21. Use of DICOM as an Input for Volume Rendering on Head-mounted Display in Telemedicine Jakub Kamiński, Msc, Jane Krzysztof, PhD, Mateusz Kierepka, Msc MedApp S.A. Background: An advanced issue in head-mounted displays for augmented reality (AR) applications in medical procedure is the visualization of volumetric images, such as from CT or MRI from DICOM files. Volume rendering is commonly used for 3D images that contain rich information with opacity and color throughout the volume that cannot be easily expressed as surfaces such as polygonal meshes. The ability to change lighting conditions and the transfer function on the-fly makes it amongst the most flexible techniques. This in turn provides opportunities for better embedding virtual objects in the real world. Methods: Current implementation is based on thin-client solution for volume rendering that exploits a high- performance laptop or standard desktop workstation as a server (host application), allowing access to more system re- sources. A lightweight software client running on a Microsoft HoloLens device sends in a real-time input data stream to the server using a standard Wi-Fi connection. Host application performs a raycasting rendering with color transfer function and advanced shading from a corresponding camera position at the client’s requested resolution and streams content frames back to device. Results: The developed methodology allows for the use of raw 3D or 4D data in DICOM files, in contrast to a common approach with additional surface reconstruction to polygonal models. Possible interactions include visualizing, slicing and interacting with the holographic image by gestures and voice commands. Conclusions: The presented approach aims to achieve the feasibility of using a Microsoft HoloLens to augment patient- specific holographic images without preprocessing for pre- operative diagnosis and during surgeries. tablets) are beneficial in rapidly reducing symptoms, relieving caregiver anxiety and providing psychological support in the homebound patient. Live video communication can “see” the patients in their environment, however, cameras are limited to targeted views. A protocol will guide both targeted views and an integrated rapid assessment. The Home Assessment Protocol (HAP) was developed based upon an integrated ap- proach from the Empowerment Framework. The HAP includes observation in four categories: Patient Physical Characteris- tics, Treatment Equipment Functioning, Environmental Quality and Medications Available. Methods: The HAP was evaluated by seven home hospice nurse experts. The experts rated the importance of each item, using a 5-point Likert scale (strongly agree to strongly disa- gree). A content validity index required 5 of 7 experts to sig- nificantly agree on item importance (p<0.05). Results: Experts significantly agreed on all items in the cate- gories of Patient Characteristics (SD<0.49), except skin (SD=1.06) and Medications Available (SD<0.38). In the catego- ry of Treatment Equipment Functioning and Environmental Quality experts disagreed on item importance (SD≥0.88) ex- cept for oxygenation (SD=0.76) and safety (SD=0). Expert im- portance ratings ranked from greatest to least are: safety, administration guide and nonverbal gestures, breathing, med- ication dosage and medication administration, positioning, oxygenation, urine collection bags, feeding, fans, skin, mas- sage equipment, bedding. Additional comments advocate for inclusion of fall prevention, oxygenation equipment and envi- ronmental assessment. Conclusions: The HAP provides a strategy to prioritize items for viewing in critical moments. Expert home hospice nurses strongly endorse the assessment of medication type, dosage and administration; non-verbal gestures, breathing and safety in remote home visits. 23. Health Plan Cost Impacts of a Health System Virtual Visit Program Tim Lovell, MBA 1,2 , Joe Dalto 1 , Cheryl Ledward 1 , William Daines, MD 1 , Doug Elmer 2 , Michelle James 2 1 22. Evaluation of a Home Assessment Protocol for using Mobile Technology for Integrated Viewing Melissa Koon, MSN, APRN, FNP-BC, NP-C and Kimberly Shea, PhD, RN, CHPN University of Arizona, College of Nursing Background: The purpose of this project is to evaluate a pro- tocol for technological assessment strategies that ensure the use of an integrated visualization approach in remote home visits. Remote visits using mobile technology (i.e. phones/ 45 | Page Intermountain Healthcare and 2 SelectHealth Background: On Demand, Direct-To-Consumer telehealth programs are appearing rapidly across the country, providing quick and convenient access to patients for low acuity condi- tions. But are these programs making an impact on the over- all cost of care? This study evaluates health plan data for Utah based SelectHealth using similar criteria as an Anthem study published earlier this year. Based on index visits for various health care venues, including urgent care, emergency care and primary care, this study will compare the total cost of all incurred care charges within 21 days following the index visit and for each care venue.