coumans, J., Mian, M., Nahe, B. and Kahle, K. (2011) ‘Interfacility helicopter ambulance transport of neurosurgical patients: observations, utilization, and outcomes from a quanternary level care hospital’, PLoS ONE, Vol. 6, pp.1–6.

Telementoring: using the Kinect and Microsoft Azure to save lives

47

Walter, S., Kostpopoulos, P., Haass, A., Helwig, S., Keller, I., Licina, T., Schlechtriemen, T., Roth, C., Papanagiotou, P., Zimmer, A., Vierra, J., Körner, H., Schmidt, K., Romann, M-S., Alexandrou, M., Yilmaz, U., Grunwald, I., Kubulus, D., Lesmeister, M., Ziegeler, S., Pattar, A., Golinski, M., Liu, Y., Volk, T., Bertsch, T., Reith, W. and Fassbender, K. (2010) ‘Bringing the hospital to the patient: first treatment of stroke patients at the emergency site’, PLoS ONE, Vol. 5, pp.1–5. Whitten, P., Davenport, B., Sypher, H. and Patterson, J.D. (2000) ‘Transcending the technology of telemedicine: an analysis of telemedicine in North Carolina’, Health Communications, Vol. 12, pp.109–135. Zaidan, B.B. and Zaidan, A.A. (2011) ‘Impact of data privacy and confidentiality on developing telemedicine applications: a review participates opinion and expert concerns’, International Journal of Pharmacology, Vol. 7, pp.382–387.